Impact of junctional zone adenomyosis on reproductive outcomes after first single embryo transfer with donated oocytes: A retrospective single-center cohort study

Andrea Etrusco, Belén Moliner Renau, Moliner Renau B, Agrifoglio V, Vittorio Agrifoglio, Maiorana A, Antonio Maiorana, Castillo Farfán JC, Juan Carlos Castillo Farfán, Bernabeu García A, Andrea Bernabeu García
International Journal of Gynecology & Obstetrics · 2026 · doi:10.1002/ijgo.70991 · PMID:41960937
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Junctional zone adenomyosis negatively impacts live birth and miscarriage rates during first single embryo transfer with donor oocytes, independent of implantation rates.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This retrospective single-center cohort study evaluated 240 infertile women undergoing their first single embryo transfer (SET) with donated oocytes at Instituto Bernabeu, comparing 120 with isolated junctional zone (JZ) adenomyosis diagnosed by 2D–3D transvaginal ultrasound using MUSA criteria to 120 controls without uterine abnormalities. The authors reported that women with JZ adenomyosis had lower live birth rates (34.16% vs 50.83%) and higher miscarriage rates (32.93% vs 11.11%), while implantation rates were not significantly different between groups; multivariable models indicated JZ adenomyosis independently predicted reduced live birth and increased miscarriage risk, and greater severity correlated with higher miscarriage risk. A key limitation explicitly noted is partial data availability due to data loss after analyses, although results were based on the complete dataset originally collected. This paper is centrally about endometriosis-related disease mechanisms and specifically focuses on endometriosis/adenomyosis—namely junctional zone adenomyosis—as it assesses its impact on reproductive outcomes after SET.

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Abstract

OBJECTIVE: To evaluate whether junctional zone (JZ) adenomyosis adversely affects assisted reproductive technologies (ART) outcomes in infertile women undergoing their first single embryo transfer (SET) using donor oocytes. METHODS: This retrospective single-center cohort study was conducted at Instituto Bernabeu (Alicante, Spain). A total of 240 infertile women undergoing their first SET with donor oocytes between December 2021 and June 2024 were included: 120 with isolated JZ adenomyosis diagnosed by two-dimensional (2D)-three-dimensional (3D) transvaginal ultrasound according to morphological uterus sonographic assessment (MUSA) criteria, matched to 120 controls without uterine abnormalities. Primary outcomes were live birth and miscarriage rates. Secondary outcomes included implantation rate and the relationship between adenomyosis severity and reproductive outcomes. Multivariable models were used to adjust for potential confounders. RESULTS: Women with JZ adenomyosis had significantly lower live birth rates than controls (34.16% vs 50.83%; P = 0.009) and higher miscarriage rates (32.93% vs 11.11%; P < 0.001), while implantation rates were comparable (68.33% vs 75.00%; P = 0.25). JZ adenomyosis independently predicted reduced live birth (odds ratio [OR] 0.43, 95% confidence interval [CI]: 0.24-0.76; P = 0.004) and increased miscarriage risk (OR 3.33, 95% CI: 1.42-7.82; P = 0.005). Increasing disease severity was associated with a higher risk of miscarriage. CONCLUSION: JZ adenomyosis is associated with significantly lower live birth rates and higher miscarriage rates after a first SET with donor oocytes, despite similar implantation rates. Comprehensive pre-ART ultrasound assessment of the JZ may improve counseling and support targeted strategies to optimize reproductive outcomes.
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Abstract

Objective To evaluate whether junctional zone (JZ) adenomyosis adversely affects assisted reproductive technologies (ART) outcomes in infertile women undergoing their first single embryo transfer (SET) using donor oocytes.

Methods

This retrospective single-center cohort study was conducted at Instituto Bernabeu (Alicante, Spain). A total of 240 infertile women undergoing their first SET with donor oocytes between December 2021 and June 2024 were included: 120 with isolated JZ adenomyosis diagnosed by two-dimensional (2D)–three-dimensional (3D) transvaginal ultrasound according to morphological uterus sonographic assessment (MUSA) criteria, matched to 120 controls without uterine abnormalities. Primary outcomes were live birth and miscarriage rates. Secondary outcomes included implantation rate and the relationship between adenomyosis severity and reproductive outcomes. Multivariable models were used to adjust for potential confounders.

Results

Women with JZ adenomyosis had significantly lower live birth rates than controls (34.16% vs 50.83%; P = 0.009) and higher miscarriage rates (32.93% vs 11.11%; P < 0.001), while implantation rates were comparable (68.33% vs 75.00%; P = 0.25). JZ adenomyosis independently predicted reduced live birth (odds ratio [OR] 0.43, 95% confidence interval [CI]: 0.24–0.76; P = 0.004) and increased miscarriage risk (OR 3.33, 95% CI: 1.42–7.82; P = 0.005). Increasing disease severity was associated with a higher risk of miscarriage.

Conclusion

JZ adenomyosis is associated with significantly lower live birth rates and higher miscarriage rates after a first SET with donor oocytes, despite similar implantation rates. Comprehensive pre-ART ultrasound assessment of the JZ may improve counseling and support targeted strategies to optimize reproductive outcomes. CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interests. DATA AVAILABILITY STATEMENT The dataset used and analyzed during the current study is partially available due to data loss that occurred after completion of the analyses. The available data supporting the findings of this study are retained by Dr. Belen Moliner and can be shared upon reasonable request. The results presented in this manuscript are based on the complete dataset as originally collected and analyzed prior to the data loss.

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Outcome instruments

MUSA

Condition tags

adenomyosis

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