The Adenomyosis and infertility - underestimated challenge in reproductive medicine

Katarzyna Znamirowska, Martyna Bukała, Karolina Ochyra, Kornelia Pudło, Jowita Frydrych, Gabriela Prucnal, Karolina Ryba, Klaudia Zacher, Patrycja Walkiewicz, Anna Rakoczy
In: Quality in Sport · 2025 · vol. 42 , pp. 60935 · doi:10.12775/qs.2025.42.60935 · W4411654209
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This review summarizes current knowledge on adenomyosis, detailing its pathophysiological mechanisms, diagnostic tools, and classification systems in relation to female infertility and impaired reproductive outcomes.

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This paper is a narrative literature review that synthesizes evidence on how adenomyosis affects fertility, focusing on proposed pathophysiological mechanisms, diagnostic approaches, and classification systems, using selected PubMed articles indexed by keywords such as “adenomyosis” and “infertility.” It describes adenomyosis as underdiagnosed and characterized by endometrial glands and stroma within the myometrium, leading to progressive structural and functional uterine changes that may impair endometrial receptivity, contribute to implantation failure, and disrupt early pregnancy development. The review concludes that adenomyosis is increasingly recognized as a potential contributor to infertility and argues that it should be considered within the diagnostic work-up and management of infertile patients, while noting that deeper mechanistic understanding is needed. This paper is centrally about adenomyosis—summarizing its effects on infertility and reproductive outcomes.

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Abstract

Introduction: Adenomyosis is considered as a chronic gynecological condition increasingly observed among women of reproductive age. It remains underdiagnosed and frequently underestimated as a contributing factor in fertility disorders. Characterized by the presence of endometrial glands and stroma within the myometrium, adenomyosis causes progressive structural and functional uterine changes that may impair endometrial receptivity and disrupt implantation. Aim of the study: This review aims to summarize current knowledge on the effects of adenomyosis on fertility. It focuses on the pathophysiological mechanisms involved, diagnostic tools, classification systems.. It explores the pathophysiological mechanisms that contribute to impaired reproductive outcomes, as well as available diagnostic methods that enable an effective identification of the condition. Materials and methodology:The literature review includes articles from databases (PubMed), selected to their citation, using keywords “adenomyosis”, “infertility” Conclusion: Adenomyosis is increasingly recognized as a potential contributing factor to female infertility. Anatomical and functional alterations within the uterus may impair embryo implantation and early pregnancy development. Current evidence highlights the importance of including adenomyosis in the diagnostic work-up and management of infertile patients. A deeper understanding of its underlying mechanisms may lead to more effective and individualized treatment strategies.
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Introduction

Adenomyosis is considered as a chronic gynecological condition increasingly observed among women of reproductive age. It remains underdiagnosed and frequently underestimated as a contributing factor in fertility disorders. Characterized by the presence of endometrial glands and stroma within the myometrium, adenomyosis causes progressive structural and functional uterine changes that may impair endometrial receptivity and disrupt implantation. Aim of the study: This review aims to summarize current knowledge on the effects of adenomyosis on fertility. It focuses on the pathophysiological mechanisms involved, diagnostic tools, classification systems.. It explores the pathophysiological mechanisms that contribute to impaired reproductive outcomes, as well as available diagnostic methods that enable an effective identification of the condition.

Materials

and methodology:The literature review includes articles from databases (PubMed), selected to their citation, using keywords “adenomyosis”, “infertility”

Conclusion

Adenomyosis is increasingly recognized as a potential contributing factor to female infertility. Anatomical and functional alterations within the uterus may impair embryo implantation and early pregnancy development. Current evidence highlights the importance of including adenomyosis in the diagnostic work-up and management of infertile patients. A deeper understanding of its underlying mechanisms may lead to more effective and individualized treatment strategies.

References

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Published 2023 Apr 23. doi:10.3390/jcm12093069 35.Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility. Acta Obstet Gynecol Scand. 2017;96(6):707-714. doi:10.1111/aogs.13159 36.Liu L, Wang T, Lei B. Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis. Int J Hyperthermia. 2021;38(1):948-962. doi:10.1080/02656736.2021.1939443 Downloads Published How to Cite Issue Section License Copyright (c) 2025 Katarzyna Znamirowska, Martyna Bukała, Karolina Ochyra, Kornelia Pudło, Jowita Frydrych, Gabriela Prucnal, Karolina Ryba, Klaudia Zacher, Patrycja Walkiewicz, Anna Rakoczy This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Stats Number of views and downloads: 356 Number of citations: 0

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adenomyosisinfertility

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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