Effect of adenomyosis on the cumulative live birth rate in oocyte donation cycles: a retrospective analysis

RESEARCH QUESTION: What is the effect of adenomyosis on cumulative live birth rate (CLBR) in women undergoing single embryo transfer in donor-oocyte cycles, with specific attention to type, location and severity of disease. DESIGN: Retrospective observational study of 228 infertile women treated at IVI Roma between 2019 and 2024. Adenomyosis was diagnosed via ultrasound using the MUSA criteria and classified by type, location and severity. Endometrial preparation involved hormone replacement therapy or modified natural cycles. Primary outcome was CLBR per woman; secondary outcome was serum progesterone concentrations on embryo transfer day in the adenomyosis and control groups. RESULTS: The CLBR did not differ significantly between the adenomyosis group and controls (both 74.29%, P = 0.81). Women with adenomyosis in the outer myometrium and junctional zone had a lower CLBR (62.5%) compared with those with adenomyosis limited to the junctional zone (83.33%) or outer myometrium (78.57%). The estimated number of transfers for 50% CLBR was also higher in the outer myometrium and junctional zone group (median 3) versus junctional zone or outer myometrium alone (median 2) (P = 0.04). Multivariate analysis confirmed outer myometrium and junctional zone adenomyosis as a negative predictor of live birth (hazard ratio 0.44, P = 0.03). No significant differences were found in CLBR by type or severity of adenomyosis or in serum progesterone concentrations. CONCLUSIONS: Ultrasound mapping to identify adenomyosis location is crucial in fertility counselling. Adenomyosis involving outer myometrium and junctional zone presented a lower CLBR. No differences were found in serum progesterone concentrations.