L26/O-242 Reproductive outcomes after hysteroscopic treatment of adenomyosis in infertile patients undergoing IVF

Abstract Study question Does hysteroscopic treatment of adenomyosis improve clinical pregnancy and live birth outcomes in infertile patients undergoing IVF? Summary answer In this retrospective cohort, hysteroscopic treatment of adenomyosis was associated with a clinical pregnancy rate of 15/22 (68.2%) following IVF treatment. What is known already Adenomyosis is a common uterine disorder associated with impaired implantation and reduced IVF success. Medical suppression protocols and surgical approaches have been proposed to improve reproductive outcomes, but evidence remains heterogeneous. Hysteroscopy enables direct visualization and minimally invasive treatment of superficial adenomyotic lesions close to the uterine cavity. Barrier agents such as hyaluronic acid gels may also be used to reduce intrauterine adhesions after surgery. However, data regarding reproductive outcomes after combined hysteroscopic intervention followed by IVF using ultra-long protocols remain scarce. Study design, size, duration This retrospective cohort study screened 41 infertile women who underwent hysteroscopic surgery for suspected adenomyosis between October 2022 and October 2025. Among them, 25 patients with adenomyosis confirmed according to the Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features, and a history of recurrent implantation failure or pregnancy loss, were included in the final analysis. All eligible cases treated at our center were evaluated. Participants/materials, setting, methods All patients underwent hysteroscopic treatment with intrauterine Hyalobarrier gel applied at the end of the procedure. After one month of recovery, IVF preparation was initiated using an ultra-long GnRH agonist protocol with two doses of leuprolide acetate. Endometrial preparation included oral estradiol (2 mg;3 × 1), followed by vaginal progesterone (200 mg; 3 × 1) and additional subcutaneous progesterone support. Clinical pregnancy was defined as ultrasound visualization of a gestational sac. The secondary outcome was live birth rate. Main results and the role of chance In total, 25 patients were included, with a mean age of 38.2 ± 4.5 years and a mean BMI of 21.3 ± 3.8 kg/m². Diffuse adenomyosis was observed in 88% of cases, while the remaining patients had focal disease. Preimplantation genetic testing (PGT) was performed in 32% of women. Hysteroscopic procedures mainly consisted of fundal incisions and/or coagulation of adenomyotic lesions. Following hysteroscopic surgery, three women (12%) achieved spontaneous pregnancy within two months, resulting in live birth prior to IVF initiation. The remaining 22 patients proceeded to embryo transfer after completing an ultra-long GnRH agonist protocol. All transfers were performed at the blastocyst stage (day 5–6). The clinical pregnancy rate after IVF was 68.2% (15/22), while the live birth rate was 45.5% (10/22). Overall, 13 out of 25 women (52%) achieved live birth, including spontaneous conceptions. Two pregnancies ended in miscarriage, and three were ongoing at the time of evaluation. No statistically significant associations were identified between clinical pregnancy and baseline characteristics such as age, BMI, PGT use, adenomyosis type, or transfer day. These results should be interpreted cautiously given the limited sample size and retrospective design. Limitations, reasons for caution This study is limited by its retrospective design, small sample size, and lack of a control group. Results should therefore be interpreted cautiously, and larger prospective studies are needed to confirm the reproductive impact of hysteroscopic treatment in adenomyosis. Wider implications of the findings Hysteroscopic treatment of adenomyosis, combined with standardized endometrial preparation and ultra-long IVF protocols, may represent a fertility-preserving approach in selected infertile patients. The observation of both favorable IVF outcomes and spontaneous conceptions highlights the need for further research in larger cohorts. Trial registration number No