P14.03: Diagnosis of adenomyosis determines the choice of the IVF protocol

Adenomyosis represents a common gynecological disorder with a negative impact on fertility. In around one third of cases, adenomyosis is completely asymptomatic. We wanted to assess whether the diagnosis of adenomyosis was underestimated. We searched: 1. The uterus is globally enlarged in the absence of other pathologies; 2. Asymmetrically enlarged uterus; 3. The junctional zone (JZ) is not clearly visible; 4. The myometrium shows hyperechoic linear near the endometrial-myometrial interface; 5. The myometrium can present cysts; 6. The myometrium can appear heterogeneous as it presents areas with decreased or increased echogenicity; 7. The sign called “the question mark form of the uterus”. Finding at least three of these signs is highly suggestive of adenomyosis. We selected 120 patients under the age of 35 to which we used a short protocol with antagonists. All patients did not have pelvic endometriosis and not reported a history of Caesarean section and myomectomy. The ultrasound re-examination was done 6-12 months after the IVF cycle failed. All patients underwent 2D, 3D and power Doppler TVS of the pelvic organs in a single examination during the secretory phase of the menstrual cycle. 3D reconstruction of uterine anatomy in the coronal plane provides new and unrivaled views of the JZ. 35 patients showed at least three ultrasound signs supporting the diagnosis of adenomyosis. 28 had changes to the junctional zone, 25 had “question sign”. We determined that JZmax ≥8 mm and JZdif ≥4 mm were significantly more accurate in diagnosing adenomyosis than were 2D features. We found the subjective evaluation of infiltration and disruption by endometrial tissue in the JZ to be a very accurate tool for the diagnosis of adenomyosis. It is necessary carefully examination of the junctional zone and we believe the use of 3D ultrasound examination is necessary. We recommend the use of GnRH agonist long protocol in the cases with adenomyosis or suspicion of adenomyosis.