Successful pregnancy in a series of patients with adenomyosis

Objective: To report the surgical technique and pregnancy outcome in a series of patients with adenomyosis. Methods: This is an observational study of patients who underwent laparoscopy or laparoscopically assisted cytoreductive surgery for symptomatic enlarged uterus due to uterine myoma or adenomyosis or both who desired to preserve their reproductive system. Results: We present a series of nine patients—mean age 36.2 years (range, 31–41 years), mean gravida 1.7, para 0.3, with histologically confirmed adenomyosis or ademyoma—who achieved pregnancy. The average length of time from surgery to conception was 6.9 months (range, 3–14). One patient was treated preoperatively with danazol (case 1); one with nafarelin acetate (case 2); and two with oral contraceptive pills (cases 4, 6). Five patients conceived spontaneously (cases 2, 4, 5, 7, 9). Two patients used clomiphene citrate and intrauterine insemination (cases 1, 3); one used clomiphene citrate and timed intercourse (case 8). Case 6 had in vitro fertilization. Five patients carried to term (cases 1, 2, 3, 4, 8); one had a cesarean birth at 36 weeks, delivering twins (case 6); one is currently in the second trimester (case 5); and two patients had missed abortion at 12 and 9 weeks (cases 7, 9). The most common associated pathologies were endometriosis (56%), adhesions (56%), and leiomyomata (22%). Conclusion: Adenomyosis theoretically is associated with infertility, and hysterectomy has been considered the treatment of choice. However, previous anecdotal case reports and our series indicate that in patients with adenomyosis who desire pregnancy, there is a good chance for successful pregnancy after cytoreductive surgery.