L26/O-116 Adenomyosis and deep endometriosis-related infertility: ultrasound is a powerful tool for the clinician

Abstract Adenomyosis and deep endometriosis frequently coexist and represent a major challenge in the assessment and management of infertility. Both conditions are associated with impaired uterine function, pelvic inflammation, and distorted pelvic anatomy, yet their impact on fertility is variable and highly patient-specific. As care increasingly moves toward individualized decision-making, clinicians require accurate, accessible tools that allow comprehensive evaluation and meaningful counselling. High-quality transvaginal ultrasound, performed using a systematic and standardized approach, has become a powerful first-line modality in this context. Contemporary ultrasound allows reliable identification and characterization of adenomyosis using established morphological criteria, including myometrial cysts, asymmetric myometrial thickening, hyperechogenic islands, fan-shaped shadowing, irregular or interrupted junctional zone, and global uterine enlargement. Beyond diagnosis, ultrasound enables assessment of disease extent and pattern, which is increasingly recognized as clinically relevant when counselling infertile patients. Features such as junctional zone disruption and altered uterine architecture may be associated with abnormal uterine peristalsis, impaired implantation, and adverse reproductive outcomes. Expert transvaginal ultrasound also demonstrates high accuracy for the detection and mapping of deep endometriosis, particularly involving the uterosacral ligaments, posterior compartment, bowel, bladder, and parametrium. Precise pre-treatment mapping provides essential information regarding disease distribution, organ involvement, and anticipated surgical complexity. Importantly, ultrasound enables simultaneous assessment of ovarian endometriomas, pelvic adhesions, organ mobility, and ovarian reserve surrogates, supporting a comprehensive fertility-focused evaluation within a single examination. From a clinical standpoint, ultrasound findings directly inform management strategies. In patients planning assisted reproductive treatment, characterization of adenomyosis may influence counselling regarding prognosis, pretreatment options, and embryo transfer strategies. In patients with deep endometriosis-associated infertility, detailed ultrasound mapping supports shared decision-making by balancing potential fertility benefits of surgery against procedural risks and delays to conception. Ultrasound also allows longitudinal, non-invasive follow-up, facilitating monitoring of disease progression or response to medical or surgical intervention. Crucially, ultrasound is not merely a diagnostic investigation but an extension of the clinical consultation. Real-time image acquisition, dynamic assessment, and direct patient engagement allow findings to be integrated immediately into individualized counselling and treatment planning. In conclusion, transvaginal ultrasound is a powerful and versatile tool in the evaluation of adenomyosis and deep endometriosis-related infertility. When performed by trained clinicians using standardized terminology, ultrasound enhances diagnostic precision, supports personalized management, and strengthens clinician–patient communication in the care of complex reproductive disease.