Adenomyosis: Impact on Fertility and Obstetric Outcomes

In this commentary, we discuss the associations between adenomyosis, fertility, and obstetric outcomes. A recent meta-analysis on the impact of adenomyosis on reproductive outcomes found a 43% reduction in the odds ratio (OR) for clinical pregnancy and a threefold increase in the risk of miscarriage in women with adenomyosis compared with controls. Moreover, adenomyosis seems to be strongly associated with pre-eclampsia with an OR of almost 8. Also, the risk for small for gestational age was almost fourfold increased, whereas for preterm deliveries was threefold increased. The presence of deep infiltrating endometriosis and adenomyosis seems associated with particularly adverse obstetric outcomes, especially concerning natural conception. Some observations suggest that the probability of clinical pregnancy is considerably low in these cases, around 11.8%. Although several methodological drawbacks prevent definitive conclusions, all these elements should be considered in counseling women with adenomyosis seeking pregnancy, especially in cases of IVF. Similar content being viewed by others

Tellum T, Nygaard S, Lieng M. Noninvasive diagnosis of adenomyosis: a structured review and meta-analysis of diagnostic accuracy in imaging. J Minim Invasive Gynecol. 2020;27(2):408–418.e3. https://doi.org/10.1016/j.jmig.2019.11.001. Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392–411. https://doi.org/10.1093/humupd/dmz049. Buggio L, Monti E, Gattei U, Dridi D, Vercellini P. Adenomyosis: fertility and obstetric outcome. A comprehensive literature review. Minerva Ginecol. 2018;70(3):295–302. https://doi.org/10.23736/S0026-4784.17.04163-6. Stoelinga B, Hehenkamp WJ, Brölmann HA, Huirne JA. Real-time elastography for assessment of uterine disorders. Ultrasound Obstet Gynecol. 2014;43(2):218–26. https://doi.org/10.1002/uog.12519. Stoelinga B, Hehenkamp WJK, Nieuwenhuis LL, Conijn MMA, van Waesberghe JHHTM, Brölmann HAM, et al. Accuracy and reproducibility of sonoelastography for the assessment of fibroids and adenomyosis, with magnetic resonance imaging as reference standard. Ultrasound Med Biol. 2018;44(8):1654–63. https://doi.org/10.1016/j.ultrasmedbio.2018.03.027. Liu X, Ding D, Ren Y, Guo SW. Transvaginal elastosonography as an imaging technique for diagnosing adenomyosis. Reprod Sci. 2018;25(4):498–514. https://doi.org/10.1177/1933719117750752. Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964–77. https://doi.org/10.1093/humrep/deu041. Younes G, Tulandi T. Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. Fertil Steril. 2017;108(3):483–490.e3. https://doi.org/10.1016/j.fertnstert.2017.06.025. Horton J, Sterrenburg M, Lane S, Maheshwari A, Li TC, Cheong Y. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(5):592–632. https://doi.org/10.1093/humupd/dmz012. Hashimoto A, Iriyama T, Sayama S, Nakayama T, Komatsu A, Miyauchi A, et al. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J Matern Fetal Neonatal Med. 2018;31(3):364–9. https://doi.org/10.1080/14767058.2017.1285895. Mochimaru A, Aoki S, Oba MS, Kurasawa K, Takahashi T, Hirahara F. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement. J Obstet Gynaecol Res. 2015;41(4):529–33. https://doi.org/10.1111/jog.12604. Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, Spaanderman M, Kramer BW, Mueller MD, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod BioMed Online. 2021;42(1):185–206. https://doi.org/10.1016/j.rbmo.2020.09.023. Razavi M, Maleki-Hajiagha A, Sepidarkish M, Rouholamin S, Almasi-Hashiani A, Rezaeinejad M. Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis. Int J Gynaecol Obstet. 2019;145(2):149–57. https://doi.org/10.1002/ijgo.12799. Shin YJ, Kwak DW, Chung JH, Kim MY, Lee SW, Han YJ. The risk of preterm births among pregnant women with adenomyosis. J Ultrasound Med. 2018;37(8):1937–43. https://doi.org/10.1002/jum.14540. Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod. 2005;20(8):2309–16. https://doi.org/10.1093/humrep/dei021. Scala C, Leone Roberti Maggiore U, Racca A, et al. Influence of adenomyosis on pregnancy and perinatal outcomes in women with endometriosis. Ultrasound Obstet Gynecol. 2018;52(5):666–71. https://doi.org/10.1002/uog.18989. Sharma S, Bathwal S, Agarwal N, Chattopadhyay R, Saha I, Chakravarty B. Does presence of adenomyosis affect reproductive outcome in IVF cycles? A retrospective analysis of 973 patients. Reprod BioMed Online. 2019;38(1):13–21. https://doi.org/10.1016/j.rbmo.2018.09.014. Vercellini P, Consonni D, Barbara G, Buggio L, Frattaruolo MP, Somigliana E. Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod BioMed Online. 2014;28(6):704–13. https://doi.org/10.1016/j.rbmo.2014.02.006. Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand. 2017;96(6):715–26. https://doi.org/10.1111/aogs.13158. Rocha TP, Andres MP, Borrelli GM, Abrão MS. Fertility-sparing treatment of adenomyosis in patients with infertility: a systematic review of current options. Reprod Sci. 2018;25(4):480–6. https://doi.org/10.1177/1933719118756754. Donnez O, Donnez J. Gonadotropin-releasing hormone antagonist (linzagolix): a new therapy for uterine adenomyosis. Fertil Steril. 2020;114(3):640–5. https://doi.org/10.1016/j.fertnstert.2020.04.017. Borini A, Coticchio G. Gonadotropin-releasing hormone antagonist linzagolix: possible treatment for assisted reproduction patients presenting with adenomyosis and endometriosis? Fertil Steril. 2020;114(3):517–8. https://doi.org/10.1016/j.fertnstert.2020.06.003. Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, et al. Reproductive outcomes after fertility-sparing surgery for focal and diffuse adenomyosis: a systematic review. J Minim Invasive Gynecol. 2018;25(4):608–21. https://doi.org/10.1016/j.jmig.2017.12.020. Markou GA, Muray JM, Poncelet C. Risk factors and symptoms associated with maternal and neonatal complications in women with uterine rupture. A 16 years multicentric experience. Eur J Obstet Gynecol Reprod Biol. 2017;217:126–30. https://doi.org/10.1016/j.ejogrb.2017.09.001. Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril. 2018;109(3):406–17. https://doi.org/10.1016/j.fertnstert.2018.01.032. Morimatsu Y, Matsubara S, Higashiyama N, et al. Uterine rupture during pregnancy soon after a laparoscopic adenomyomectomy. Reprod Med Biol. 2007;6(3):175–7. https://doi.org/10.1111/j.1447-0578.2007.00182.x. Author information Authors and Affiliations Contributions LB: manuscript writing/editing and data collection; DD: data collection and manuscript editing; GB: manuscript editing. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of Interest The authors declare no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Buggio, L., Dridi, D. & Barbara, G. Adenomyosis: Impact on Fertility and Obstetric Outcomes. Reprod. Sci. 28, 3081–3084 (2021). https://doi.org/10.1007/s43032-021-00679-z Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s43032-021-00679-z