OP11.09: New ultrasound markers for the diagnosis of adenomyosis in infertile population

Adenomyosis is associated with infertility and with implantation failure in IVF. So there is a need to find new ultrasound markers to screen infertile patients for adenomyosis. We present clinical and new ultrasound markers and compare them with MRI in a prospective study. Sixty infertile patients were prospectively followed by studying the following four markers: (1) premenstrual bleeding or spotting; (2) uterine pain on bimanual examination; (3) the hyperechoic halo between the endometrium and the myometrium; and (4) the number of hyperechogenic round cysts in the isthmus sticking to the cervical canal. All patients underwent MRI to confirm the presence of adenomyosis. The patients were divided into two groups - in Group A the mean junctional zone (JZ) on MRI was ≥ 7 mm or the maximal JZ was > 10 mm, and in Group B the mean JZ was < 7 mm or the maximal JZ was < 10 mm. The 29 patients in Group A had a mean age of 38 (range, 23–42) years, mean parity of 0.57 children and nulliparity of 52%. The 31 patients in Group B had a mean age of 38 (range, 32–42) years, mean parity of 0.58 children and nulliparity of 58%. In Group A, 15 patients had IVF with their own eggs with a 6% pregnancy rate by cycle (3/49 trials). In Group B, 19 patients had IVF with their own eggs with a 33% pregnancy rate by cycle (19/57 trials). The mean hyperechoic halo between the endometrium and myometrium was 10 mm in Group A and 5.8 mm in Group B. The number of cysts was 5.8 in Group A and 2.6 in Group B. These markers–a hyperechoic halo between the endometrium and myometrium and the number of cysts in the isthmus–plus the clinical signs are predictive of uterine adenomyosis. However, more data are needed to confirm these new markers.