Association of revised morphological uterus sonographic assessment (MUSA) features of adenomyosis and IVF outcomes

Abstract This study aimed to investigate the association between sonographic features of adenomyosis defined by the revised MUSA criteria and pregnancy outcomes in women undergoing in vitro fertilization (IVF) and embryo transfer (ET). All autologous ET cycles at a university-affiliated infertility center in Seoul, South Korea, between May 2022 and January 2024 were included in this study. All patients undergoing IVF were examined by the ultrasound strictly adhering to the revised MUSA definition at the time of examination. Patients with sonographic features of adenomyosis were assigned to the adenomyosis group (n = 300). During the same period, an age-matched 1:1 control group (n = 300) was selected from women who underwent embryo transfer and had no sonographic features of adenomyosis. Logistic regression analysis and generalized estimating equations were used to evaluate which specific sonographic features of adenomyosis are associated with pregnancy outcomes. Among the MUSA features, the interrupted junctional zone was the only independent factor significantly associated with a lower chance of clinical pregnancy (aRR = 0.75, 95% CI 0.58–0.95, p = 0.020), ongoing pregnancy (aRR = 0.72, 95% CI 0.52–0.99, p = 0.049), and an increased risk of biochemical pregnancy loss (aRR = 1.98, 95% CI 1.02–3.84, p = 0.044). This finding suggests that sonographic evaluation of the junctional zone should be considered in women with adenomyosis who desire pregnancy. Similar content being viewed by others Author information Authors and Affiliations Corresponding author Ethics declarations Competing interests The authors declare no competing interests. Ethical approval This study was approved by the Institutional Review Board of CHA Gangnam Medical Center (Approval number: 2024-05-004). The data collection and analysis complied with the Declaration of Helsinki guidelines. Informed consent was waived by the Institutional Review Board due to the retrospective nature of the study. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Han, S.J., Lee, J.Y., Kim, HO. et al. Association of revised morphological uterus sonographic assessment (MUSA) features of adenomyosis and IVF outcomes. Sci Rep (2026). https://doi.org/10.1038/s41598-026-50999-w Received: Accepted: Published: DOI: https://doi.org/10.1038/s41598-026-50999-w