Abstract
Adenomyosis is a benign gynecological disease observed in women in their reproductive age. Recent studies have shown that adenomyosis might be a relevant factor for infertility, either impairing implantation or leading to early miscarriage. However, conservative treatment of infertility related to adenomyosis is still unclear. This study systematically reviews the literature for the reproductive outcomes of the available conservative treatments for patients with adenomyosis-associated infertility. We conducted a search in PubMed/Medline for studies in English published in the last 7 years and included 16 studies. Six studies evaluated surgical treatments of adenomyosis. When considering only spontaneous pregnancies, the overall clinical pregnancy rate was very low (18.2%). However, when using GnRH analogues for 24 weeks after surgery, the pooled spontaneous pregnancy rate was higher (40.7% vs 15.0%; P =.002). No significant difference was observed in the other outcomes. Ten studies evaluated exclusive assisted reproductive techniques for infertility related to adenomyosis and showed that the long stimulation protocol had better outcomes compared to short stimulation protocol in pregnancy rate (43.3% vs 31.8%; P =.0001), live birth (43.0% vs 23.1 %; P =.005), and miscarriage (18.5% vs 31.1 %; P <.0001).
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Vercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani PG. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod. 1995;10(5):1160–1162.
Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod. 2012;27(12):3432–3439.
Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen F. Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril. 2001; 76(3):588–594.
Chopra S, Lev-Toaff AS, Ors F, Bergin D. Adenomyosis: common and uncommon manifestations on sonography and magnetic resonance imaging. J Ultrasound Med. 2006;25(5):617–627, quiz 629.
Puente JM, Fabris A, Patel J, et al. Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease. Reprod Biol Endocrinol. 2016;14(1):60.
Maubon A, Faury A, Kapella M, et al. Uterine junctional zone at magnetic resonance imaging: a predictor of in vitro fertilization implantation failure. J Obstet Gynaecol Res. 2010;36(3):611–618.
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):964–977.
Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The impact of adenomyosis on women’s fertility. Obstet Gynecol Surv. 2016;71(9):557–568.
Lazzeri L, Di Giovanni A, Exacoustos C, et al. Preoperative and postoperative clinical and transvaginal ultrasound findings of adenomyosis in patients with deep infiltrating endometriosis. Reprod Sci. 2014;21(8):1027–1033.
Vercellini P, Consonni D, Barbara G, et al. Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod Biomed Online. 2014;28(6):704–713.
Streuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C. An update on the pharmalogical management of adenomyosis. Expert Opin Pharmacother. 2014;15(16):2347–2360.
Maheshwari A, Gurunath S, Fatima F, Bhattacharya S. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18(4):374–392.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. J Clin Epidemiol. 2009; 62(10):1006–1012.
Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R. Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril. 2010;94(2):715–719.
Al Jama FE. Management of adenomyosis in subfertile women and pregnancy outcome. Oman Med J. 2011;26(3):178–181.
Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22(1):94–99.
Huang BS, Seow KM, Tsui KH, Huang CY, Lu YF, Wang PH. Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: long-term follow-up in a series of nine patients. Taiwan J Obstet Gynecol. 2012;51(2):212–216.
Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril. 2014;102(3):802–807.
Saremi A, Bahrami H, Salehian P, Hakak N, Pooladi A. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed Online. 2014;28(6):753–760.
Mijatovic V, Florijn E, Halim N, Schats R, Hompes P. Adenomyosis has no adverse effects on IVF/ICSI outcomes in women with endometriosis treated with long-term pituitary down-regulation before IVF/ICSI. Eur J Obstet Gynecol Reprod Biol. 2010;151(1):62–65.
Costello MF, Lindsay K, McNally G. The effect of adenomyosis on in vitro fertilisation and intra-cytoplasmic sperm injection treatment outcome. Eur J Obstet Gynecol Reprod Biol. 2011; 158(2):229–234.
Martinez-Conejero JA, Morgan M, Montesinos M, et al. Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation. Fertil Steril. 2011;96(4):943–950.
Youm HS, Choi YS, Han HD. In vitro fertilization and embryo transfer outcomes in relation to myometrial thickness. J Assist Reprod Genet. 2011;28(11):1135–1140.
Salim R, Riris S, Saab W, Abramov B, Khadum I, Serhal P. Adenomyosis reduces pregnancy rates in infertile women undergoing IVF. Reprod Biomed Online. 2012;25(3):273–277.
Thalluri V, Tremellen KP. Ultrasound diagnosed adenomyosis has a negative impact on successful implantation following GnRH antagonist IVF treatment. Hum Reprod. 2012;27(12):3487–3492.
Niu Z, Chen Q, Sun Y, Feng Y. Long-term pituitary downregula-tion before frozen embryo transfer could improve pregnancy outcomes in women with adenomyosis. Gynecol Endocrinol. 2013;29(12):1026–1030.
Benaglia L, Cardellicchio L, Leonardi M, et al. Asymptomatic adenomyosis and embryo implantation in IVF cycles. Reprod Biomed Online. 2014;29(5):606–611.
Yan L, Ding L, Tang R, Chen ZJ. Effect of adenomyosis on in vitro fertilization/intracytoplasmic sperm injection outcomes in infertile women: a retrospective cohort study. Gynecol Obstet Invest. 2014;77(1):14–18.
Park CW, Choi MH, Yang KM, Song IO. Pregnancy rate in women with adenomyosis undergoing fresh or frozen embryo transfer cycles following gonadotropin-releasing hormone agonist treatment. Clin Exp Reprod Med. 2016;43(3):169–173.
de Souza NM, Brosens JJ, Schwieso JE, Paraschos T, Winston RML. The potential value of magnetic resonance imaging in infertility. Clin Radiol. 1995;50(2):75–79.
Barrier BF, Malinowski MJ, Dick EJ Jr, Hubbard GB, Bates GW. Adenomyosis in the baboon is associated with primary infertility. Fertil Steril. 2004;82(3):1091–1094.
Campo S, Campo V, Benagiano G. Infertility and adenomyosis. Obstet Gynecol Int. 2012;2012:786132.
Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril. 2014;101(2):472–487.
Zhang X, Li K, Xie B, He M, He J, Zhang L. Effective ablation therapy of adenomyosis with ultrasound-guided high-intensity focused ultrasound. Int J Gynaecol Obstet. 2014;124(3):207–211.
Shui L, Mao S, Wu Q, et al. High-intensity focused ultrasound (HIFU) for adenomyosis: two-year follow-up results. Ultrason Sonochem. 2015;27:677–681.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rocha, T.P., Andres, M.P., Borrelli, G.M. et al. Fertility-Sparing Treatment of Adenomyosis in Patients With Infertility: A Systematic Review of Current Options. Reprod. Sci. 25, 480–486 (2018). https://doi.org/10.1177/1933719118756754
Published:
Issue Date:
DOI: https://doi.org/10.1177/1933719118756754