Can IVF be successful with adenomyosis?

Until a few years ago, very little was known about adenomyosis. Adenomyosis is known to be associated with heavy bleeding and severe menstrual pain, as well as a larger uterus. Today, advances in ultrasound technologies have made it easier for specialists to diagnose adenomyosis in less time.

The effective implantation of an embryo can be hampered by this uterine alteration, leading to repeated implantation failures. (1)

Studies examining adenomyosis’ effect on infertility are contentious, particularly when they center on IVF. The results of IVF are reported to be negatively impacted by adenomyosis in numerous studies, however, age is closely linked to both the prevalence of adenomyosis and poorer reproductive outcomes. (2)

What is adenomyosis?

Adenomyosis is a situation where the tissue lining the inside of the uterus (endometrium) penetrates the muscle layer of the uterus, causing the uterine lining to grow inside the uterine muscle (myometrium). This myometrium tissue swells and bleeds during menstruation in a manner similar to the uterine lining. (3)

Although it is unclear whether this affects pregnancy chances, it is crucial to understand this before undergoing IVF for infertility. (4)

Adenomyosis affects one in ten women between the ages of 35 and 50, according to the World Health Organization. In recent years, it has also been proven that this illness can also affect younger women. (5)

What are the types of adenomyosis?

  • Focal: Also known as adenomyoma, these tumors develop inside the myometrium and take the form of tumors. 
  • Diffuse: The most typical form of adenomyosis is this one. The myometrium is significantly impacted, which causes the uterus to enlarge excessively. 

On the other hand, it is distinguished between superficial and deep adenomyosis based on where the endometrial tissue is located within the myometrium.

How does adenomyosis affect IVF?

The effects of adenomyosis on IVF outcomes should be considered when adjusted for confounding factors such as maternal age and smoking status. 

Studies examining adenomyosis’ effect on infertility are contentious, particularly when they center on IVF. The results of IVF are reported to be negatively impacted by adenomyosis in numerous studies, however, age is closely linked to both the prevalence of adenomyosis and poorer reproductive outcomes. (6)

How is adenomyosis diagnosed? 

Although it can be challenging to make a conclusive diagnosis, the onset of specific symptoms may help the professional do so. 

However, imaging techniques are necessary for a reliable diagnosis. Transvaginal ultrasound in 2D (and possibly 3D) can be utilized by the specialist to identify an enlarged uterus brought on by diffuse or localized adenomyosis. An MRI scan is frequently required to confirm the condition. (7)

What fertility treatments are suggested for adenomyosis-affected women?

In adenomyosis cases, the patient’s uterus must be prepared for the procedure. Because of this, it is advised to perform in vitro fertilization treatment only after obtaining a sufficient number of oocytes by stimulating the ovaries. The embryos with the best chances of successfully implanting in the woman’s uterus are then transferred after the oocytes have been fertilized in the lab. 

Another alternative is to choose egg vitrification and then think about fixing this problem afterward.

The ideal way to reduce the symptoms of this condition may be to start fertility treatment before giving out contraceptives or estrogen receptor medicines. 

Adenomyosis often has no impact on the success of IVF treatment in Turkey, but in a few instances, patients may additionally require treatment with GnRH agonists, which can temporarily resemble menopause. (8)

Source: 

1- https://www.ivf-spain.com/en/adenomyosis-a-possible-cause-of-infertility-in-women/#:~:text=Generally%2C%20adenomyosis%20does%20not%20affect,temporary%20condition%20similar%20to%20menopause.

2- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054136/

3- https://www.ivf-spain.com/en/adenomyosis-a-possible-cause-of-infertility-in-women/#:~:text=Generally%2C%20adenomyosis%20does%20not%20affect,temporary%20condition%20similar%20to%20menopause.

4- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054136/

5- https://www.ivf-spain.com/en/adenomyosis-a-possible-cause-of-infertility-in-women/#:~:text=Generally%2C%20adenomyosis%20does%20not%20affect,temporary%20condition%20similar%20to%20menopause.

 6- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054136/

7- https://www.ivf-spain.com/en/adenomyosis-a-possible-cause-of-infertility-in-women/#:~:text=Generally%2C%20adenomyosis%20does%20not%20affect,temporary%20condition%20similar%20to%20menopause.

8- https://www.ivf-spain.com/en/adenomyosis-a-possible-cause-of-infertility-in-women/#:~:text=Generally%2C%20adenomyosis%20does%20not%20affect,temporary%20condition%20similar%20to%20menopause.

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