Can IVF be successful with adenomyosis?

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)

Does adenomyosis mean high risk pregnancy?

Adenomyosis is more prevalent in women who have given birth in the past and it has been found to have an impact on fertility and reproductive issues according to studies. Research has revealed a higher incidence of pregnancy complications in women with adenomyosis. Preterm delivery was the most prevalent complication, impacting nearly one-quarter of women. This means that their babies were born before 37 weeks of pregnancy. Preterm birth can be a cause of concern since the last weeks of pregnancy are crucial for the full development of babies’ brains, lungs, and livers.

Other research has indicated that adenomyosis during pregnancy may also raise the risk of miscarriage, postpartum hemorrhage, or infections in the uterus. Fetal growth restriction, in which babies are smaller than expected, is another complication that has been linked to adenomyosis. Adenomyosis is also connected with labor complications.

According to some studies, women with adenomyosis may have reduced chances of success with in vitro fertilization (IVF). A recent study published in the Reproductive Biomedicine Online journal examined pregnancy outcomes among women with adenomyosis. The study found that while 34.55 percent of the control group got pregnant through IVF, only 23.44 percent of women with adenomyosis were able to conceive. These findings suggest that individuals with this condition may encounter greater difficulty in getting pregnant.

Can adenomyosis cause symptoms other than menstrual problems?

Adenomyosis, a condition characterized by the presence of endometrial tissue within the muscular walls of the uterus, manifests in symptoms extending beyond menstrual discomforts. This condition often leads to a spectrum of experiences that can significantly impact daily living. Initially, sufferers may notice an exacerbation of pelvic pain, not limited to the menstrual period but spanning the entire cycle. Additionally, sexual activities become notably uncomfortable due to the pervasive pain associated with this condition.

  • Painful bowel movements or urination during menstruation further complicate the lives of those affected.
  • Lower back pain emerges as a common complaint, likely tied to the inflammation and irritation caused by the misplaced endometrial tissue.
  • Bloating and a sense of abdominal pressure frequently occur, contributing to a general feeling of discomfort.
  • Fatigue often accompanies these physical symptoms, likely a result of the body’s ongoing response to the internal stress caused by adenomyosis.

Importantly, the intensity and presence of these symptoms vary widely among individuals. While some may encounter a broad array of challenges, others might experience a more muted form of the disease. Moreover, not every person diagnosed with adenomyosis will endure these additional symptoms, highlighting the complex and highly individualized nature of this condition.

Source: 

2,4,6- Higgins, C., Fernandes, H., Da Silva Costa, F., Martins, W. P., Vollenhoven, B., & Healey, M. (2021). The impact of adenomyosis on IVF outcomes: a prospective cohort study. Human Reproduction Open, 2021(2), hoab015.

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