Adenomyosis and Reproduction: a Narrative Review

Purpose of Review To investigate the reproductive outcome of infertile women with adenomyosis who undergo assisted reproductive technologies (ART) or conservative surgical treatment. Recent Findings Among 23 studies evaluating the outcome of ART, 12 compared women with adenomyosis with controls, while 11 included only women with adenomyosis, accounting for a total of 3791 women with adenomyosis and 6841 controls. Compared to controls, patients with adenomyosis had a pregnancy rate of 39.4% vs 49.8%, a live birth rate of 29.9% vs 42.6%, a miscarriage rate of 26.3% vs 15.3%, and an implantation rate of 30.0% vs 31.6%, respectively. When comparing women receiving pre-treatment with GnRH agonists with those not receiving pre-treatment, 20% of studies reported an improved pregnancy rate, 20% reported a reduced miscarriage rate, and 50% reported an improved live birth rate. Among the 11 studies evaluating previous conservative surgical treatment on a total of 961 women, pregnancy rate was 38.1%, live birth rate was 63.7%, and miscarriage rate was 20.9%. A not negligible risk of placenta previa, placenta accreta, uterine rupture, and postoperative adhesions was reported. Summary The available evidence shows that adenomyosis negatively affects reproductive outcome. Pre-treatment with GnRH agonists improved the live birth rate, but the magnitude of such improvement needs to be better defined in future studies. Conservative surgical treatment of both focal and diffuse adenomyosis was associated with a similar pregnancy rate to that of women who did not undergo surgery. However, an increase in live birth rate was observed after surgery.