No external funding was used for this study. None of the authors have any conflict of interest to declare.

Research on the effect of adenomyosis on the rate of success of IVF is controversial. Differences in study design, study power, criteria and instrument used to diagnose adenomyosis and choice of controls may explain these discrepancies. To establish whether embryo implantation is impaired in women with adenomyosis, women scheduled for IVF were prospectively evaluated for the presence of adenomyosis and whether this condition affected embryo implantation. Forty-nine women with adenomyosis diagnosed at transvaginal ultrasound with no abnormal uterine bleeding were recruited. They were matched for study period, age, day of embryo transfer and number of transferred embryos to 49 controls without the disease. In women with adenomyosis, 24 out of 76 embryos transferred implanted (32%); this occurred in 16 out of 76 (21%) in unaffected controls. The crude odds ratio of implantation in affected women was 1.73 (95% CI 0.83 to 3.60). The odds ratio adjusted for body mass index (the unique variable found to differ at univariate analysis) was 1.78 (95% CI 0.85 to 3.77). In conclusion, implantation rate is not impaired in asymptomatic women who are diagnosed with adenomyosis at transvaginal sonography. Affected women can be reassured about the effect of this condition on their chances of success.

This study evaluated the impact of age and ovarian reserve status on cumulative pregnancy rates. Approximately 1200 women from a general infertile population underwent ovarian reserve screening with the clomiphene citrate challenge test in the first few months of their initial evaluation. All patients then underwent a thorough infertility evaluation with therapy appropriate for their specific diagnoses. Patients with evidence of tubal disease, peritoneal adhesive disease, or male factor were eliminated. The 588 remaining patients were evaluated based on their age and ovarian reserve status, and their long-term pregnancy rates were compared using life table analyses. There was a dramatic decrease in pregnancy rates associated with an abnormal clomiphene citrate challenge test which was uniformly poor independent of age. Patients with normal ovarian reserve had much higher pregnancy rates, but a significant age-related decline in pregnancy rates was clearly identified. We conclude that women with evidence of diminished ovarian reserve have uniformly poor pregnancy rates independent of their age, but that age remains an important prognostic factor among those with a normal ovarian reserve. The combined use of maternal age and ovarian reserve screening should be used when counselling individual patients regarding their long-term prognoses for conception.