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Introduction: Magnetic resonance imaging (MRI) is the current reference standard for noninvasive imaging of the pelvis. In patients with infertility potentially earmarked for in vitro fertilization/intracytoplasmic sperm injection procedures, the distinction between adenomyosis and its mimics is extremely vital. This article highlights the vital role of MRI in the detection of subtle nuances of adenomyosis in infertility and the key imaging features of its associated conditions and mimics. Materials and Methods: This is a retrospective Health Insurance Portability and Accountability Act compliant study. Inclusion criteria consisted of (a) clinically diagnosed cases of primary infertility; (b) suspicion of adenomyosis on transabdominal and transvaginal ultrasonography; (c) nonvisualization/obscuration of the junctional zone; (d) multiparametric MRI performed at 3 T. Exclusion criteria included (a) other causes of primary infertility including Mullerian ductal anomalies, ovulation factors, and, hormonal factors such as hypothalamic-pituitary axis abnormalities; (b) secondary infertility. We identified a cohort of 114 patients who underwent multiparametric pelvic MRI on a 3 T system between July 2011 and March 2017 at our institution to rule out adenomyosis as a cause of primary infertility. Results: A total of 38 of 114 patients were diagnosed with adenomyosis, with focal adenomyosis seen in 20 patients and diffuse adenomyosis in 18 patients. Isolated adenomyosis was seen in 10 patients, whereas 28 patients had adenomyosis in combination with other pelvic pathologies. Twelve patients had isolated junctional zone thickening without any other features of adenomyosis or deep pelvic endometriosis. Conclusions: Pelvic MRI is the reference standard for the noninvasive detection of the subtle nuances of uterine adenomyosis, and, its associations including deep pelvic endometriosis in patients with infertility.

Problem Diagnosis of female genital tuberculosis (FGTB) remains elusive due to the paucibacillary nature of the disease. We evaluated if analysis of inflammatory pathways of endometrial tissue could establish a better diagnosis of FGTB. Method of Study One hundred and four infertile women suspected of having GTB or having been treated for GTB in the past, underwent endometrial biopsies for diagnosis and Gene Inflammatory Pathways analysis at our center between 2018–2020. Diagnosis of FGTB was based on acid‐fast bacilli culture, immunocytochemistry, nested‐polymerase chain reaction, histopathological examination, TB GeneXpert, or combinations thereof. Gene expression profiles were also analyzed. Results Based on diagnostic tests of 104 women, 44 (42%) were considered TB‐positive, 35 (34%) TB‐negative, and 25 (24%) TB‐negative after TB treatment in the past. Inflammatory pathways were significantly upregulated in TB‐positive women versus TB‐negative (41% vs. 6%; p = .0005), and in women who were TB‐negative after TB treatment in the past versus TB‐negative (never treated for TB in the past) (38% vs. 6%; p = .0037). Two‐hundred seventy‐one genes were upregulated, and 61 genes were downregulated in TB‐positive women versus those who were TB‐negative. Differentially expressed genes were mapped to various interlinked inflammatory signaling pathways, including mitogen‐activated protein kinase (MAPK), Natural Killer (NK) cells, nuclear factor kappa‐B (NF‐kB), tumor necrosis factor (TNF), and Toll‐like receptors (TLR) signaling. Conclusions Inflammatory pathways and gene expression profiles add to the diagnostic tools to identify TB‐positive women at an early stage. The results from this study are still experimental and large multi‐centric studies are suggested before their recommendation in routine clinical practice.

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