Adenomyosis and in vitro fertilization impacts - A literature review

Abstract

Adenomyosis is a gynecological condition, which is characterized by stromal and glandular endometrial tissue infiltration inti the myometrium, resulting in an increase of uterine volume. The etiology of adenomyosis is presently unknown, but some theories assist us in understanding its pathogenesis and natural history. Clinical manifestations are increased menstrual flow and dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and dyspareunia. The signs and symptoms suggestive of adenomyosis are complemented by diagnostic methods such as transvaginal ultrasound (TVUS), ideally with intestinal preparation, magnetic resonance imaging (MRI) and surgery; although currently, there are no precise criteria for the classification of findings on imaging studies. The clinical and surgical therapeutic approach must be individualized, taking into account the patient’s characteristics, for instance, age, parity, depth and number of adenomyotic foci, uterine volume and, mainly, clinical manifestations. A causal relation between adenomyosis and infertility has been repeatedly suggested, mostly due to the anatomo-physiopathological conditions originated by the adenomyosis on the female genital tract; however, definitive conclusions are still lacking. This pathology is found in approximately 25% of infertile women, especially those who have had recurrent pregnancy loss (RPL), recurrent implantation failure, older women seeking In Vitro fertilization (IVF) treatment, and those with concomitant endometriosis. To determine whether adenomyosis per se affects fertility, several researchers have focused on women who are affected by the condition and underwent IVF/intracytoplasmic sperm injection (ICSI); for this model provides more accurate data about the influence of adenomyosis on embryo implantation. Therefore, our objective was to analyze, through a systematic literature review, the effect of uterine adenomyosis on the probability of pregnancy by IVF / ICSI, as well as trying to point out the main difficulties and gaps to establish a standard protocol for the management of these patients, since most of the patients with adenomyosis have other associated gynecological pathologies, mostly endometriosis; in addition to the heterogeneity of the studies still remaining as an obstacle to precise conclusions.

Impact of adenomyosis and endometriosis on IVF/ICSI pregnancy outcome in patients undergoing gonadotropin-releasing hormone agonist treatment and frozen embryo transfer

“…The lower cLBRs in adenomyosis patients could mostly be explained by patients being aged ≥ 38 years. Adenomyosis probably irreversibly injures the myometrial architecture and function after years of disease progression 13 . If the damage is severe enough, it might still affect implantation potential even after applying GnRH agonist pre-treatment to achieve a seemingly normal CA-125 value, eventually leading to a lower chance of achieving a live birth chance.…”

“…In infertile women, around 24% of women are diagnosed with adenomyosis, especially in those suffering from recurrent implantation failures and recurrent miscarriages, as well as in women diagnosed with endometriosis or in their last decade of reproductive age 10 , 11 . There are several hypothetical mechanisms in adenomyosis-associated infertility, including dysregulations of the myometrial architecture and function, chronic inflammation, presence of local oxygen, and altered endometrial function, which can cause implantation failure 12 , 13 . Although numerous studies have attempted to explain the relationship between adenomyosis and infertility, there are still no definitive conclusions 11 , 14 .…”

Impact of adenomyosis and endometriosis on IVF/ICSI pregnancy outcome in patients undergoing gonadotropin-releasing hormone agonist treatment and frozen embryo transfer

“…Adenomyosis probably irreversibly injures the myometrial architecture and function after years of disease progression [12]. If the damage is severe enough, it might still affect implantation potential even after applying GnRH agonist pre-treatment to achieve a seemingly normal CA-125 value, eventually leading to a lower chance of achieving a live birth chance.…”

“…In infertile women, around 24% of women are diagnosed with adenomyosis [9,10]. There are several hypothetical mechanisms in adenomyosis-associated infertility, including dysregulations of the myometrial architecture and function, chronic in ammation, presence of local oxygen, and altered endometrial function, which can cause implantation failure [11,12]. Although numerous studies have attempted to explain the relationship between adenomyosis and infertility, there are still no de nitive conclusions [10,13].…”

Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes

“…Additionally, adenomyosis seems to be a risk factor for infertility, but due to a small number of case series with low level of evidence, it is difficult to mention exact data [ 9 ]. Those studies report differences of adenomyosis prevalence in infertile patients, ranging from 7 to 28 % [ 10 , 11 ]. Puente et al and Sharma et al published data concerning an adenomyosis rate of 24.4% in infertile women, especially in those who suffered from recurrent miscarriages and recurrent implantation failures, in older women seeking IVF treatment, and in those with endometriosis [ 12 , 13 ].…”