Different subtypes of ultrasound‐diagnosed adenomyosis and in vitro fertilization outcomes: A systematic review and meta‐analysis

Abstract

Introduction Adenomyosis prevalence among women with infertility is increasing; their management during in vitro fertilization is usually based on ultrasound diagnosis alone. Herein, we summarize the latest evidence on the impact of ultrasound‐diagnosed adenomyosis on in vitro fertilization outcomes. Material and methods The study was registered with The International Prospective Register of Systematic Reviews (CRD42022355584). We searched PubMed, Embase, and Cochrane Library databases from inception to January 31, 2023, for cohort studies on the impact of adenomyosis on in vitro fertilization outcomes. Fertility outcomes were compared according to the presence of adenomyosis as diagnosed by ultrasound, concurrent endometriosis and adenomyosis, and MRI‐based or MRI‐ and ultrasound‐based adenomyosis diagnosis. Live birth rate was the primary outcome while clinical pregnancy and miscarriage rates were secondary outcomes. Results Women diagnosed with adenomyosis by ultrasound had lower live birth (odds ratio [OR] = 0.66; 95% confidence interval [CI]: 0.53–0.82, grade: very low), lower clinical pregnancy (OR = 0.64; 95% CI: 0.53–0.77, grade: very low), and higher miscarriage (OR = 1.81; 95% CI: 1.35–2.44, grade: very low) rates than those without adenomyosis. Notably, symptomatic and diffuse, but not asymptomatic adenomyosis as diagnosed by ultrasound, adversely affected in vitro fertilization outcomes, with lower live birth (OR = 0.57; 95% CI: 0.34–0.96, grade: very low), clinical pregnancy (OR = 0.69; 95% CI: 0.57–0.85, grade: low), and miscarriage (OR = 2.48, 95% CI: 1.28–4.82, grade: low) rates; and lower live birth (OR = 0.37; 95% CI: 0.23–0.59, grade: low) and clinical pregnancy (OR = 0.50; 95% CI: 0.34–0.75, grade: low), but not miscarriage rate (OR = 2.18; 95% CI: 0.72–6.62, grade: very low), respectively. Concurrent adenomyosis in endometriosis is associated with a significantly lower live birth rate (OR = 0.44; 95% CI: 0.26–0.75, grade: low) than endometriosis alone. Finally, the use of MRI‐based or MRI‐ and ultrasound‐based adenomyosis diagnosis showed no significant association with in vitro fertilization outcomes (grade: very low for all outcomes). Conclusions Considering ultrasound findings, symptoms, and different subtypes of adenomyosis may aid in offering personalized counseling, improving treatment decisions, and achieving better outcomes of in vitro fertilization.

Presence of Adenomyosis Impairs Clinical Outcomes in Women Undergoing Frozen Embryo Transfer: A Retrospective Cohort Study

“…In the literature, a recent retrospective study reported that patients with focal adenomyosis or with tubal infertility may have better reproduction outcomes compared with patients with diffuse adenomyosis following an embryo transfer with an ultra-long GnRH agonist protocol [ 20 ]. Similarly, a recent meta-analysis reported that diffuse adenomyosis had an adverse impact on in vitro fertilization outcomes, resulting in lower live birth and clinical pregnancy rates, while the miscarriage rates remained unchanged [ 21 ]. Furthermore, other data show that an increase in uterine volume can negatively affect reproductive outcomes in patients with adenomyosis.…”

“…Another retrospective study, conducted by Li et al, shared the same conclusion and suggested that a uterine volume of more than 98.81 cm 3 might lead to a lower live birth rate due to a higher incidence of miscarriage [ 23 ]. On the other hand, Wang et al reported that symptomatic adenomyosis was found to affect live birth, clinical pregnancy, and miscarriage rates, while asymptomatic adenomyosis may not have a significant impact on pregnancy outcomes [ 21 ]. However, to date, no studies have investigated the influence of different subtypes of adenomyosis diagnosed using the MUSA criteria on reproductive outcomes.…”

Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions

“… 4 , 5 , 6 More data regarding the prevalence and characteristics of adenomyosis, as diagnosed by noninvasive methods in subfertile women, is needed. 7 , 8 …”

“…Studies that describe the prevalence of different ultrasonographic adenomyosis features in subfertile women, adhering to standardized diagnostic criteria, would facilitate further studies on the potential impact on fertility and ART outcome. 7 , 8 …”

Impact of adenomyosis on the outcome of in vitro fertilization

“…We recently read an article by Wang et al in Acta Obstetricia et Gynecologica Scandinavica . 1 The authors reviewed the available literature to quantitatively assess the impact of adenomyosis diagnosed by ultrasound on the outcome of in vitro fertilization. 1 However, this study may have some methodological flaws.…”