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

Abstract

Adenomyosis is associated with a negative impact on reproductive outcomes. Although adenomyosis is detected more frequently in women of late reproductive age, its impact on pregnancy rates is important because, in today’s world, family planning has shifted towards the late reproductive phase of life for many women. Although the diagnostic indications for imaging studies are well-known, we lack strict diagnostic criteria and classification systems concerning the extent of the disease. Selecting the optimal evidence-based treatment option for adenomyosis is difficult because of the paucity of evidence concerning the association between fertility and the degree and composition of adenomyosis. Furthermore, the treatment of infertility might interfere with the treatment of adenomyosis due to the presence of pain. The aim of this review is to analyze the association between adenomyosis and infertility, and describe treatment options to enhance reproductive outcomes. The following aspects will be addressed in detail: (a) prevalence and causes of adenomyosis, (b) diagnostic tools with imaging techniques, (c) clinical symptoms, (d) proposed pathomechanism of adenomyosis and infertility, and (e) different treatment approaches (pharmacological, surgical, others) and their impact on reproductive outcomes.

Adenomyosis and fertility‐sparing surgery: A literature appraisal

“…Among the anatomical alterations, we can include uterine enlargement, the presence of intramural adenomyomas that may distort the uterine cavity, anomalies in utero‐tubal transport and impairment of contractility and spermatozoic migration, functional endometrial disturbance, and malformation of the junctional zone 22 . At the microscopic level can be seen myocytic and nuclear hypertrophy, morphological abnormalities in cells and mitochondria, as well as disruptions in the Ca 2+ cycle, leading to muscular dyskinesia 23 . Maubon et al.…”

“…22 At the microscopic level can be seen myocytic and nuclear hypertrophy, morphological abnormalities in cells and mitochondria, as well as disruptions in the Ca 2+ cycle, leading to muscular dyskinesia . 23 Maubon et al showed that a junctional zone (JZ) bigger than 7 mm was correlated to a higher implantation failure; 24 taking into consideration the myometrial wall, a thickness of more than 2.5 cm on TVUS seems to have an increasingly adverse effect on IVF/intracytoplasmic sperm injection (ICSI). 25 The pathological alteration of the consistency of the myometrium, along with myocyte dyskinesia, distorts the balance of intracellular calcium concentrations with repercussions such as disturbed contractility and consequent hindrances to sperm migration.…”

Adenomyosis and Infertility: A Literature Review

“…Possible mechanisms through which adenomyosis causes impairment of implantation have been described in the recent literature, including anatomical distortion of the uterine cavity, disturbed uterine peristalsis and sperm transport, dysfunctional hyperperistalsis of the inner myometrium, increased intrauterine pressure, a disturbance in normal myocyte contractility with a subsequent loss of normal rhythmic contraction, altered sex steroid hormone pathways, increased inflammatory markers and oxidative stress, the reduced expression of implantation markers, a lack of expression of adhesion molecules, and altered function of the gene for embryonic development (the HOXA 10 gene) [14]. Different locations in the female genital tract and the negative impact of adenomyosis on the individual steps of reproduction are shown in Figure 2 [45]. Other suggested mechanisms are focused on P450 (P450arom) and mRNA expression, which seem to be present in women with adenomyosis, leading to lower clinical pregnancy rates [46].…”