Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis?

Wang, Peng-Hui; Fuh, Jong Ling; Chao, Hsiang‐Tai; Liu, Weimin; Cheng, Ming-Huei; Chao, Kuan-Chong

doi:10.1111/j.1447-0756.2008.00951.x

Cited by 76 publications

(55 citation statements)

References 40 publications

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“…Wang compared 28 women who had surgery and 37 women who had only GnRH‐a treatment and found a higher delivery rate (33 vs. 8%) in the surgery group. He also compared GnRH‐a combined with surgery and surgery alone (Figure ) and found no difference in delivery outcome, but the medical‐surgical group was older than the surgery group .…”

Section: Treatment Of Adenomyosis In the Infertile Patientsmentioning

confidence: 99%

Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery

Dueholm

2017

Acta Obstet Gynecol Scand

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This review includes an analysis of the clinical studies evaluating reproductive outcome and adenomyosis, and a review of studies on reproductive outcome and surgical treatment options for adenomyosis. Strict diagnostic criteria and classification of disease are needed for an image diagnosis of adenomyosis. Studies of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) populations and women with surgically treated deep endometriosis have suggested that adenomyosis has a negative impact on reproductive outcome, although there are substantial variations between studies. Few data are available on the relation between the extent of disease and impact on reproductive outcome, but a correlation appears to exist. Case series seem to confirm a positive effect of gonadotropin-releasing hormone analog treatment and surgery on reproductive outcome, but there are no controlled trials. Evidence is impaired by the poor quality of many studies, a lack of strict image diagnosis, and the absence of a classification of the extent of disease. Selection of the optimal evidence-based treatment options for adenomyosis in the fertility clinic is difficult because of a lack of evidence regarding the relation between fertility and the degree and composition of adenomyosis. Adenomyosis may reduce implantation so severely that surgical or other treatment options should be recommended, but the benefit of these treatment options needs to be verified. Referral of women with adenomyosis and recurrent miscarriage and repeated failure of assisted reproductive technology to centers with a special interest in adenomyosis research and treatment may be critical.

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Section: Treatment Of Adenomyosis In the Infertile Patientsmentioning

confidence: 99%

Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery

Dueholm

2017

Acta Obstet Gynecol Scand

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“…Thus, adenomyosis has a negative effect on female fertility. Several measures have been used to improve pregnancy outcomes, including a levonorgestrel-releasing intrauterine system, surgery, and gonadotropin-releasing hormone (GnRH) agonists 6–10…”

Section: Introductionmentioning

confidence: 99%

Transcriptome analysis of endometrial tissues following GnRH agonist treatment in a mouse adenomyosis model

Guo

et al. 2017

DDDT

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PurposeAdenomyosis is a common, benign gynecological condition of the female reproductive tract characterized by heavy menstrual bleeding and dysmenorrhea. Gonadotropin-releasing hormone (GnRH) agonists are one of the medications used in adenomyosis treatment; however, their underlying mechanisms are poorly understood. Moreover, it is difficult to obtain endometrial samples from women undergoing such treatment. To overcome this, we generated an adenomyosis mouse model, which we treated with an GnRH agonist to determine its effect on pregnancy outcomes. We also analyzed endometrial gene expression following GnRH agonist treatment to determine the mechanisms that may affect pregnancy outcome in individuals with adenomyosis.MethodsNeonatal female mice were divided into a control group, an untreated adenomyosis group, and an adenomyosis group treated with a GnRH agonist (n=6 each). The pregnancy outcome was observed and compared among the groups. Then, three randomly chosen transcriptomes from endometrial tissues from day 4 of pregnancy were analyzed between the adenomyosis group and the GnRH agonist treatment group by RNA sequencing and quantitative reverse transcription polymerase chain reaction (PCR).ResultsThe litter size was significantly smaller in the adenomyosis group than in the control group (7±0.28 vs 11±0.26; P<0.05). However, the average live litter size was increased (10±0.28 vs 7±0.28; P<0.05) after GnRH agonist treatment. Three hundred and fifty-nine genes were differentially expressed in the GnRH agonist-treated group compared with the untreated group (218 were downregulated and 141 were upregulated). Differentially expressed genes were related to diverse biological processes, including estrogen metabolism, cell cycle, and metabolite biosynthesis.ConclusionGnRH agonist treatment appears to improve the pregnancy outcome of adenomyosis in a mouse model. Besides pituitary down-regulation, other possible mechanisms such as the regulation of cell proliferation may play a role in this. These new insights into GnRH agonist mechanisms will be useful for future adenomyosis treatment.

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“…In 2009, Wang et al 28 carried out a study to evaluate the role of surgery in the management of severe symptomatic adenomyosis. This was a retrospective study analysing outcomes in 65 women treated with conservative surgery (adenomyomectomy) with or without 6 months of GnRH agonist (group A) or 6 months of GnRH alone (group B).…”

Section: Discussionmentioning

confidence: 99%

An unexpected diagnosis of adenomyosis in the subfertile woman

Hunjan

Davidson

2015

BMJ Case Reports

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SUMMARYA 38-year-old nulliparous female presented to an assisted conception clinic with subfertility and a long-standing history of dysmenorrhoea. Transvaginal ultrasound revealed two lesions in the body of the uterus, which were presumed to be fibroids. A decision was made to remove these lesions prior to attempting in vitro fertilisation (IVF). However, on laparotomy, deeply penetrating adenomyosis was discovered, resulting in an unexpected hysterectomy and significant blood loss. Based on our experience, we highlight the importance of suspecting a diagnosis of adenomyosis preoperatively and the methods by which this diagnosis can be made, in order to avoid potential unforeseen outcomes as described in this case. We discuss conservative management options for this condition, particularly in women wishing to preserve fertility. BACKGROUND

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Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis?

Cited by 76 publications

References 40 publications

Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery

Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery

Transcriptome analysis of endometrial tissues following GnRH agonist treatment in a mouse adenomyosis model

An unexpected diagnosis of adenomyosis in the subfertile woman

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