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Alson S, Henic E, Hansson SR, Sladkevicius P. Correlation of adenomyosis features to live birth rates after the first IVF/ICSI treatment, when using the revised Morphological Uterus Sonographic Assessment group definitions. Acta Obstet Gynecol Scand 2024. [PMID: 39382305 DOI: 10.1111/aogs.14986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/21/2024] [Accepted: 09/25/2024] [Indexed: 10/10/2024]
Abstract
INTRODUCTION Data regarding the impact of adenomyosis on the outcomes after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment are conflicting. Standardized diagnostic criteria are prerequisites for studying a potential association between adenomyosis and IVF/ICSI treatment outcomes. This study aims to examine the cumulative live birth rate (CLBR) after the first IVF/ICSI treatment in women with or without direct or indirect features of adenomyosis, using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions. MATERIAL AND METHODS This was a prospective cohort study of 1037 women aged 25-≤39 years, undergoing their first IVF/ICSI treatment between January 2019 and October 2022. The presence of MUSA features of adenomyosis was assessed prior to treatment start. RESULTS The CLBR after the first IVF/ICSI treatment was 424/1037 (40.9%, 95% CI, 37.9-43.8) in the total cohort. Women with direct features of adenomyosis had lower CLBR, 25/102 (24.5%; 95% CI, 17.5-31.5) than women without, 399/935 (42.7%; 95% CI, 39.5-45.8), p < 0.001. The adjusted relative risk (aRR) for live birth for women with direct features of adenomyosis compared to women without was 0.62 (95% CI, 0.43-0.88), p = 0.007. Direct features were associated with a higher risk of miscarriage after frozen embryo transfer, aRR 2.88 (95% CI, 1.49-5.57), p = 0.002. Women with indirect features had a lower CLBR [50/188 (26.6%, 95% CI, 20.3-32.9)] than women without [399/935, (42.7%, 95% CI, 39.5-45.8)], aRR 0.58 (95% CI, 0.45-0.75), p < 0.001. For features located in the inner myometrium, the aRR for live birth was 0.29 (95% CI 0.11-0.74), p = 0.010 and for the outer myometrium 2.61 (95% CI 1.42-4.8), p = 0.002. An interrupted junctional zone was the single feature that impacted CLBR the most. CONCLUSIONS The presence of direct or indirect MUSA features of adenomyosis correlates to reduced live birth rates in women undergoing their first IVF/ICSI treatment. Features located in the inner myometrium, particularly an interrupted junctional zone, reduced the chance of live birth the most, whereas location in the outer myometrium was associated with higher chances of live birth. Systematic ultrasound examinations should be considered for women scheduled for IVF/ICSI treatment, for adequate counseling on the chances of successful treatment.
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Affiliation(s)
- Sara Alson
- Department of Clinical Sciences, Obstetric, Gynecological and Prenatal Ultrasound Research, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden
| | - Emir Henic
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Unit for Translational Obstetric Research, Lund University, Sweden
| | - Povilas Sladkevicius
- Department of Clinical Sciences, Obstetric, Gynecological and Prenatal Ultrasound Research, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
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Ma R, Briones DAB, Zou M, Xiong Y, Bai J, Zhang L. Analysis of factors affecting pregnancy outcomes in patients with adenomyosis after high intensity focused ultrasound ablation: a retrospective study. Int J Hyperthermia 2024; 41:2390124. [PMID: 39159942 DOI: 10.1080/02656736.2024.2390124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/30/2024] [Accepted: 08/04/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES To investigate all pregnancies and analyze the factors influencing pregnancy outcomes in patients with adenomyosis after high intensity focused ultrasound (HIFU). MATERIALS AND METHODS A total of 231 patients with adenomyosis who completed HIFU and wished to conceive were enrolled. The symptom improvement and information of pregnancy were recorded during the follow-up period. Factors influencing pregnancy outcomes were analyzed using multivariate regression analysis and survival analysis. RESULTS After HIFU, 100 of 231 (43.3%) patients became pregnant within 96 months, including 77 (77/194, 39.7%) in natural and 23 (23/37, 62.2%) in vitro fertilization and embryo transfer (IVF-ET) pregnancies following gonadotropin-releasing hormone agonist (GnRHa). Among the 108 (46.8%, 108/231) infertile patients (defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse, 40 primary infertility and 68 secondary infertility), 31 (28.7%) became pregnant. At the end of the follow-up, 70 successfully delivered 71 healthy babies. No uterine rupture occurred during pregnancy and delivery. Patients with pelvic adhesion and infertility history had a lower pregnancy chance than that of patients without pelvic adhesion and infertility history (OR < 1, p < 0.05). Patients with small adenomyotic lesion volume had a greater pregnancy chance than that of patients with large lesion volume (OR < 1, p < 0.05). IVF-ET following GnRHa had a better pregnancy chance (p < 0.05). CONCLUSIONS HIFU seems to have a beneficial effect on fertility of patients with adenomyosis. Pelvic adhesion, infertility history, and large adenomyotic lesion volume have adverse effects on pregnancy, but IVF-ET following GnRHa after HIFU could increase the pregnancy chance.
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Affiliation(s)
- Rong Ma
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Diego Armando Burgos Briones
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Min Zou
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Yu Xiong
- Department of Gynecology, Chongqing Haifu Hospital, Chongqing, China
| | - Jin Bai
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Lian Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Wu HM, Tsai TC, Liu SM, Pai AHY, Chen LH. The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology. Int J Mol Sci 2024; 25:8937. [PMID: 39201621 PMCID: PMC11354813 DOI: 10.3390/ijms25168937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Adenomyosis, endometriosis of the uterus, is associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development, resulting in disrupted fertility, including the local effects of sex steroid and pituitary hormones, immune responses, inflammatory factors, and neuroangiogenic mediators. In the recent literature, all of the proposed pathogenetic mechanisms of adenomyosis reduce endometrial receptivity and alter the adhesion molecule expression necessary for embryo implantation. The evidence so far has shown that adenomyosis causes lower pregnancy and live birth rates, higher miscarriage rates, as well as adverse obstetric and neonatal outcomes. Both pharmaceutical and surgical treatments for adenomyosis seem to have a positive impact on reproductive outcomes, leading to improved pregnancy and live birth rates. In addition, adenomyosis has negative impacts on reproductive outcomes in patients undergoing assisted reproductive technology. This association appears less significant after patients follow a long gonadotropin-releasing hormone agonist (GnRHa) protocol, which improves implantation rates. The pre-treatment of GnRHa can also be beneficial before engaging in natural conception attempts. This review aims to discover adenomyosis-associated infertility and to provide patient-specific treatment options.
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Affiliation(s)
- Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-M.W.); (T.-C.T.); (S.-M.L.); (A.H.-Y.P.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tian-Chi Tsai
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-M.W.); (T.-C.T.); (S.-M.L.); (A.H.-Y.P.)
| | - Shang-Min Liu
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-M.W.); (T.-C.T.); (S.-M.L.); (A.H.-Y.P.)
| | - Angel Hsin-Yu Pai
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-M.W.); (T.-C.T.); (S.-M.L.); (A.H.-Y.P.)
| | - Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (H.-M.W.); (T.-C.T.); (S.-M.L.); (A.H.-Y.P.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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Sokteang S, Tran C, Ou P, Ouk C, Pirtea P, de Ziegler D. Clinical Management of Infertility Associated with Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102409. [PMID: 38340984 DOI: 10.1016/j.jogc.2024.102409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE This study aimed to review recent data that affected the clinical management of infertility associated with endometriosis. DATA SOURCES We completed a PubMed review of all articles that included the following keywords: endometriosis, infertility, IVF, and ART. STUDY SELECTION A study was selected based on the pertinence of the topic addressed in relation to the study's set objectives. DATA EXTRACTION AND SYNTHESIS All identified articles were first assessed based on a review of the abstract. Pertinent articles were reviewed in depth. CONCLUSION Endometriosis interferes with natural conception primarily by altering the quality of gametes-oocytes and sperm-and early-stage embryos. On the contrary, recent data indicate that gametes and early-stage embryos are not altered in the case of ART. Surgery-a classical approach in yesteryears-does appear to improve ART outcomes and may affect ovarian reserve and the number of oocytes retrieved in ART. Surgery is thus more rarely opted for today and only when necessary; proceeding to fertility preservation prior to surgery is recommended. When ART is performed in women with endometriosis, it is recommended to use an antagonist or progesterone-primed ovarian stimulation approach followed by deferred embryo transfer. In this case, GnRH (gonadotropin releasing hormone) agonist is preferred for triggering ovulation, as it limits the risk of cyst formation as well as ovarian hyperstimulation syndrome. Frozen embryo transfers are best performed in E2 (estradiol) and progesterone replacement cycle.
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Affiliation(s)
- Sean Sokteang
- Fertility Clinic of Cambodia (FCC), Phnom Penh, Kingdom of Cambodia
| | - Chloe Tran
- Fertility Clinic of Cambodia (FCC), Phnom Penh, Kingdom of Cambodia
| | - Pichetra Ou
- Fertility Clinic of Cambodia (FCC), Phnom Penh, Kingdom of Cambodia
| | - Chanpisey Ouk
- Fertility Clinic of Cambodia (FCC), Phnom Penh, Kingdom of Cambodia
| | - Paul Pirtea
- Fertility Clinic of Cambodia (FCC), Phnom Penh, Kingdom of Cambodia; Department of Ob-Gyn, Hopital Foch, Paris, France
| | - Dominique de Ziegler
- Fertility Clinic of Cambodia (FCC), Phnom Penh, Kingdom of Cambodia; Department of Ob-Gyn, Hopital Foch, Paris, France.
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Alson S, Jokubkiene L, Henic E, Sladkevicius P. Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions. Acta Obstet Gynecol Scand 2024; 103:1142-1152. [PMID: 38410091 PMCID: PMC11103150 DOI: 10.1111/aogs.14812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Studies that use standardized ultrasonographic criteria to diagnose adenomyosis in subfertile women are needed. These would improve the understanding of the disease burden and enable further studies on its impact on fertility and assisted reproductive treatment (ART) outcome. The aim of this study was to determine the prevalence of different features of adenomyosis in women scheduled for their first ART, diagnosed at two (2D) and three-dimensional (3D) transvaginal ultrasonography (TVUS) using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions. MATERIAL AND METHODS This was a prospective, observational cross-sectional study of subfertile women aged 25 to ≤39 years, that were referred to a university hospital for their first ART between December 2018 and May 2021. Of 1224 eligible women, 1160 women fulfilled the inclusion criteria and consented to participate in the study. All women underwent a systematic 2D and 3D TVUS examination. The primary outcome was the presence of direct and indirect features of adenomyosis, as proposed by the MUSA group. Secondary outcomes were to describe the ultrasonographic characteristics of the different features, as well as any difference in the diagnostics at 2D or 3D TVUS and any association with clinical characteristics such as endometriosis. RESULTS At least one direct or indirect feature of adenomyosis was observed in 272 (23.4%, 95% confidence interval [CI] 21.0-25.9) women. Direct features that are pathognomonic for the disease were observed in 111 (9.6%, 95% CI, 7.9-11.3) women. Direct features were visible only at 3D TVUS in 56 (4.8%, 95% CI 3.6-6.1) women, that is, 56/111 (50.5%) of women with at least one direct adenomyosis feature. Direct features were more common in women with endometriosis (OR 2.8, 95% CI 1.8-4.3). CONCLUSIONS We found than one in 10 women scheduled for ART had direct features of adenomyosis at ultrasound examination. The present study suggests that the use of 3D TVUS is an important complement to 2D in the diagnostics of adenomyosis. Our results may further improve the counseling of women scheduled for ART and enables future studies on the impact of different features of adenomyosis on subfertility, ART results and obstetric outcomes.
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Affiliation(s)
- Sara Alson
- Department of Clinical Sciences, ObstetricGynecological and Prenatal Ultrasound Research, Lund UniversityMalmöSweden
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
- Reproductive Medicine CenterSkåne University HospitalMalmöSweden
| | - Ligita Jokubkiene
- Department of Clinical Sciences, ObstetricGynecological and Prenatal Ultrasound Research, Lund UniversityMalmöSweden
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
| | - Emir Henic
- Reproductive Medicine CenterSkåne University HospitalMalmöSweden
- Department of Translational MedicineLund UniversityMalmöSweden
| | - Povilas Sladkevicius
- Department of Clinical Sciences, ObstetricGynecological and Prenatal Ultrasound Research, Lund UniversityMalmöSweden
- Department of Obstetrics and GynecologySkåne University HospitalMalmöSweden
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Qin Y, Liu C, Zhang F, Zhao M. Impact of adenomyosis on the outcome of in vitro fertilization. Acta Obstet Gynecol Scand 2023; 102:1756. [PMID: 37594144 PMCID: PMC10619605 DOI: 10.1111/aogs.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/11/2023] [Accepted: 07/23/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Yaoqin Qin
- Reproductive Medicine Center, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Chunlei Liu
- Reproductive Medicine Center, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Fengfeng Zhang
- Reproductive Medicine Center, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Min Zhao
- Reproductive Medicine Center, The Central Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
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Sachs-Guedj N, Coroleu B, Pascual MÁ, Rodríguez I, Polyzos NP. Presence of Adenomyosis Impairs Clinical Outcomes in Women Undergoing Frozen Embryo Transfer: A Retrospective Cohort Study. J Clin Med 2023; 12:6058. [PMID: 37762998 PMCID: PMC10531755 DOI: 10.3390/jcm12186058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) was investigated in several studies and demonstrated a potentially detrimental effect on live birth rates following IVF, most of them were small studies in which the adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. (2) Methods: 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Among them, 140 women had a confirmed diagnosis of adenomyosis based on the MUSA criteria. (3) Results: Adenomyosis patients were more likely to proceed with deferred FET compared with no-adenomyosis women (p = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 months) (p < 0.001). The presence of adenomyosis significantly decreased the clinical pregnancy rates (aOR 0.62, 95% CI: 0.39-0.98, p = 0.040) and live birth rates (aOR 0.46, 95% CI: 0.27-0.75, p = 0.003) and significantly increased the miscarriage rates (aOR 2.13, 95% CI: 0.98-4.37, p = 0.045). Multivariable logistic regression adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis demonstrated that the use of the GnRH agonist protocol did not decrease or increase the miscarriage rate, clinical pregnancy rate, or live birth rate. (4) Conclusions: The presence of adenomyosis had a significant negative impact on the clinical outcomes of patients undergoing FET and was associated with higher miscarriage, lower clinical pregnancy, and live birth rates. GnRH agonist pre-treatment does not appear to improve clinical outcomes.
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Affiliation(s)
- Noémie Sachs-Guedj
- Department of Obstetrics, Gynecology and Reproduction, Dexeus University Hospital, 08028 Barcelona, Spain; (N.S.-G.); (B.C.); (M.Á.P.); (I.R.)
- Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Buenaventura Coroleu
- Department of Obstetrics, Gynecology and Reproduction, Dexeus University Hospital, 08028 Barcelona, Spain; (N.S.-G.); (B.C.); (M.Á.P.); (I.R.)
| | - María Ángela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Dexeus University Hospital, 08028 Barcelona, Spain; (N.S.-G.); (B.C.); (M.Á.P.); (I.R.)
| | - Ignacio Rodríguez
- Department of Obstetrics, Gynecology and Reproduction, Dexeus University Hospital, 08028 Barcelona, Spain; (N.S.-G.); (B.C.); (M.Á.P.); (I.R.)
| | - Nikolaos P. Polyzos
- Department of Obstetrics, Gynecology and Reproduction, Dexeus University Hospital, 08028 Barcelona, Spain; (N.S.-G.); (B.C.); (M.Á.P.); (I.R.)
- Faculty of Medicine and Health Sciences, Ghent University (UZ Gent), 9000 Gent, Belgium
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Wang X, Xu Z, Huang Y, Lin S, Lyu G. Different subtypes of ultrasound-diagnosed adenomyosis and in vitro fertilization outcomes: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2023; 102:657-668. [PMID: 37078454 PMCID: PMC10201963 DOI: 10.1111/aogs.14580] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
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.
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Affiliation(s)
- Xia‐Li Wang
- Department of UltrasoundSecond Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
- Department of Clinical MedicineQuanzhou Medical CollegeQuanzhouChina
| | - Zi‐Wei Xu
- Department of UltrasoundSecond Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Yan‐Yan Huang
- Department of UltrasoundSecond Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Shu Lin
- Center of Neurological and Metabolic ResearchSecond Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
- Diabetes and Metabolism DivisionGarvan Institute of Medical ResearchDarlinghurstSydneyAustralia
| | - Guo‐Rong Lyu
- Department of UltrasoundSecond Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
- Department of Clinical MedicineQuanzhou Medical CollegeQuanzhouChina
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