Adenomyosis and your implications on fertility and on the results of assisted reproduction techniques (ART)

Abstract

Introduction: Adenomyosis is a benign invasion of the endometrium into the myometrium, which produces an enlarged uterus with ectopic endometrial glands and stroma surrounded by the myometrium, with hyperplastic and hypertrophic changes. This condition has characteristic symptoms such as abnormal uterine bleeding, dysmenorrhea, chronic pelvic pain, miscarriage, and infertility. Objective: To assess the relationship between adenomyosis and infertility, as well as its possible impact on the outcomes of assisted reproductive technology. Methods: It is a review, with articles searched in the PubMed, UpToDate and SciELO databases, in Portuguese and English, published from 1989 to 2021. Results: Currently, the diagnosis of adenomyosis is made by imaging tests, which allow the early diagnosis in young women and makes it possible to investigate the relationship between adenomyosis and infertility. This relationship has not yet been established, but several theories have been proposed, such as impaired tubal transport, decreased sperm function related to nitric oxide levels in the uterine cavity, impaired embryo implantation, and altered uterine contractility. Furthermore, outcomes of assisted reproduction techniques and pregnancy outcomes appear to be affected, with studies showing lower rates of implantation and pregnancy, as well as higher rates of miscarriage and preterm birth. Conclusion: Although adenomyosis has negative impacts on women’s fertility and on the abortion rate, more studies and research are needed to, for example, define diagnostic criteria and create protocols for approaching adenomyosis.

Keywords

• adenomyosis
• infertility
• reproduction