Abstract
BackgroundUterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has also been reported to have different characteristics depending on the adenomyotic lesion localisation. The effect of its localisation on IVF/ICSI-ET outcomes is unclear. This study aimed to investigate whether adenomyotic lesion localisation, assessed using magnetic resonance imaging (MRI), was associated with outcomes of IVF/ICSI-ET cycles.MethodsThis multicentre, joint, retrospective cohort study analysed the medical records of 67 infertile patients with adenomyosis who underwent IVF/ICSI with fresh and frozen-thawed ET at five participating facilities from January 2012 to December 2016 and for whom MRI data were available. Fifteen patients were excluded; therefore, the MRI data of 52 patients were evaluated by two radiologists. We assessed the localisation of and classified adenomyotic lesions into advanced (invades the full thickness of the uterine myometrium), extrinsic (localised on the serosal side), and intrinsic (localised on the endometrial side) subtypes.ResultsThere were 40 advanced, nine extrinsic, and three intrinsic cases, and the outcomes of 100, 27, and nine ET cycles, respectively, were analysed. Pregnancy loss/clinical pregnancy and live birth rates of the advanced, extrinsic, and intrinsic groups were 64 % (16/25) and 9 % (9/100), 33.3 % (3/9) and 22.2 % (6/27), and 50 % (1/2) and 11.1 % (1/9), respectively. A logistic regression analysis adjusted for age, prior miscarriage, and body mass index showed that the extrinsic group had fewer pregnancy losses (odds ratio 0.06; 95 % confidence interval [CI]: 0.00–0.54, p = 0.026) and more live births (odds ratio 6.05; 95 % CI: 1.41–29.65, p = 0.018) than the advanced group.ConclusionsAdenomyotic lesions exert different effects on IVF/ICSI-ET outcomes. Thus, MRI assessments of adenomyosis in infertile patients are beneficial. Establishment of treatment plans based on adenomyotic lesion localisation should be considered.
Highlights
Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer
A logistic regression analysis adjusted for age, prior miscarriage, and body mass index showed that the extrinsic group had fewer pregnancy losses and more live births than the advanced group
Of the 67 patients, 15 were excluded for the following reasons: oocytes, fertilised oocytes, or frozen embryos could not be obtained (n = 7) and, embryo transfer (ET) could not be performed during the study period; conservative surgery was performed for adenomyosis before ET (n = 6); and the diagnostic criteria of adenomyosis by magnetic resonance imaging (MRI), as diagnosed by the two radiologists, were not met (n = 2) (Fig. 1)
Summary
Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has been reported to have different characteristics depending on the adenomyotic lesion localisation. Uterine adenomyosis is a benign disease that is common among women in their 40 and 50 s [1] It is characterised by ectopic endometrial tissue in the uterine myometrial layer [2]. Adenomyosis may present different characteristics depending on the origin. A systematic review regarding the outcomes of in vitro fertilisation/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) reported that patients with adenomyosis had a 28 % lower clinical pregnancy rate and a two-fold higher miscarriage rates than patients without adenomyosis [10]. This may be because of the general lack of consensus on the diagnostic criteria for adenomyosis; various forms of adenomyosis are not classified by severity or localisation, and this condition is currently treated as a homogenous disease [10, 11]
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