Impact of Uterine Adenomyosis on Pregnancy Outcomes in Women Undergoing In Vitro Fertilization Treated With a Long-Term Pituitary Downregulation Protocol

Jiaxin Zhang,Zhiqin Bu,Linli Hu,Yingpu Sun

doi:10.3389/fendo.2021.655803

Jiaxin Zhang, Zhiqin Bu + Show 2 more

Open Access

https://doi.org/10.3389/fendo.2021.655803

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Abstract

BackgroundSome studies have demonstrated that adenomyosis patients can achieve a comparable pregnancy outcome with women with normal uteruses, while there is no unanimous conclusion at present.MethodWe recruited 65 adenomyosis patients and 260 frequency-matched control women with endometriosis at a ratio of 1:4 according to age. Clinical pregnancy rate, spontaneous abortion rate, and live birth rate were compared between these two groups after controlling other factors.ResultsCompared with endometriosis patients, adenomyosis patients had a higher antral follicle count (AFC) (12.71 vs 11.65, P=0.027). Though the two groups had the same number of embryos transferred, adenomyosis patients had an obviously declined implantation rate (31.91% vs 46.74%, P=0.005), clinical pregnancy rate (47.06% vs 64.42%, P=0.028), live birth rate (31.37% vs 54.81%, P=0.004), and significantly increased spontaneous abortion rate (33.33% vs 13.43%, P=0.034). Multivariate logistic regression analysis showed that adenomyosis had adverse influences on pregnancy outcome when age and the number of embryo transfers were controlled (adjusted OR=0.361, P=0.003).ConclusionEven after being matched with age, adenomyosis still had adverse influences on the pregnancy outcome of IVF in patients undergoing the long protocol.

Highlights

Adenomyosis, which can influence uterine peristalsis, the transportation of sperm in the uterine cavity, and embryo implantation, leads to fertility decline [1, 2]
Except that adenomyosis patients had an increased antral follicle count (AFC) (12.71 ± 6.43 vs 11.65 ± 5.50, P=0.027), there was no difference between the two groups on the length of Gn duration (Table 2)
For adenomyosis patients undergoing IVF treatment, the oversize of the uterus, tissue necrosis factors, and other toxicants owing to chronic inflammation caused by invading endometrial glands, all have adverse influences on embryo implantation [15]

Summary

Introduction

Adenomyosis, which can influence uterine peristalsis, the transportation of sperm in the uterine cavity, and embryo implantation, leads to fertility decline [1, 2]. Since adenomyosis is an estrogen-dependent disease, the use of long-acting GnRH-a can control the growth of endometriosis by inhibiting ovary function [7]. Some scholars have found that, in adenomyosis patients who received a super long protocol (pretreatment of long-acting GnRH-a for ≥3 months) in IVF treatment, the pregnancy outcome was comparable to that of the controls with a normal uterus [10]. Though the two groups had the same number of embryos transferred, adenomyosis patients had an obviously declined implantation rate (31.91% vs 46.74%, P=0.005), clinical pregnancy rate (47.06% vs 64.42%, P=0.028), live birth rate (31.37% vs 54.81%, P=0.004), and significantly increased spontaneous abortion rate (33.33% vs 13.43%, P=0.034). Conclusion: Even after being matched with age, adenomyosis still had adverse influences on the pregnancy outcome of IVF in patients undergoing the long protocol

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Conclusion