Impact Of Endometriosis Research Articles

Impact of adenomyosis on the prognosis of patients with endometrial cancer.

BackgroundDespite the high prevalence of adenomyosis in hysterectomy specimens of endometrial carcinoma (EC) patients, the relationship between adenomyosis and EC prognosis appears unclear.ObjectiveTo assess the prognostic value of coexistent adenomyosis in patients with EC.MethodsA systematic review and meta‐analysis was performed by searching six electronic databases for studies reporting data on prognosis of EC patients with and without coexistent adenomyosis. Studies with patient selection based on prognostic factors were excluded. Pooled univariate hazard ratio (HR) analyses for overall survival (OS) and disease‐free survival (DRF) were performed, using EC patients without adenomyosis as a control group. For DFS, pooled multivariate HR analysis was also evaluable.ResultsThree studies of 2505 EC patients (553 with and 1952 without adenomyosis) were included. Compared with EC patients without adenomyosis, EC patients with coexistent adenomyosis showed a pooled HR of 0.533 (CI 95%, 0.329–0.864) for OS at univariate analysis; 0.536 (CI 95%, 0.334–0.859) for DFS at univariate analysis; and 0.875 (CI 95%, 0.331–2.315) for DFS at multivariate analysis.ConclusionIn EC patients with coexistent adenomyosis, the risk of death is halved compared with EC patients without adenomyosis. However, the independence of this association needs to be verified in future studies.

Adenomyosis: Impact on Fertility and Obstetric Outcomes.

In this commentary, we discuss the associations between adenomyosis, fertility, and obstetric outcomes. A recent meta-analysis on the impact of adenomyosis on reproductive outcomes found a 43% reduction in the odds ratio (OR) for clinical pregnancy and a threefold increase in the risk of miscarriage in women with adenomyosis compared with controls. Moreover, adenomyosis seems to be strongly associated with pre-eclampsia with an OR of almost 8. Also, the risk for small for gestational age was almost fourfold increased, whereas for preterm deliveries was threefold increased. The presence of deep infiltrating endometriosis and adenomyosis seems associated with particularly adverse obstetric outcomes, especially concerning natural conception. Some observations suggest that the probability of clinical pregnancy is considerably low in these cases, around 11.8%. Although several methodological drawbacks prevent definitive conclusions, all these elements should be considered in counseling women with adenomyosis seeking pregnancy, especially in cases of IVF.

The impact of adenomyosis on IVF outcomes: a prospective cohort study

STUDY QUESTIONDoes the presence of adenomyosis in women treated with IVF alter IVF outcomes?SUMMARY ANSWERAdenomyosis does not significantly alter IVF outcomes when adjusted for confounding factors including maternal age and smoking status.WHAT IS KNOWN ALREADYStudies evaluating adenomyosis and its impact on infertility, particularly when focusing on IVF, remain controversial. Many studies report that adenomyosis has a detrimental effect on IVF outcomes, however age is strongly related with both the prevalence of adenomyosis and worse reproductive outcomes.STUDY DESIGN, SIZE, DURATIONA prospective cohort study of women undergoing 4002 IVF cycles who had undergone a screening ultrasound assessing features of adenomyosis from 1 January 2016 to 31 March 2018 at a multi-site private fertility clinic. Of these women, 1228 fulfilled the inclusion criteria and commenced an IVF cycle, with a subset of 715 women undergoing an embryo transfer (ET). Women were defined as having adenomyosis if there was sonographic evidence of adenomyosis on ultrasound as per the Morphological Uterus Sonographic Assessment criteria, and were then compared to women without.PARTICIPANTS/MATERIALS, SETTING, METHODSAll women at a private multi-site IVF clinic who underwent a standardised ultrasound to identify features of adenomyosis and also commenced an IVF cycle were assessed for their outcomes. These included clinical pregnancy (defined as the presence of a gestational sac on ultrasound at 7 weeks’ gestation), clinical pregnancy loss, number of cancelled cycles, number of useful embryos for transfer or freezing and live birth rates. As a secondary aim, initiated stimulation cycles and those that had an ET were analysed separately to determine when an effect of adenomyosis on IVF might occur: during stimulation or transfer.MAIN RESULTS AND THE ROLE OF CHANCEWhen adjusting for confounders, women with and without sonographic features of adenomyosis had no significant differences in most of their IVF outcomes including live birth rates.LIMITATIONS, REASONS FOR CAUTIONAdenomyosis had a detrimental impact on IVF outcomes prior to adjusting for confounding factors. No allowance was made for the possibility that confounding factors may merely reduce the effect size of adenomyosis on IVF outcomes. Second, despite a power calculation, the study was underpowered as not all fresh cycles led to an ET.WIDER IMPLICATIONS OF THE FINDINGSThis is one of the largest studies to evaluate adenomyosis and IVF outcomes, while also importantly adjusting for confounding factors. The results suggest that adenomyosis does not have the detrimental impact on IVF that has previously been suggested, possibly reducing the importance of screening for and treating this entity.STUDY FUNDING/COMPETING INTEREST(S)The study received no external funding. The authors declare no conflicts of interest.TRIAL REGISTRATION NUMBERACTRN12617000796381.

Adenomyosis and Infertility-Review of Medical and Surgical Approaches.

The aim of this review is to clarify the relative association between adenomyosis and infertility and the possible treatment for an infertile patient. Although adenomyosis is detected more often in women of late reproductive age, its influence on pregnancy rates is important, especially considering the tendency to delay pregnancy among women in developed countries. In this article, we present a critical analysis of the literature data concerning the impact of adenomyosis on fertility. The possible effects of treatment on the pregnancy rate will also be discussed. We conducted a literature search; publications from Pubmed, Embase and Cochrane databases published from 1982 to 2019 were retrieved using terms ’adenomyosis and infertility’ and ’adenomyosis and pregnancy outcomes’, extensively studied in the aspects of diagnosis, pathogenesis of infertility and possible treatment methods. Molecular studies have given deep insight into the pathogenesis of adenomyosis in the recent few years, but there is a huge discrepancy between in vitro studies and praxis. Oral contraceptive pills, anti-prostaglandins, oral or parenteral progestins, danazol and gonadotrophin-releasing hormone (GnRH) analogues have all been used to control menstrual pain and menorrhagia in women with adenomyosis, but they temporarily suppress the menstrual cycle. Additionally, endometrial ablation and hysterectomy used to alleviate pain caused by adenomyosis exclude pregnancy planning. The development of imaging techniques—ultrasound and MRI—enables the diagnosis of adenomyosis with very high accuracy nowadays, but the methods of treatment mentioned above have not given satisfactory results in women planning pregnancy. For these patients, the high-intensity-focused ultrasound method (HIFU) and combined treatment before assisted reproductive techniques can prove beneficial in adenomyosis patients.

Impact of Adenomyosis on Women's Psychological Health and Work Productivity: A Comparative Cross-Sectional Study.

Background: Quality of life in adenomyosis (AD) patients has been poorly investigated. Previous data suggest that AD has negative impact on the quality of life in these women. Materials and Methods: From September 2018 to December 2019, all consecutive female premenopausal patients aged ≥18 years diagnosed with AD by transvaginal ultrasound (TVU) were invited to participate in a comparative cross-sectional study. The Short Form-36-item (SF-36) health questionnaire and the Hospital Anxiety and Depression Scale (HADS) were administered. Work productivity and activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH). Data obtained from these patients were compared with women with normal-appearing myometrium in the TVU recruited during routine gynecological visits. The study was approved by the Clinical Research Ethics Committee of the Hospital Clinic (reference HCB/2018/0919). Results: One hundred three patients with AD and 214 without AD were analyzed. Patients with AD compared to those without AD showed significantly lower scores in all domains of the SF-36 questionnaire and mean (SD) higher scores in the HADS questionnaire for anxiety (10.06 [3.04] vs. 6.92 [2.98], p < 0.001) and depression (6.39 [3.89] vs. 2.74 [2.01], p < 0.002). Significant differences (p < 0.001) were also found for the percentages of absenteeism (12.2% vs. 1.1%), presenteeism (31.1% vs. 11.4%), overall work productivity loss (38.2% vs. 12.4%), and activity impairment (55.7% vs. 9.9%). The presence of AD was associated with higher yearly estimated indirect costs of €5161.32 (€7928.0 vs. €2460.8, p < 0.001). Conclusions: AD negatively affects women's health-related quality of life, psychological health, and work productivity, with impairment at work and daily activities, and higher risk for anxiety and depression.

Immunological changes associated with adenomyosis: a systematic review

Adenomyosis is a benign gynecological disorder associated with subfertility, pelvic pain and abnormal uterine bleeding that have significant consequences for the health and quality of life of women. Histologically, it is defined as the presence of ectopic endometrial islets within the myometrium. Its pathogenesis has not yet been elucidated and several pieces of the puzzle are still missing. One process involved in the development of adenomyosis is the increased capacity of some endometrial cells to infiltrate the myometrium. Moreover, the local and systemic immune systems are associated with the onset of the disease and with maintaining it. Numerous observations have highlighted the activation of immune cells and the release of immune soluble factors in adenomyosis. The contribution of immunity occurs in conjunction with hormonal aberrations and activation of the epithelial to mesenchymal transition (EMT) pathway, which promotes migration of endometrial cells. Here, we review current knowledge on the immunological changes in adenomyosis, with the aim of further elucidation of the pathogenesis of this disease. The objective was to systematically review the literature regarding the role of the immune system in development of adenomyosis in the inner and the outer myometrium, in humans. A systematic review of published human studies was performed in MEDLINE, EMBASE and Cochrane Library databases from 1970 to February 2019 using the combination of Medical Subject Headings (MeSH): Adenomyosis AND ('Immune System' OR 'Gonadal Steroid Hormones'), and free-text terms for the following search terms (and their variants): Adenomyosis AND (immunity OR immune OR macrophage OR 'natural killer cell' OR lymphocyte* OR leucocyte* OR HLA OR inflammation OR 'sex steroid' OR 'epithelial to mesenchymal transition' OR 'EMT'). Studies in which no comparison was made with control patients, without adenomyosis (systemic sample and/or eutopic endometrium), were excluded. A total of 42 articles were included in our systematic review. Changes in innate and adaptive immune cell numbers were described in the eutopic and/or ectopic endometrium of women with adenomyosis compared to disease-free counterparts. They mostly described an increase in lymphocyte and macrophage cell populations in adenomyosis eutopic endometrium compared to controls. These observations underscore the immune contributions to the disease pathogenesis. Thirty-one cytokines and other markers involved in immune pathways were studied in the included articles. Pro-inflammatory cytokines (interleukin (IL) 6, IL1β, interferon (IFN) α, tumor necrosis factor α, IFNγ) as well as anti-inflammatory or regulatory mediators (IL10, transforming growth factor β…) were found to be elevated in the eutopic endometrium and/or in the ectopic endometrium of the myometrium in women with adenomyosis compared to controls. Moreover, in women affected by adenomyosis, immunity was reported to be directly or indirectly linked to sex steroid hormone aberrations (notably changes in progesterone receptor in eutopic and ectopic endometrium) in three studies and to EMT in four studies. The available literature clearly depicts immunological changes that are associated with adenomyosis. Both systemic and local immune changes have been described in women affected by adenomyosis, with the coexistence of changes in inflammatory as well as anti-inflammatory signals. It is likely that these immune changes, through an EMT mechanism, stimulate the migration of endometrial cells into the myometrium that, together with an endocrine imbalance, promote this inflammatory process. In light of the considerable impact of adenomyosis on women's health, a better understanding of the role played by the immune system in adenomyosis is likely to yield new research opportunities to better understand its pathogenesis.

Association and Management of Adenomyosis Amongst Patients with Asherman's Syndrome

Study Objective To provide the first characterization of concomitant Asherman's syndrome and adenomyosis, and subsequent obstetrical outcomes. Design A retrospective cohort study from 01 January 2015 to 01 March 2019. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants 227 Asherman's syndrome patients with available hysteroscopy and pelvic ultrasound reports. Interventions Determinants of adenomyosis and the impact of adenomyosis on fertility and obstetrical outcomes in Asherman's syndrome patients. Measurements and Main Results A telephone survey and confirmatory chart review were conducted to obtain information on patients’ demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman's syndrome management. Adenomyosis was the most common co-occurring uterine finding, detected in 39 Asherman's patients. The overall primary symptom was infertility. Adenomyosis patients reported a different menstrual pattern than patients with Asherman's syndrome only. Adenomyosis prevalence trended higher with increasing Asherman's severity, but there were no significant independent predictors of adenomyosis. In this cohort, 77 patients attempted conception and produced 87 pregnancies, 13 of which were ongoing at study conclusion. Age (OR 0.7, 95% CI 0.5-0.9) and use of assisted reproductive technology (OR 0.1, 95% CI 0.02-0.995) were negatively associated with pregnancy. Postpartum dilation & curettage/dilation & evacuation was a risk factor for miscarriage (OR 13.6, 95% CI 1.4-129.5). Age (OR 0.9, 95% CI 0.8-0.988) and severe Asherman's disease (OR 0.1, 95% CI 0.001-0.1) were negatively associated with live birth. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among Asherman's patients. Conclusion Adenomyosis is relatively common in Asherman's syndrome patients. Any distinct detriment to fertility from adenomyosis may be overshadowed by the lasting effects of Asherman's adhesions when these diseases occur together. Larger studies to establish management guidelines for concomitant disease are needed.

IMPACT OF ULTRASOUND DIAGNOSIS OF ADENOMYOSIS ON PREGNANCY RATE AND OUTCOME IN IVF CYCLES WITH DONATED OOCYTES: A PROSPECTIVE STUDY

The aim of this prospective study was to evaluate in patients who underwent embryo transfer (ET) in an oocyte donation cycle, the impact of adenomyosis, diagnosed by transvaginal sonographic (TVS), on the implantation rate. Also type and degree of adenomyosis scored by TVS were correlated to the implantation rate and pregnancy outcome.

Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis.

Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. Observational studies with medically confirmed pregnancy outcomes as endpoints. Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model. Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P˂0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042). Adenomyosis seems to have a detrimental impact on pregnancy outcomes,resulting in a higher likelihood of preterm birth, small for gestational age, andpre-eclampsia.

Adenomyosis and IVF Outcomes - where we are and where we need to be

Better imaging techniques will result in more women who are undergoing in vitro fertilization (IVF) being diagnosed with adenomyosis. Preliminary data suggest that adenomyosis may have implications for the outcome of IVF. However, available evidence is limited to data from retrospective studies with major inconsistencies in the diagnostic criteria used to confirm adenomyosis. Despite this uncertainty, a number of therapeutic modifications have been suggested to minimize the impact of adenomyosis in women undergoing IVF. In this brief report, we summarize current limitations in diagnosing adenomyosis and critically evaluate the available evidence on its impact on IVF outcomes. We set out a number of steps needed to generate the evidence to underpin the diagnosis, prognosis and effective treatment so that women undergoing IVF can be adequately counselled.

Myomas and Adenomyosis: Impact on Reproductive Outcome.

Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome.

Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease.

BackgroundAdenomyosis is linked to infertility, but the mechanisms behind this relationship are not clearly established. Similarly, the impact of adenomyosis on ART outcome is not fully understood. Our main objective was to use ultrasound imaging to investigate adenomyosis prevalence and severity in a population of infertile women, as well as specifically among women experiencing recurrent miscarriages (RM) or repeated implantation failure (RIF) in ART.MethodsCross-sectional study conducted in 1015 patients undergoing ART from January 2009 to December 2013 and referred for 3D ultrasound to complete study prior to initiating an ART cycle, or after ≥3 IVF failures or ≥2 miscarriages at diagnostic imaging unit at university-affiliated private IVF unit. Adenomyosis was diagnosed in presence of globular uterine configuration, myometrial anterior-posterior asymmetry, heterogeneous myometrial echotexture, poor definition of the endometrial-myometrial interface (junction zone) or subendometrial cysts. Shape of endometrial cavity was classified in three categories: 1.-normal (triangular morphology); 2.- moderate distortion of the triangular aspect and 3.- “pseudo T-shaped” morphology.ResultsThe prevalence of adenomyosis was 24.4 % (n = 248) [29.7 % (94/316) in women aged ≥40 y.o and 22 % (154/699) in women aged <40 y.o., p = 0.003)]. Its prevalence was higher in those cases of recurrent pregnancy loss [38.2 % (26/68) vs 22.3 % (172/769), p < 0.005] and previous ART failure [34.7 % (107/308) vs 24.4 % (248/1015), p < 0.0001]. The presence of adenomyosis has been shown to be associated to endometriosis [35.1 % (34/97)]. Adenomyosis was diagnosed as a primary finding “de novo” in 80.6 % (n = 200) of the infertile patients. The impact on the uterine cavity was mild, moderate and severe in 63.7, 22.6 and 10.1 % of the cases, respectively.ConclusionsOur results indicate that adenomyosis is a clinical condition with a high prevalence that may affect the reproductive results. The described severity criteria may help future validating studies for better counseling of infertile couples.

The Impact of Adenomyosis on Women's Fertility.

Until recently, adenomyosis has been associated with multiparity, not impaired fertility. Currently, adenomyosis is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy until their late 30s or early 40s. Although an association between adenomyosis and infertility has not been fully established, based on the available information, recent studies suggested that adenomyosis has a negative impact on female fertility. Several uncontrolled studies with limited data also suggested that treatment of adenomyosis may improve fertility. This article discusses (i) the hypothesis and epidemiology of adenomyosis, (ii) diagnostic techniques, (iii) clinical evidence of correlation between adenomyosis and infertility, (iv) proposed mechanism of infertility in women with adenomyosis, (v) different treatment strategies and reproductive outcomes, and (vi) assisted reproductive technology outcome in women with adenomyosis.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to: Recall the hypothesis and epidemiology of adenomyosis; Evaluate the important findings on improved imaging techniques to diagnose adenomyosis; Understand that the presence of adenomyosis may impair the reproductive outcomes in women with adenomyosis; Explain the proposed mechanism of infertility in women with adenomyosis; Give the most appropriate treatment for better reproductive outcomes in women with adenomyosis; and Advise patients that surgery could be effective in women with adenomyosis with a history of IVF failure although latter finding could be partly attributed to the higher rate of early miscarriage.

OC16.01: Prospective evaluation of impact of adenomyosis on in vitro fertilisation outcome

OC16.01: Prospective evaluation of impact of adenomyosis on <i>in vitro</i> fertilisation outcome

Adenomyosis and Its Effect on Reproductive Outcomes

Background: Adenomyosis was historically diagnosed on histological examination of the uterus after hysterectomy in older parous women. However, it is becoming more prevalent in women wishing to conceive due to the social trend towards delaying fertility alongside improved imaging techniques. This has led to a dilemma regarding whether adenomyosis should be actively diagnosed and treated in the fertility setting. This review aims to present the current controversies in the evidence with regards to (i) prevalence of adenomyosis in the sub-fertile population (ii) its effects on fertility, (iii) its effects on assisted reproduction techniques (ART), (iv) its effects on obstetric outcomes, (v) the efficacy of fertility sparing treatments in the sub-fertile population. Methods: Searches of Medline and Pubmed were searched independently by the reviewers using the key words ‘adenomyosis’, ‘adenomyoma’, ‘reproductive outcomes’, ‘obstetric outcomes’, ‘miscarriage’, ‘ART’, ‘assisted reproductive technique’. Animal studies were excluded and studies were limited to the English language. Results: The prevalence of adenomyosis in the sub-fertile population is difficult to determine due to a lack of robust epidemiological studies. There are conflicting and variable reports in the literature regarding the effects of adenomyosis on fertility and ART with the majority of studies supporting no association. There is some evidence to suggest that the condition does increase the incidence of preterm labour and premature rupture of membranes once pregnancy is achieved. Most of the fertility sparing treatment options for adenomyosis are cited in case series and reports from limited populations, hence their true effect on conception remains unclear. Conclusion: Further epidemiological studies are needed to evaluate the prevalence and impact of adenomyosis in the sub-fertile population. Currently the existing literature on the effect of the disease on fertility is inconclusive; hence, actively diagnosing and treating the condition is debateable in women wishing to conceive. However, once pregnancy is achieved, the evidence suggests a detrimental effect on delivery rate, with an increased risk of miscarriage and preterm labour. There is some success seen in treating women undergoing assisted reproduction. Clinicians could consider a long course of pituitary down regulation prior to ART in appropriately informed sub-fertile women.

Ultrasound diagnosed adenomyosis has a negative impact on successful implantation following GnRH antagonist IVF treatment

Does the presence of ultrasound diagnosed adenomyosis interfere with successful implantation in patients undergoing IVF treatment with GnRH antagonist ovarian stimulation? The presence of ultrasound diagnosed adenomyosis was associated with a significant reduction in successful implantation of good quality embryos in patients undergoing GnRH antagonist stimulation for IVF treatment (viable clinical pregnancy rate 23.6% versus 44.6%, P= 0.017). There is currently no consensus regarding the impact of adenomyosis on implantation potential. Although some studies have identified alterations in the endometrial milieu in adenomyosis patients that may impact implantation, several papers have reported no associated reproductive deficit. However, these pregnancy outcome studies have primarily investigated patients undergoing long down-regulation IVF protocols, where low levels of serum estrogen (before commencing the ovarian stimulation) may inactivate the adenomyosis and potentially negate its effect on implantation. Given that the majority of fertility clinics are now moving towards the more 'patient-friendly' antagonist protocol, where patients are not placed in a hypo-estrogen state before commencing ovarian stimulation, the question of whether adenomyosis has an impact on IVF success rates in GnRH antagonist-stimulated IVF treatment needs to be examined. This is a retrospective cohort study of 748 patients who, between April 2010 and March 2012, underwent a screening transvaginal ultrasound to identify possible pelvic pathology before commencing their IVF treatment. From this screening group, 213 patients were eligible to be included in the study as they had no obvious underlying uterine or embryonic factors that could have interfered with successful implantation (aged ≤39 years, good quality Day 4/5 embryo for single-embryo transfer, no uterine fibroids/hydrosalpinx or endometrial polyps). There were 213 patients in a private IVF unit eligible to be included in the study, with 38 patients (17.84%) having ultrasound diagnosed adenomyosis and 175 patients having no adenomyosis on the scan. Only the first treatment cycle for each patient was included. The adenomyosis group had a viable clinical pregnancy rate of 23.6% compared with 44.6% in the non-adenomyosis group (P =0.017). However, the median maternal age and duration of infertility of the adenomyosis group was 2 years older and 4 months greater, respectively, than that of the non-adenomyosis group. A logistic regression analysis was performed to account for these differences between the two groups, with the adjusted results still showing a statistically significant decline in viable pregnancy rate in the adenomyosis group (OR = 0.408, CI = 0.181-0.922, P =0.031 when adjusting for maternal age; OR = 0.417, CI = 0.175-0.989, P =0.047 when adjusting for duration of infertility) Given the retrospective nature of this study, there is risk of bias. This risk was minimized by having subjective variables such as embryo quality assessed by individuals not involved in the study, while strictly applying the pre-determined inclusion/exclusion criteria to all study participants. Furthermore, it is acknowledged that ultrasound is not a perfect test for the diagnosis of adenomyosis and, therefore, may underestimate the incidence of adenomyosis by misclassifying some patients with mild adenomyosis as not affected. The results of this study should be representative of outcomes for any patient undergoing a GnRH antagonist ovarian stimulation cycle for IVF since standard IVF treatment protocols were used. MSD Australia have provided us with a small amount of funding to cover our costs (including a travel grant for Dr Thalluri to present this work at a conference).