Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis

Adenomyosis is characterized by the existence of endometrial epithelial and stromal cells within the myometrium. It is an enigmatic gynecological disorder and a heterogeneous disease, both in anatomical and clinical phenotype. They can have varying presentations from normally sized to much-enlarged uterus and from heavy dysmenorrhoea and hypermenorrhea to no symptoms. It is also frequently described to exist with endometriosis.

Endometriosis is known to be associated with pain and impacts the quality of life, and also may have a negative influence on pregnancy and neonatal outcomes.

A recent study thus investigated the association of adenomyosis with fertility, pregnancy and neonatal outcomes by searching the MEDLINE, PubMed and Cochrane databases up to April 2020. 

The observations were as follows-

• 17 observational studies qualified the search criteria. 
• Adenomyosis was found to be significantly associated with a lower clinical pregnancy rate and higher miscarriage rate after treatment with assisted reproductive technology (ART). 
• The subgroup of patients with short down-regulation protocols had more significant lower clinical pregnancy rate. 
• Age adjustment also revealed similar associations. 
• Adenomyosis was also found to be significantly associated with an augmented risk of pre-eclampsia, preterm delivery, Caesarean section, fetal malpresentation, small for gestational age infancy and post-partum hemorrhage, which was verified following correction for age and mode of conception. 

Thus adenomyosis can be said to be associated with negative effects on fertility after ART. The potentially protective role of the ultra-long down-regulation protocols needs to be verified. Adenomyosis (independently of the mode of conception) also leads to adverse pregnancy and neonatal outcomes. It is recommended to properly counsel the patient with adenomyosis before ART and closely monitor their pregnancy.

SOURCE- Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reproductive Biomedicine Online, 2021;42(1): P185-206. DOI:https://doi.org/10.1016/j.rbmo.2020.09.023