Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis

This meta-analysis shows that adenomyosis has a detrimental effect on IVF clinical outcomes. Pretreatment with GnRHa could be beneficial.

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Volume 108, Issue 3, Pages 483–490.e3

Authors:

Grace Younes, M.D., Togas Tulandi, M.D., M.H.C.M.

Abstract:

Objective

To systematically review and summarize the existing evidence related to the effect of adenomyosis on fertility and on in vitro fertilization (IVF) clinical outcomes, and to explore the effects of surgical or medical treatments.

Design

Meta-analysis.

Setting

Not applicable.

Patient(s)

An electronic-based search was performed with the use of the following databases: Pubmed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Google Scholar, identifying all related articles up to November 2016. We included 11 comparative studies that evaluated the clinical outcomes of IVF treatments in women with (519 patients) and without (1,535 patients) adenomyosis diagnosed with the use of magnetic resonance imaging or transvaginal ultrasound. We also separately evaluated four articles comparing fertility outcomes in two groups of infertile adenomyotic patients untreated and treated surgically or medically with the use of GnRH agonist (GnRHa).

Intervention(s)

None.

Main Outcome Measure(s)

Primary outcome: clinical pregnancy rate after IVF. Secondary outcomes: rates of implantation, ongoing pregnancy, live birth, miscarriage, and ectopic pregnancy. The summary measures were expressed as odds ratio (OR) and 95% confidence interval (CI).

Result(s)

The rates of implantation, clinical pregnancy per cycle, clinical pregnancy per embryo transfer, ongoing pregnancy, and live birth among women with adenomyosis were significantly lower than in those without adenomyosis. The miscarriage rate in women with adenomyosis was higher than in those without adenomyosis. It appears that surgical treatment or treatment withf GnRHa increases the spontaneous pregnancy rate in women with adenomyosis.

Conclusion(s)

Adenomyosis has a detrimental effect on IVF clinical outcomes. Pretreatment with the use of long-term GnRHa or long protocol could be beneficial.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

2 Comments

Go to the profile of Alexander Quaas
Alexander Quaas about 3 years ago

This is the most complete and thorough collection of data regarding adenomyosis and IVF outcomes published to date.

As in the past the main obstacles to adenomyosis research are the diagnostic uncertainties and the absence of a clear gold standard. The traditional gold standard, pathology, is not standardized from one pathology department to another (or even between one pathologist to another in the same department)- and in the IVF population hysterectomy specimens are rarely obtained (luckily).

Imaging modalities are improving, and more providers (and editorial offices) accept a diagnosis of adenomyosis made on MRI or US. However ultrasound still remains somewhat operator-dependent and subjective.

In addition the majority of trials are retrospective cohort studies on convenience populations. Should we accept the above pitfalls and conclude from the existing data that adenomyosis has a negative impact on IVF outcomes, or is there hope that even more convincing data will become available in the future? What direction will the adenomyosis / IVF research take? RCTs for interventions such as pre-IVF GnRHa downregulation in a well defined population of adenomyosis patients?

Go to the profile of Intisar alnajar
Intisar alnajar about 3 years ago

how we improve pregnancy rate in patient w adenomyosis .