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Pregnancy is a unique biological phenomenon. Implantation of a human embryo requires a complex collaboration of many factors between mother and the baby.

For a woman to become pregnant, a competent and good quality embryo must attach to a receptive womb with a prepared inner layer and then invade the underlying tissue.

IVF is one of the best treatments for infertility we have today. However, although a lot of knowledge and improvement with reproductive technologies, only about half of IVF trials result in a successful pregnancy.

What can be the reasons for failure ?

According to the scientific evidence, poor embryo quality is considered to be the one of the major causes of implantation failure, and largely reflects the high incidence of chromosomal abnormalities inside the embryo.

We also know that the frequency of embryonic genetic abnormality increases with women’s age but also appears higher among infertile couples than in the general population.

In addition to the abnormalities of the embryos, some other special maternal diseases such as Endometriosis or Adenomyosis have been reported to be responsible for a failure.

What is adenomyosis?

Adenomyosis is a frequent condition where the endometrium (inner layer of the womb) grows into the muscular wall of the uterus, causing it to become thickened and enlarged. This sometimes can cause painful and heavy menstrual periods. It may also cause discomfort during sex.

This condition has been reported to affect 20% to 25% of females. Fibroids and endometriosis (chocolate cysts) frequently accompany adenomyosis. Studies have estimated that approximately 40 % of women with endometriosis, may also have adenomyosis.

Adenomyosis is usually diagnosed with using Ultrasound and/or MRI


Adenomyosis and IVF results

According to some studies, it may also decrease your chance with IVF.

Adenomyosis can impair the implantation of the embryo by providing the endometrial environment with a low expression of adhesive molecules and some genetic alterations necessary for early embryonic development (Harada et al, 2016).

It may also cause an increase in early pregnancy loss. (Vercellini et al.2014) and, as a result, a decrease in live births rates (Younes & Tulandi 2017), (Harada et al 2019).


What can we do for that ?

As the cause of adenomyosis is still not fully understood, there is no effective prevention. However, there are some measures which we can apply during IVF treatment aiming to decrease the negative effect of these condition.

Is surgical treatment possible ?

For some cases with focal or nodular adenomyosis, the answer is yes. These islets can be removed by surgery. However, it is obviously the most invasive and the most risky alternative. Because, these are difficult surgeries to perform since adenomyosis does not always have distinct borders with the normal uterus that’s why a precise and complete removal is difficult.

This is obviously not an option for diffuse adenomyosis as well.

Medications for adenomyosis and infertility

It is basically a hormone-dependent disorder, characterized by increased inflammation. The rationale for using medical treatment is based on the pathogenetic mechanisms of adenomyosis. Several non-hormonal and hormonal treatments (i.e., progestins, oral contraceptives, gonadotropin-releasing hormone [GnRH] analogues) are currently used off-label to control pain symptoms and abnormal uterine bleeding in adenomyosis.

When we look at the infertility problem, adenomyosis has a detrimental effect on IVF clinical outcomes, reducing pregnancy and live birth rates and increasing the miscarriage rate.

A recent systematic review summarized the existing evidence related to the effect of adenomyosis on fertility and on IVF clinical outcomes (Youness 2017) . It also showed that pretreatment with the use of long-term GnRH analogues could be beneficial in increasing the clinical pregnancy rate, both in symptomatic and asymptomatic patients. However, further studies are needed.

In our Centre, if we diagnose or highly suspicious for this condition, we recommend freezing all the embryos and transferring them later in two to three months after suppression of adenomyosis with effective drugs.



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