It is common for adenomyosis patients to deal with infertility. However, many women with this disorder do have children, so it is possible to obtain and maintain a pregnancy. Even so, it is important to know that infertility risk in these women is higher than normal.
It has been reported in the literature that adenomyosis can cause an increased risk of the following during pregnancy:
- Pre-term birth
- Premature rupture of membranes
- Small for gestational ageneonates
- Post-partum hemorrhage
- Fetal malpresentation
- Second-trimester spontaneous abortion
- Placental malposition
In addition to the above issues, the risk of cervical incompetence increases with the severity of adenomyosis. Also, the risk of pregnancy-induced hypertension and uterine infections are higher in women with diffuse adenomyosis as compared to women with focal adenomyosis.
According to Vannuccini and Petraglia (2019), a review of 519 patients who were undergoing IVF treatment and who had been diagnosed with adenomyosis through TVUS or MRI prior to treatment showed “Rates of implantation, clinical pregnancy per cycle, clinical pregnancy per embryo transfer, ongoing pregnancy, and live-birth rate among women with adenomyosis were significantly reduced, whereas miscarriage rate was increased.”
Studies have shown that the probable mechanisms behind the infertility issue are as follows:
- Abnormal utero-tubal transport due to distortion of the uterus
- Disturbance in peristalsis (uterine contractions) resulting in problems with sperm transport
In addition to the above, the eutopic endometrium shows the following alterations that could impact fertility:
- Abnormal sex steroid hormone pathway
- Oxidative stress/increase in inflammatory markers
- Reduction in the expression of implantation markers
- Altered function of the HOXA10 gene which is necessary for the development of the embryo
- Lack of expression of adhesion molecules
A study by Mavrelos et al. (2017, Abstract) showed the following in women who have adenomyosis and undergo IVF and embryo transfer:
- If there is no indication that the woman has adenomyosis, there is an estimated probability of clinical pregnancyof 42.7%.
- If the woman has 4 symptoms of adenomyosis, the estimated probability of clinical pregnancy is 22.9%.
- If the woman has 7 symptoms of adenomyosis, the estimated probability of clinical pregnancyis 13.0%.
From the results of this study, it appears that the more severe the adenomyosis, the less likely it is to achieve and maintain a successful pregnancy. Therefore, it is impossible to give a blanket statement of ability to achieve a pregnancy in all patients with adenomyosis. It will depend on your own circumstances – mostly the severity of disease.