Adenomyosis and infertility: the role of the junctional zone

Chiara Barbanti, Gabriele Centini, Lucia Lazzeri, Nassir Habib, Luca Labanca, Errico Zupi, Karolina Afors, Antonella Clara Starace
Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology · 2021 · vol. 37(7) , pp. 577–583 · doi:10.1080/09513590.2021.1878131 · PMID:33587014 · W3131574579
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This review examines how alterations in the adenomyosis-affected junctional zone may contribute to infertility and adverse pregnancy outcomes by impairing uterine peristalsis and vascular plasticity.

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Abstract

Objective Adenomyosis is a benign uterine disorder characterized by the invasion of the endometrium within the myometrium, starting from the junctional zone (JZ), the inner hormone dependent layer of the myometrium that plays an important role in sperm transport, implantation and placentation. The resulting histological abnormalities and functional defects may represent the pathogenic substrate for infertility and pregnancy complications. The objective of this paper is to review the literature to evaluate the correlation between inner myometrium alterations and infertility and to assess the role of JZ in the origin of adverse obstetric outcomes of both spontaneous and in vitro fertilization (IVF) pregnancies.Methods we searched Pubmed for all original and review articles in the English language from January1962 until December 2019, using the MeSH terms of ‘adenomyosis’, ‘junctional zone’, combined with ‘infertility’, ‘obstetrical outcomes’, ‘spontaneous conception’, ‘in vitro fertilization’ and ‘classification’. The review was divided into three sections to assess this pathogenic correlation, evaluating also the importance of classification of the disease.Results and conclusions Absent or incomplete remodeling of the JZ can affect uterine peristalsis, alter vascular plasticity of the spiral arteries and activate inflammatory pathways, all related to adverse obstetric outcomes. Despite these observations, there is still limited evidence whether adenomyosis is a cause of infertility. However, it is reasonable to screen patients for adenomyosis, to consider pregnant women with diffuse adenomyosis at high risk of adverse obstetric outcomes, and to evaluate the importance of a noninvasive validated classification in the management of women with adenomyosis.

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Condition tags

adenomyosisinfertility

MeSH descriptors

Adenomyosis Endometrium Infertility, Female Myometrium Pregnancy Complications Adenomyosis Adenomyosis Adenomyosis Adenomyosis Endometrium Endometrium Female Fertilization in Vitro Humans Imaging, Three-Dimensional Infertility, Female Magnetic Resonance Imaging Myometrium Myometrium Pregnancy

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Cited by (23)

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