Adenomyosis and Infertility

Mosammat Rashida Begum, Nazia Ehsan
In: Bangladesh Journal of Obstetrics & Gynaecology · 2019 · vol. 34(2) , pp. 112–123 · doi:10.3329/bjog.v34i2.58278 · W4285785004
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Adenomyosis, a condition where endometrial tissue invades the myometrium, causes pain and infertility, and is treated surgically, medically, or with HIFU, with ART being a treatment of choice for reproduction.

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This review paper discusses adenomyosis as an abnormal invasion of endometrial glands and stroma into the myometrium, emphasizing its association with severe dysmenorrhea and infertility, with imaging by ultrasound or MRI and histopathology as confirmatory diagnosis. It summarizes fertility-related outcomes and notes that treatment modalities may fail when adenomyosis is diffuse, and that while total hysterectomy is described as definitive for complete cure, it is not considered logical for women seeking fertility. The paper outlines fertility-sparing surgical options, medical approaches using GnRHa and progesterone preparations to reduce adenomyotic mass and symptoms, and non-surgical reduction via non-surgical HIFU, alongside reproduction-directed strategies including controlled ovarian hyperstimulation with IUI for patients with patent tubes or ART when tubes are not patent. This paper is centrally about adenomyosis — specifically its relationship to infertility and fertility-sparing and reproduction-directed treatment approaches.

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Abstract

Adenomyosis is an abnormal growth of endometrial glands and stroma into the myometrium causing diffusely enlarged uterus. Due to the abnormal growth of endometrial glands and stroma it causes severe pain during menstruation. Though USG and MRI can help, histopathology of the lesion is confirmatory diagnosis of the disease. It is one of the important causes of infertility with very poor prognosis. Any treatment modalities can fail when lesion is diffuse in nature. Surgery in the form of total hysterectomy is the definitive treatment for complete cure but hysterectomy is not logical for infertile patients. So, fertility sparing surgery can be done to improve fertility. Medical treatment in the form of GnRHa and different form of progesterones can be used to eliminate symptoms and to reduce the adenomyotic mass, which may improve the fertility status. Non-surgical High Intensity Focused Ultrasound (HIFU) is another option to reduce the size of the lesion. For reproduction active treatment is ideal to accelerate live birth. Controled ovarian hyperstimulation and Intrauterine Insemination (IUI) can be done if tube(s) are patent. If not, Assisted Reproductive Technology (ART) is the treatment of choice for this group of patients. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(2): 112-123
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Adenomyosis and Infertility DOI: https://doi.org/10.3329/bjog.v34i2.58278Keywords: Adenomyosis and InfertilityAbstract Adenomyosis is an abnormal growth of endometrial glands and stroma into the myometrium causing diffusely enlarged uterus. Due to the abnormal growth of endometrial glands and stroma it causes severe pain during menstruation. Though USG and MRI can help, histopathology of the lesion is confirmatory diagnosis of the disease. It is one of the important causes of infertility with very poor prognosis. Any treatment modalities can fail when lesion is diffuse in nature. Surgery in the form of total hysterectomy is the definitive treatment for complete cure but hysterectomy is not logical for infertile patients. So, fertility sparing surgery can be done to improve fertility. Medical treatment in the form of GnRHa and different form of progesterones can be used to eliminate symptoms and to reduce the adenomyotic mass, which may improve the fertility status. Non-surgical High Intensity Focused Ultrasound (HIFU) is another option to reduce the size of the lesion. For reproduction active treatment is ideal to accelerate live birth. Controled ovarian hyperstimulation and Intrauterine Insemination (IUI) can be done if tube(s) are patent. If not, Assisted Reproductive Technology (ART) is the treatment of choice for this group of patients. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(2): 112-123 Downloads 221 292

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