Improved Pregnancy Rates in Infertile Women with Severe Adenomyosis

Adenomyosis is a medical condition that affects the uterus in women. It occurs when the tissue that usually lines the inner wall of the uterus (endometrium) starts to grow into the muscular wall of the uterus (myometrium). This abnormal growth of endometrial tissue within the uterine muscle can cause the uterus to become enlarged and tender.

The exact cause of adenomyosis is unknown, but hormonal imbalances, such as high estrogen levels, are thought to play a role. It typically affects women in their 30s to 50s, particularly those who have had children or undergone multiple pregnancies. Adenomyosis can also be associated with other conditions, such as endometriosis.

Symptoms of adenomyosis can vary in severity. Common symptoms include heavy and prolonged menstrual bleeding, severe menstrual cramps, pelvic pain or pressure, and bloating. Some women may experience pain during sexual intercourse or have an enlarged uterus that can be felt during a physical examination.

Adenomyosis treatment options depend on the severity of symptoms and a woman's desire for future fertility. Mild cases may be managed with pain medication and hormonal therapies to help regulate the menstrual cycle and reduce symptoms. In cases where symptoms are severe or when a woman no longer desires fertility, more invasive treatments may be considered. These may include endometrial ablation, where the lining of the uterus is destroyed to alleviate symptoms, or hysterectomy, which involves surgical removal of the uterus.

Clinical Trial

Surgical adenomyomectomy refers to the surgical removal of adenomyotic tissue from the uterus. The effect of surgical adenomyomectomy on infertile women with severe diffuse adenomyosis is still debated. A clinical trial investigated if a new fertility-preserving method of adenomyomectomy could improve pregnancy rates and alleviate symptoms in these patients. The researchers conducted a prospective clinical trial between December 2007 and September 2016, enrolling 50 women with infertility due to adenomyosis.

Out of the 50 patients, 45 underwent the novel fertility-preserving adenomyomectomy procedure. The surgical technique involved making an incision in the uterine serosa, removing the adenomyotic tissue using an argon laser under ultrasound guidance, and suturing between the remaining myometrium and serosal flap. After the surgery, the researchers recorded and analyzed changes in menstrual blood volume, relief of dysmenorrhea (painful periods), pregnancy outcomes, clinical characteristics, and surgical features.

Findings

All patients experienced relief from dysmenorrhea six months after the surgery, with a significant decrease in menstrual blood volume. Among the 33 patients who attempted pregnancy following the adenomyomectomy, 18 (54.5%) conceived through natural means, in vitro fertilization, embryo transfer, or thawing embryo transfer. Eight patients experienced miscarriages, while 10 (30.3%) had viable pregnancies.

Overall, this novel method of adenomyomectomy demonstrated improved pregnancy rates and relief from dysmenorrhea and heavy menstrual bleeding. The procedure effectively preserved fertility potential in infertile women with severe diffuse adenomyosis.

Conclusion

Although adenomyosis can be challenging to treat, various options are available to help manage symptoms and improve the quality of life for affected women. Fertility-preserving adenomyomectomy may be a beneficial treatment option for women with severe adenomyosis who desire to conceive. However, it is essential to consult with healthcare professionals to determine the most appropriate treatment approach based on individual circumstances. Further research and more extensive studies are needed to validate these findings and assess long-term outcomes.
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