Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study

Marques, Ana; Andres, Marina Paula; Mattos, Leandro Accardo de; Gonçalves, Maynara Santana; Baracat, Edmund Chada; Abrão, Maurício Simões

doi:10.6061/clinics/2021/e2981

Cited by 9 publications

(4 citation statements)

References 23 publications

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“…Three-dimensional (3D) TVUS can be used for better visualization of the junctional zone with a specificity of 81% and sensitivity of 85% [ 36 ]. Features of adenomyosis on 3D TVUS include an irregular, interrupted junctional zone, a junctional zone thickness > 8 mm, and a significant difference between maximum and minimum thickness measurements of the junctional zone > 4 mm [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

Adenomyosis and Infertility: A Literature Review

Pados,

Gordts,

Sorrentino

et al. 2023

Medicina

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Background and Objectives: Adenomyosis (the presence of ectopic endometrial glands and stroma below the endometrial–myometrial junction) is a benign condition which is increasingly diagnosed in younger women suffering from infertility. The aim of this narrative review was to study the pathophysiology and prevalence of adenomyosis, the mechanisms causing infertility, treatment options, and reproductive outcomes in infertile women suffering from adenomyosis. Materials and Methods: A literature search for suitable articles published in the English language was performed using PubMed from January 1970 to July 2022. Results: The literature search retrieved 50 articles that met the purpose of this review and summarized the most recent findings regarding the accuracy of diagnostic methods, pathophysiology, and the prevalence of adenomyosis and optimal strategies for the treatment of infertile women with adenomyosis. Conclusions: Adenomyosis is a common gynecological disorder, affecting women of reproductive age. It negatively affects in vitro fertilization, pregnancy and the live birth rate, as well as increases the risk of miscarriage. With the advent of non-invasive diagnoses with MRI and TVUS, the role of adenomyosis in infertility has been better recognized. Overall, more randomized controlled trials (RCTs) are needed to provide strong data on the accuracy of diagnostic methods, the pathophysiology and the prevalence of adenomyosis, the fertility outcomes of patients and the optimal strategy for the treatment.

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Section: Resultsmentioning

confidence: 99%

Adenomyosis and Infertility: A Literature Review

Pados,

Gordts,

Sorrentino

et al. 2023

Medicina

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“…One study found a prevalence of 34.0% in women 18–30 years referred for TVUS due to symptoms, excluding those with endometriosis or infertility 28 . Another study of 78 symptomatic women found a 55.12% prevalence of adenomyosis 29 . These studies included either the JZ thickness and/or the question mark sign as diagnostic criteria, 28,29 neither of which is included in the revised MUSA definitions 9 .…”

Section: Discussionmentioning

confidence: 99%

“… 28 Another study of 78 symptomatic women found a 55.12% prevalence of adenomyosis. 29 These studies included either the JZ thickness and/or the question mark sign as diagnostic criteria, 28 , 29 neither of which is included in the revised MUSA definitions. 9 In addition, there has previously been a lack of a clear and metric definition of asymmetrical myometrial thickening.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions

Alson,

Jokubkiene,

Henic

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionStudies that use standardized ultrasonographic criteria to diagnose adenomyosis in subfertile women are needed. These would improve the understanding of the disease burden and enable further studies on its impact on fertility and assisted reproductive treatment (ART) outcome. The aim of this study was to determine the prevalence of different features of adenomyosis in women scheduled for their first ART, diagnosed at two (2D) and three‐dimensional (3D) transvaginal ultrasonography (TVUS) using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions.Material and methodsThis was a prospective, observational cross‐sectional study of subfertile women aged 25 to ≤39 years, that were referred to a university hospital for their first ART between December 2018 and May 2021. Of 1224 eligible women, 1160 women fulfilled the inclusion criteria and consented to participate in the study. All women underwent a systematic 2D and 3D TVUS examination. The primary outcome was the presence of direct and indirect features of adenomyosis, as proposed by the MUSA group. Secondary outcomes were to describe the ultrasonographic characteristics of the different features, as well as any difference in the diagnostics at 2D or 3D TVUS and any association with clinical characteristics such as endometriosis.ResultsAt least one direct or indirect feature of adenomyosis was observed in 272 (23.4%, 95% confidence interval [CI] 21.0–25.9) women. Direct features that are pathognomonic for the disease were observed in 111 (9.6%, 95% CI, 7.9–11.3) women. Direct features were visible only at 3D TVUS in 56 (4.8%, 95% CI 3.6–6.1) women, that is, 56/111 (50.5%) of women with at least one direct adenomyosis feature. Direct features were more common in women with endometriosis (OR 2.8, 95% CI 1.8–4.3).ConclusionsWe found than one in 10 women scheduled for ART had direct features of adenomyosis at ultrasound examination. The present study suggests that the use of 3D TVUS is an important complement to 2D in the diagnostics of adenomyosis. Our results may further improve the counseling of women scheduled for ART and enables future studies on the impact of different features of adenomyosis on subfertility, ART results and obstetric outcomes.

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“…Addition of US technologies, such as 3D TVUS, elastography, and Doppler studies may increase TVUS accuracy for detecting adenomyosis. 3D TVUS can help evaluate the junctional zone and increase diagnostic accuracy [15,16 ▪ ,17 ▪ ]. Elastography has been proposed to help differentiate between fibroids and adenomyosis, with mixed results [16 ▪ ,18 ▪ ].…”

Section: Imaging Findingsmentioning

confidence: 99%

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

French

Zhang

Movilla

et al. 2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewAdenomyosis has recently been associated with infertility. Relief of bleeding and pain has been demonstrated with medical and surgical therapy. Less is known about reproductive outcomes after treatment. Recent findingsImaging findings during infertility evaluation can be suggestive of adenomyosis without pathologic evaluation. Among women with infertility undergoing assisted reproductive technologies (ART), adenomyosis is associated with lower live birth rates and clinical pregnancy rates. Treatment with gonadotropin releasing hormone (GnRH) modulators prior to frozen embryo transfer may increase the live birth rate and clinical pregnancy rate among women with adenomyosis. Pregnancy has been documented following image-guided adenomyosis ablation; however, the reproductive impact is not well established. Pregnancy following excisional procedures appears to be well tolerated, although may carry a higher risk of uterine rupture compared with pregnancy following myomectomy. It is not clear if ablative therapy or resection increases pregnancy rates. SummaryAdenomyosis is associated with lower embryo implantation rates and ongoing pregnancy rates. Adenomyotic changes in the uterus can be seen by ultrasound and MRI. GnRH modulators may be useful for women with adenomyosis undergoing ART. Additional prospective data is warranted to determine the optimal medical or surgical therapy for women with adenomyosis desiring conception.

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Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study

Cited by 9 publications

References 23 publications

Adenomyosis and Infertility: A Literature Review

Adenomyosis and Infertility: A Literature Review

Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

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