Infertility and Adenomyosis

Abstract

Classically, the diagnosis of adenomyosis has only been possible on a hysterectomy specimen, usually in women in their late fourth and fifth decades, and, therefore, evaluating any relationship with infertility was simply not possible. As a consequence, to this day, no epidemiologic data exists linking adenomyosis to a state of subfertility. Today, new imaging techniques have enabled a noninvasive diagnosis at a much earlier time and a number of single-case or small series reports have appeared showing that medical, surgical, or combined treatment can restore fertility in women with adenomyosis, an indirect proof of an association. At the functional level, several anomalies found in the so-called junctional zone, or inner myometrium, in adenomyosis patients have been shown to be associated with poor reproductive performance, mainly through perturbed uterine peristalsis. Additional evidence for an association comes from experimental data: in baboons, adenomyosis is associated with lifelong primary infertility, as well as to endometriosis. Finally, indirect proof comes from studies of the eutopic and ectopic endometrium in women with adenomyosis proving the existence of an altered endometrial function and receptivity. In conclusion, sufficient indirect proof exists linking adenomyosis to infertility to warrant systematic clinical studies.

Adenomyosis in Infertile Women : A Review

“…In women with adenomyosis, Hoxa 10 gene expression is decreased during the secretory phase of the cycle 7 .…”

“…In women with endometriosis, an abnormal inflammatory response seems to exist in endometrium and impair implantation 7 .…”

“…Increased expression of estrogen, increased local estrogen production, a defect in progesterone production, a defect in progesterone receptor and their reduced function all explain the poor response to progestational agents in women with adenomyosis 7 . In women with adenomyosis, Hoxa 10 gene expression is decreased during the secretory phase of the cycle 7 .…”

Estradiol Reduces Connexin43 Gap Junctions in the Uterus during Adenomyosis in Cows

“…Adenomyosis is a uterine dysfunction characterized by the presence of endometrial glands with stromal elements in the myometrium (Azziz 1989, Campo et al 2012) but the etiology of this disorder is still unclear (Ferenczy 1998, Korzekwa et al 2014. Our previous studies showed that in cows the freCorrespondence to: A. Korzekwa, e-mail: a.korzekwa@pan.olsztyn.pl, tel.…”

“…During adenomyosis in cows, protein expression of the 17-beta estradiol (E2) receptor α (ERα) is increased and blood and endometrial E2 concentrations are elevated, indicating hormonal abnormalities during this condition (Campo et al 2012). Invasion by adenomyotic stromal cells was higher after E2 treatment in an in vitro model of stromal and myometrial co-culture of human cells .…”