Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis

Abstract

Background. In the past several years, there has been an increasing concern on miscarriage caused by endometriosis or adenomyosis. However, the results reported by different studies remain controversial. The present study is aimed at assessing the impact of endometriosis and adenomyosis on miscarriage. Materials and Methods. Searches were carried out in PubMed, Embase, and the Cochrane library for studies published from inception until February 29, 2020. The investigators included studies that evaluated miscarriage risk in pregnant women with endometriosis or adenomyosis by assisted reproductive technology (ART), or with spontaneous conception (SC). Miscarriage (<28 weeks) was the primary outcome. The secondary outcomes were antepartum hemorrhage (APH), postpartum hemorrhage (PPH), preterm birth, low birthweight, placenta praevia, placental abruption, ectopic pregnancy, stillbirth, gestational diabetes, preeclampsia, and intrauterine growth restriction (IUGR). Endnote was used for the study collection, and the data analyses were carried out by two authors using Review Manager version 5.2. Results. Thirty-nine studies, which is comprised of 697,984 women, were included in the present study. Miscarriage risk increased in women with endometriosis in SC (OR: 1.81, 95% CI: 1.44-2.28, I 2 = 96 % ) compared with those without endometriosis, while women with endometriosis who underwent ART had a similar miscarriage risk, when compared to those with tubal infertility (OR: 1.03, 95% CI: 0.92-1.14, I 2 = 0 % ). Compared with those without adenomyosis, women with adenomyosis had an augmented miscarriage risk in ART (OR: 2.81, 95% CI: 1.44-5.47, I 2 = 64 % ). Compared with those without endometriosis, women with endometriosis had higher odds of APH, PPH, preterm birth, stillbirth, and placenta praevia. No difference was observed in the incidence of ectopic pregnancy, placental abruption, pre-eclampsia, gestational diabetes, low birthweight, and IUGR. Conclusion. Women with endometriosis had an augmented miscarriage risk in SC and a similar miscarriage risk during ART. Adenomyosis was associated with miscarriage in pregnant women using ART.

Clinicopathological characteristics and imaging findings to identify adenomyosis‐related symptoms

“…Third, many researchers believed that patients with adenomyosis have significantly lower pregnancy and implantation rates, 36,37 and higher miscarriage rates, 38 adversely affect IVF results, increase the risk of obstetric complications such as preterm birth and premature rupture of membrane, compared to women without adenomyosis. 4,11,38 Women with infertility may have undergone surgical treatment at a young age due to frequent visits to medical institutions. Due to the small number of infertility patients and the very high odds ratios of age, parity, and DIE, no significant association was found between the adenomyosis phenotype and infertility.…”

“…Third, many researchers believed that patients with adenomyosis have significantly lower pregnancy and implantation rates, 36 , 37 and higher miscarriage rates, 38 adversely affect IVF results, increase the risk of obstetric complications such as preterm birth and premature rupture of membrane, compared to women without adenomyosis. 4 , 11 , 38 However, it is not clear which phenotype of adenomyosis causes infertility. Univariate analysis revealed that infertile women were younger, had lower gravity and parity, and more frequent coexistence of OMA and DIE/SUP compared with fertile women.…”

Effects of artificial cycles with and without gonadotropin-releasing hormone agonist pretreatment on frozen embryo transfer outcomes in patients with adenomyosis

“…Table 1 Comparison of baseline data between two groups GROUP A(n=160) [1] GROUP B(n=181) [4] 0.91 0.18 0.02 [1] the study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period. [2] The control group (n = 181) was only treated by artificial hormone cycle to prepare emdometrium.…”

“…[3] One value was missing. [4] Five values were missing. [1] the study group (n = 160) was added GnRH-a based on GnRH-a before using hormone to adjust menstruation period.…”

“…Some studies showed that patients with adenomyosis had lower implantation rates, clinical pregnancy rates and ongoing pregnancy rates but high level of miscarriage rates compared with non-adenomyosis patients [1][2]. At the same time, patients with adenomyosis bene ts less from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) [3][4]. Considering adverse effect of adenomyosis, many methods have been tried in order to obtain better reproductive outcomes.…”