Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility

Abstract

We compared the prevalence of ultrasound signs of adenomyosis in women with endometriosis who underwent surgery to those who were managed conservatively. This was a retrospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demographics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was higher in the study group. Women in the study group with ≥ 5 sonographic signs of adenomyosis had more than twice the risk of experiencing infertility (OR = 2.31, p = 0.012, 95% CI; 1.20–4.45). Sonographic signs of adenomyosis are more prevalent in women with symptomatic endometriosis who underwent surgery compared with those who continued conservative management. Women with 5+ findings have a significantly increased risk of infertility. Adenomyosis on ultrasound should be considered in the management decisions regarding these patients.

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

“…In this study, in 55.8% of cases, an association between adenomyosis and endometriosis was observed, as assessed by TVUS with bowel preparation. Both diseases share common symptoms such as dysmenorrhea, infertility, dyspareunia, and chronic pelvic pain and are reported to be associated in 13.2-89.4% of cases (20)(21)(22)(23). It was also previously reported ( 18) that women with diffuse adenomyosis showed a higher association with endometriosis than those with mild adenomyosis.…”

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

“…The type of adenomyosis (focal, diffuse, or adenomyoma) did not affect live birth rates in patients with endometriosis and adenomyosis following laparoscopy [48 ▪ ]. Women who were diagnosed with adenomyosis by ultrasound and underwent endometriosis surgery were found to have higher rates of infertility, more need for IVF treatment, and greater number of IVF cycles compared with women without ultrasound findings of adenomyosis [52 ▪ ]. Although co-occurring adenomyosis and endometriosis is associated with increased infertility and decreased live birth rate, additional prospective study is warranted to determine if treating adenomyosis medically or surgically in the setting of endometriosis and infertility improves fertility outcomes.…”

“…Additionally, adenomyosis appears to be associated with a greater number of deep infiltrating endometriotic lesions [50]. In patients with suspected or diagnosed endometriosis based on symptoms, imaging, and pathologic findings, concurrent adenomyosis has been found in 21–59% of patients [51 ▪ ,52 ▪ ].…”

Knowledge, attitudes, and practices among Chinese reproductive-age women toward uterine adenomyosis

“…The direct positive effects of knowledge on attitude and practice, as well as the influence of attitude on practice, emphasize the importance of addressing knowledge gaps to improve attitudes and, consequently, health practices. Interventions should focus not only on increasing knowledge but also on fostering positive attitudes toward uterine adenomyosis, as attitudes play a crucial role in shaping health behaviors ( 33 , 34 ).…”