The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis

Cozzolino, Mauro; Tartaglia, S.; Pellegrini, Livia; Troiano, Gianmarco; Rizzo, Giuseppe

doi:10.1007/s43032-021-00818-6

Cited by 39 publications

(31 citation statements)

References 55 publications

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“…While DNG therapy is reportedly comparable to GnRHa (triptorelin acetate [17] or goserelin [20]) treatment in alleviating the symptoms of pelvic pain and dysmenorrhea [16], a continuation of DNG therapy following the initial GnRHa treatment resulted in a lower adenomyosis recurrence rate than GnRHa monotherapy [18]. Furthermore, several studies have reported that Gn-RHa use is associated with a higher spontaneous pregnancy rate in women with adenomyosis [22] and those undergoing frozen embryo transfer [7,19,23]; however, a meta-analysis did not describe any significantly favorable results with GnRHa treatment [24]. Regarding the efficacy and side effects of DNG and COC treatments, a randomized clinical trial showed that DNG treatment reduced pain intensity and uterine volume but had a higher rate of undesirable side effects, such as abnormal uterine bleeding, compared to COC [25].…”

Section: Comparing the Efficacy And Adverse Events Of Dng And Differe...mentioning

confidence: 99%

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

Kobayashi

2023

Gynecol Obstet Invest

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Background Adenomyosis is an estrogen-dependent gynecologic condition that can cause pain symptoms, heavy menstrual bleeding, and infertility. Several treatments, including hormonal therapy can improve patients' quality of life through alleviating symptoms. Dienogest (DNG), a 19-norsteroid derivative oral progestin, is a promising treatment option for adenomyosis. Objectives This review aims to summarize the clinical outcomes (efficacy and adverse events) of DNG treatment for symptomatic adenomyosis compared with other hormonal treatments, discuss the mechanism underlying adverse events, and identify future challenges. Methods A literature search was performed across the PubMed and Google Scholar databases up to March 2022 to identify relevant literature. Outcome Out of 449 identified records, 37 articles met the inclusion and exclusion criteria. Five prospective and three retrospective studies showed that DNG and other hormonal agents had similar efficacy for pain relief; however, the most common adverse event of DNG was abnormal uterine bleeding. Specific demographic and clinicopathologic characteristics have been identified as associated with an increased risk of bleeding. Several factors, such as diffuse or type I adenomyosis, advanced reproductive age, severe dysmenorrhea, elevated serum CA125 levels, or low hemoglobin levels, may be implicated in bleeding risk; however, there is no accurate and reliable parameter. Future challenges with the widespread use of DNG include validation of candidate risk indicators and approaches to treat diffuse or type I adenomyosis. Conclusions and Outlook DNG represents an important therapeutic option to be included in the treatment algorithm for adenomyosis owing to sufficient pain relief, despite high rates of bleeding-related adverse events. Clinicians should consider an individual’s potential risk factors for bleeding until high-quality evidence is available.

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Section: Comparing the Efficacy And Adverse Events Of Dng And Differe...mentioning

confidence: 99%

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

Kobayashi

2023

Gynecol Obstet Invest

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“…In contrast to the majority of studies on this subject, a systematic review and meta-analysis performed by Cozzolino et al yielded different results [ 66 ]. The authors analyzed pregnancy outcomes in patients with untreated adenomyosis and surgically or medically treated adenomyosis.…”

Section: Reproductive Outcomes After the Treatment Of Adenomyosismentioning

confidence: 99%

“…In contrast, the treatment with GnRHa did not lead to better IVF outcomes. Only three studies concerning this topic were included in the meta-analysis [ 66 ]. The authors state that most of the studies did not make a distinction between focal and diffuse adenomyosis; such a distinction might have yielded different results in terms of clinical presentation and treatment options [ 66 ].…”

Section: Reproductive Outcomes After the Treatment Of Adenomyosismentioning

confidence: 99%

Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes

Allahqoli

Gitas²,

Maass

et al. 2022

Biomedicines

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Adenomyosis is associated with a negative impact on reproductive outcomes. Although adenomyosis is detected more frequently in women of late reproductive age, its impact on pregnancy rates is important because, in today’s world, family planning has shifted towards the late reproductive phase of life for many women. Although the diagnostic indications for imaging studies are well-known, we lack strict diagnostic criteria and classification systems concerning the extent of the disease. Selecting the optimal evidence-based treatment option for adenomyosis is difficult because of the paucity of evidence concerning the association between fertility and the degree and composition of adenomyosis. Furthermore, the treatment of infertility might interfere with the treatment of adenomyosis due to the presence of pain. The aim of this review is to analyze the association between adenomyosis and infertility, and describe treatment options to enhance reproductive outcomes. The following aspects will be addressed in detail: (a) prevalence and causes of adenomyosis, (b) diagnostic tools with imaging techniques, (c) clinical symptoms, (d) proposed pathomechanism of adenomyosis and infertility, and (e) different treatment approaches (pharmacological, surgical, others) and their impact on reproductive outcomes.

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“…With the introduction of transvaginal ultrasonography (TVUS) and MRI, adenomyosis, once diagnosed only by histopathological examination, is increasingly diagnosed in patients with infertility, suggesting that the condition may be linked to subfertility or infertility. Furthermore, a recent meta‐analysis reported that adenomyosis had a negative impact on in vitro fertilization (IVF) outcomes; the live birth rate (LBR), clinical pregnancy rate (CPR), and ongoing pregnancy rate were lower, while the miscarriage rate (MR) was higher in patients with adenomyosis than those in the control group 2 . However, a considerable proportion of patients with adenomyosis do not experience adverse IVF outcomes.…”

Section: Introductionmentioning

confidence: 99%

Different subtypes of ultrasound‐diagnosed adenomyosis and in vitro fertilization outcomes: A systematic review and meta‐analysis

Wang

Huang

et al. 2023

Acta Obstet Gynecol Scand

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Introduction Adenomyosis prevalence among women with infertility is increasing; their management during in vitro fertilization is usually based on ultrasound diagnosis alone. Herein, we summarize the latest evidence on the impact of ultrasound‐diagnosed adenomyosis on in vitro fertilization outcomes. Material and methods The study was registered with The International Prospective Register of Systematic Reviews (CRD42022355584). We searched PubMed, Embase, and Cochrane Library databases from inception to January 31, 2023, for cohort studies on the impact of adenomyosis on in vitro fertilization outcomes. Fertility outcomes were compared according to the presence of adenomyosis as diagnosed by ultrasound, concurrent endometriosis and adenomyosis, and MRI‐based or MRI‐ and ultrasound‐based adenomyosis diagnosis. Live birth rate was the primary outcome while clinical pregnancy and miscarriage rates were secondary outcomes. Results Women diagnosed with adenomyosis by ultrasound had lower live birth (odds ratio [OR] = 0.66; 95% confidence interval [CI]: 0.53–0.82, grade: very low), lower clinical pregnancy (OR = 0.64; 95% CI: 0.53–0.77, grade: very low), and higher miscarriage (OR = 1.81; 95% CI: 1.35–2.44, grade: very low) rates than those without adenomyosis. Notably, symptomatic and diffuse, but not asymptomatic adenomyosis as diagnosed by ultrasound, adversely affected in vitro fertilization outcomes, with lower live birth (OR = 0.57; 95% CI: 0.34–0.96, grade: very low), clinical pregnancy (OR = 0.69; 95% CI: 0.57–0.85, grade: low), and miscarriage (OR = 2.48, 95% CI: 1.28–4.82, grade: low) rates; and lower live birth (OR = 0.37; 95% CI: 0.23–0.59, grade: low) and clinical pregnancy (OR = 0.50; 95% CI: 0.34–0.75, grade: low), but not miscarriage rate (OR = 2.18; 95% CI: 0.72–6.62, grade: very low), respectively. Concurrent adenomyosis in endometriosis is associated with a significantly lower live birth rate (OR = 0.44; 95% CI: 0.26–0.75, grade: low) than endometriosis alone. Finally, the use of MRI‐based or MRI‐ and ultrasound‐based adenomyosis diagnosis showed no significant association with in vitro fertilization outcomes (grade: very low for all outcomes). Conclusions Considering ultrasound findings, symptoms, and different subtypes of adenomyosis may aid in offering personalized counseling, improving treatment decisions, and achieving better outcomes of in vitro fertilization.

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The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis

Cited by 39 publications

References 55 publications

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

Efficacy, Adverse Events, and Challenges of Dienogest in the Management of Symptomatic Adenomyosis: A Comparison with Different Hormonal Treatments

Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes

Different subtypes of ultrasound‐diagnosed adenomyosis and in vitro fertilization outcomes: A systematic review and meta‐analysis

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