The rate of euploid miscarriage is increased in the setting of adenomyosis

Abstract

STUDY QUESTION Does the rate of miscarriage increase in the setting of adenomyosis independent of other known risk factors for miscarriage such as maternal age, BMI, embryo genetic status? SUMMARY ANSWER Adenomyosis and high BMI both significantly increase miscarriage risk independent of each other, maternal age and embryo health. This study is the first to suggest that ultra-long down regulation GnRH agonist treatment may reduce the rate of early pregnancy loss in adenomyosis patients. WHAT IS KNOWN ALREADY The presence of adenomyosis is known to be associated with lower rates of successful implantation and increased risk of early pregnancy loss. However, it is presently unclear whether this reproductive impairment is directly mediated by adenomyosis itself, or indirectly caused by adenomyosis association with known risk factors for miscarriage such as obesity and advancing maternal age/foetal aneuploidy. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was undertaken in a private infertility (IVF) clinic examining the outcome for women ( n = 345) undergoing the transfer of a genetically screened frozen–thawed embryo between 2012 and 2015. PARTICIPANTS/MATERIALS, SETTING AND METHOD A total of 171 women who successfully conceived (positive serum βhCG) following the transfer of a single euploid good morphology frozen–thawed embryo were included in analysis after meeting the inclusion criteria. Only the first conception cycle for each patient was included in the study. Patients with known pre-existing medical risk factors for miscarriage (e.g. thrombophilia, poorly controlled diabetes, coeliac disease, SLE, uterine septum, chromosomal abnormalities) and those women undergoing treatment using donated oocytes and surrogacy were excluded. Patients were then classified as having adenomyosis or not based on a high-quality pelvic ultrasound or MRI. The direct and indirect effects of adenomyosis and BMI on overall miscarriage rate by 12 weeks gestation was then assessed using multivariate logistic regression and mediation analysis. Furthermore, the data were also analysed to elucidate the influence of GnRH ultra-long down-regulation therapy on miscarriage rates. MAIN RESULTS AND ROLE OF CHANCE Overall, the adjusted rate of miscarriage was higher in those patients with adenomyosis compared to those without (44.1 vs 15.3%, P < 0.0001), with most of these miscarriages occurring at the early biochemical stage. The rate of miscarriage was especially high in adenomyosis patients not receiving GnRH agonist pre-treatment (82.4%), compared to those patients who did receive GnRH pre-treatment (35.7%, P = 0.0089). LIMITATIONS, REASONS FOR CAUTION The study is mainly limited by its small sample size and retrospective design which carries in...

A comparison of reproductive outcomes of patients with adenomyosis and infertility treated with High-Intensity focused ultrasound and laparoscopic excision

“…Adenomyosis has been associated with an increased risk of abortion and a decreased chance of natural conception, and was regarded as one of the major contributors to infertility [3]. A study of 171 women showed that patients with adenomyosis have a significantly higher rate of miscarriage than those without it [18]. A meta-analysis that included 11 comparative studies found that women with adenomyosis have lower rates of implantation, clinical pregnancy, and live birth [19].…”

Uterus Size May Affect Reproductive Outcome in Women with Adenomyosis After Gnrh- Agonist Pretreatment Undergoing Frozen Embryo Transfer Cycles: A Retrospective Cohort Study

“…The adenomyotic uterus provides a dysfunctional environment for the maintenance of pregnancy [2,15]. Mechanisms may include uterine dysperistalsis, abnormal concentrations of free radicals in the uterine environment, and altered endometrial vascularization.…”

“…Recently, because more women are delaying childbearing until their late 30 s or 40 s, adenomyosis is being diagnosed more frequently in infertile patients undergoing in vitro fertilization (IVF). Previous studies have demonstrated that adenomyosis has a signi cant negative effect on the chance of implantation and is associated with a higher miscarriage rate and a lower live birth rate [2][3][4]. Treatment with a gonadotropin-releasing hormone agonist (GnRH-a) has been widely used for adenomyosis.…”

The Effect of Adenomyosis on the Outcome of Fresh Embryo Transfer in ICSI Cycles: a Retrospective Case-control Study

“…In that study, 34 women had adenomyosis by TVS and 137 had morphologically normal uterus. Adenomyosis group had signi cantly higher miscarriage rates than the non-adenomyosis group (53% vs.19.7%; P = < 0.0001)29 . Chiang et al performed a case control study in which 19 women with adenomyosis diagnosed by USG and 144 age matched controls with sonographically normal uterus.…”