Adenomyosis is a disorder that affects about 20% to 35% of women. Women with adenomyosis experience fertility issues, or if they conceive, they have a higher risk of miscarriage. Early diagnosis and certain treatments tailored for the expectant mother’s medical condition have proven effective in getting pregnant naturally and giving birth to a healthy baby. Continue reading to understand the association between adenomyosis and infertility.
Adenomyosis is a uterine condition in which the endometrial cells (the inner lining of the uterus) breaks, gets implanted in the myometrium and then grows with every menstrual cycle into the myometrium. The endometrium grows in size over time, and the muscle fibres get inflamed during the menstrual cycle. In response, the muscle fibres also increase, causing the uterus to grow more than normal. Occasionally, this can form an adenomyoma, a localised form of adenomyosis that may need surgery.
In adenomyosis, the endometrium continues to act similar to normal endometrial tissue. However, before and during menstruation, the endometrium swells and contracts stronger than usual, irritating the muscle fibres around it and causing bad pelvic pain. This can also lead to heavy periods and dysmenorrhea (painful period cramps).
The exact cause of this condition is not known. However, there are some risk factors linked with this condition. For instance, past surgeries like C-section deliveries, pregnancy termination, etc., may have pushed cells of the uterine lining into the muscular layer. A short menstrual cycle of less than 24 days and early menarche (first period) can also be risk factors.
Women in their peri-menopausal or menopausal phase (between 40 and 50 years) and with children are likely to have adenomyosis. However, as per a study, about 20% of cases under 40 have this condition. As many women postpone maternity to their 30s and 40s, there is a surge in cases of women with fertility issues and adenomyosis.
Obesity is another risk factor for this condition. Despite controlling their body weight, many women with adenomyosis have a higher rate of miscarriage in IVF and natural pregnancies. So, more research is needed to shed light on the association between adenomyosis and IVF success rates.
Besides disrupting your daily life, adenomyosis can also affect your ability to conceive and get pregnant. Women with this condition may have fertility issues and, if they get pregnant, may have an increased risk of miscarriage.
Although the cause of adenomyosis or its impact on fertility is unknown, research shows that uterine enlargement and distortion, a hallmark of adenomyosis, interfere with oocyte and sperm transport. A thickened uterine wall may also interfere with embryo implantation.
Earlier studies did not find any link between fertility and adenomyosis. But with growing research and better diagnostics, some suggestions show an impact on both natural and assisted pregnancy when this condition is present. A recent analysis done on women getting IVF treatment concludes that clinical pregnancy, implantation rates, and live births are lower in women with adenomyosis, and the miscarriage risk is higher.
How adenomyosis impacts fertility is being researched, and events connected to adenomyosis include altered hormone (progesterone and estrogen) receptor functions, reduced endometrial receptivity, and inflammation that is toxic to an embryo.
On the contrary, adenomyosis has not shown any impact on egg quality. While more research is needed, it can be stated that adenomyosis impacts fertility only because of changes in the uterine environment and nothing else.
Whether conceived through IVF or naturally, women with adenomyosis have a higher rate of miscarriage in the first and second trimesters. Several studies have found this connection, but the outcome is because of a few surprising factors, which are:
● Women with adenomyosis may have endometriosis, are obese, or are of advanced maternal age. These factors increase the chance of miscarriage. So, linking this to only adenomyosis is difficult. However, some studies have found that even after controlling the other common risk factors, it was still found that women with this condition had poor pregnancy outcomes.
● A study suggests that abnormal uterine contractions in women with adenomyosis undergoing IVF may have higher miscarriage rates. Embryo implantation is more successful when the uterus is in an quiescent state during the luteal phase after ovulation. Women with this condition tend to have hyper-peristaltic uterine contractions, which makes embryo implantation difficult.
● The study also suggests that this condition makes the uterine environment toxic to embryos. Women with adenomyosis may have more macrophages (natural killer cells), which causes inflammation.
● There is also research that suggests that miscarriages may be more likely because of high prostaglandin in the endometrial lining and altered functioning or levels of protein, genes and enzymes in the uterus.
Timely diagnosis is critical for getting pregnant with adenomyosis as it tends to be progressive and persistent. Women who have had multiple miscarriages should be evaluated for adenomyosis before IVF treatment to ensure the best outcome. Women with this condition who want to get pregnant may need more monitoring and management of possible complications.
Transvaginal 3D ultrasound is the standard diagnostic tool for getting a definitive diagnosis of adenomyosis. A colour Doppler may be added for a more detailed view and to eliminate other conditions. Since this condition can happen in any part of the uterus, the ultrasound should be thoroughly done. Certain ultrasound markers are checked for adenomyosis as it may indicate increased chances of miscarriage. Women with a junctional abnormality or enlarged uterus are at more risk of miscarriage. A better treatment approach can be formulated with a detailed ultrasound evaluation.
The adenomyosis treatment can be surgical or medical based on the severity. The doctor may prescribe medications to reduce the blood flow and hormonal contraception to reduce pain and bleeding. If that does not work, surgical interventions like hysteroscopy or laparoscopy may be considered for improving fertility and managing symptoms. If spontaneous pregnancy does not happen, IVF or other assisted reproductive technologies may be recommended. Once pregnant, women with this condition are prone to miscarriage, placental problems and premature delivery. So, close monitoring throughout pregnancy is required.
Dealing with adenomyosis and navigating fertility issues may seem daunting, but with the right guidance and approach, it is possible to achieve a successful pregnancy.
