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Adenomyosis and reproduction
Gerhard Leyendecker1, Georg Kunz, Stefan Kissler
1Department of Obstetrics and Gynaecology, Klinikum Darmstadt, Teaching Hospital to the Universities of Frankfurt and Heidelberg/Mannheim, Grafenstr. 9, 64283 Darmstadt, Germany. leyendecker@ferticonsult.de
Summary
Pelvic endometriosis and uterine adenomyosis are linked, with adenomyosis being a key cause of infertility. Both conditions represent a single disease entity, highlighting the need to assess adenomyosis in infertility evaluations.
Area of Science:
- Gynecology
- Reproductive Medicine
- Pathophysiology
Background:
- Pelvic endometriosis is significantly associated with uterine adenomyosis.
- Uterine adenomyosis is a major factor contributing to infertility in women with endometriosis.
- Adenomyosis and endometriosis are increasingly recognized as a single pathophysiological and nosological entity.
Purpose of the Study:
- To elucidate the pathophysiological continuum between endometriosis and adenomyosis.
- To emphasize the role of adenomyosis as a cause of infertility.
- To advocate for the inclusion of adenomyosis assessment in infertility work-ups.
Main Methods:
- Review of existing evidence linking endometriosis and adenomyosis.
- Analysis of the pathophysiological characteristics of both conditions.
- Evaluation of the impact of delayed childbearing on adenomyosis and infertility.
Main Results:
- A strong association exists between pelvic endometriosis and uterine adenomyosis.
- Adenomyosis is identified as the primary cause of infertility in women with endometriosis.
- A pathophysiological continuum, involving basal endometrium dislocation, characterizes mild endometriosis, premenopausal adenomyosis, and endometriosis-associated adenomyosis.
Conclusions:
- Adenomyosis and endometriosis are fundamentally the same disease.
- Delayed childbearing may increase the incidence of premenopausal adenomyosis as an infertility factor.
- Screening for uterine adenomyosis is crucial in all infertility evaluations.