Updates on adenomyosis and fertility

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Medical Imaging

Background:

• Adenomyosis, defined by endometrial tissue in the myometrium, causes pelvic pain, heavy bleeding, and infertility.
• Diagnosis primarily uses transvaginal ultrasound and MRI.
• Hysterectomy is curative, but fertility-sparing options are needed for younger patients.

Purpose of the Study:

• To review fertility-sparing interventions for adenomyosis.
• To evaluate their impact on fertility and obstetrical outcomes.

Main Methods:

• Review of current literature on adenomyosis management.
• Analysis of minimally invasive and surgical fertility-sparing techniques.
• Evaluation of reported fertility and obstetrical outcomes.

Main Results:

• Adenomyosis is linked to higher risks of pregnancy loss, preterm birth, and pre-eclampsia.
• Thermal ablation and hysteroscopic adenomyomectomy are potential fertility-sparing options.
• Laparoscopic and laparotomy surgeries are also explored, but comparative data is limited.
• Long-term fertility data and complication risks (e.g., uterine rupture) require further investigation.

Conclusions:

• Fertility-sparing interventions for adenomyosis have variable success rates.
• Larger trials with standardized criteria are needed to assess long-term outcomes and optimize patient selection.
• Potential risks include uterine rupture and placenta accreta spectrum, necessitating careful monitoring.