Strategies to Improve Assisted Reproductive Technique Outcomes in Women with Adenomyosis: A Narrative Review

Adenomyosis is a complex, heterogeneous condition characterised by the development of ectopic endometrial glandular and stromal tissue within the myometrium. Surrounding it, there is reactionary fibrosis, hyperplasia and hypertrophy of the surrounding smooth muscle cells. This induces inflammatory changes in the eutopic endometrium, which alters the molecular environment at the time of implantation. Evidence from systematic reviews of observational studies has suggested a lowering of implantation and live birth rates and an increase in miscarriage rates in assisted reproductive technique (ART), particularly with diffuse adenomyosis involving the inner myometrium and junctional zone. This review describes and evaluates the various medical and surgical strategies employed to improve ART outcomes. These strategies are derived from observational data, and none have been tested through randomised controlled trials. In addition, there is a need to homogenise the reporting of adenomyosis on ultrasonography and stratify adenomyosis populations based on disease burden when determining the efficacy of various interventions.