Reproductive outcomes after fertility-sparing interventions for symptomatic adenomyosis: a systematic review and...

To systematically review studies on reproductive outcomes following fertility-sparing interventions.

Various electronic databases were searched and studies reporting reproductive outcomes following fertility-sparing interventions for adenomyosis from January 2000 to July 2023 were included. The outcomes were presented as frequency with percentages, and the pooled proportions were calculated with a 95% confidence interval (CI). Subgroup and sensitivity analyses were performed if significant heterogeneity was present. The risk of bias was evaluated using the Newcastle Ottawa Scale quality assessment tool.

A total of 32 articles comprising 2501 participants were included (no RCTs were identified and included). The pooled pregnancy rates were 50.1% (95% CI: 40.0-60.2%) and 52.0% (32.4-71.6%) after adenomyomectomy and image-guided thermal ablation, respectively. The delivery rates were 39.5% (29.9-49.2%) and 32.5% (26.0-38.9%) for adenomyomectomy and thermal ablation, respectively. The pregnancy loss rates were 19.8% (12.2-27.5%) and 39.5% (13.8-65.1%) for adenomyectomy and thermal ablation, respectively. The spontaneous miscarriage rates were 16.3% (9.7-22.9%) and 27.1% (8.1-46.1%) after adenomyomectomy and thermal ablation, respectively. The rates of adverse pregnancy outcomes were 21.4% (7.5-35.3%) and 1.0% (-1.6-3.7%) after adenomyomectomy and thermal ablation, respectively. The preterm delivery rates were 18.4% (2.9-33.9%) and 0.3% (-1.0-1.7%) for adenomyomectomy and thermal ablation, respectively. The IVF-ET conception rates were 40.5% (28.8-52.1%) after adenomyomectomy and 27.5% (-17.3-72.2%) after thermal ablation. The cesarean section rates were 99.6% (98.3-100.8%) and 44.6% (13.4-75.9%) after adenomyomectomy and thermal ablation, respectively. However, as only one article reporting the reproductive outcomes after UAE met the inclusion criteria, meta-analysis could not be performed for UAE.

The reproductive outcomes following fertility-sparing interventions are promising for women with adenomyosis who desire fertility. However, limited available evidence, potential selection bias, and heterogeneity among the included articles are confounding factors that might influence the assessment of outcomes.

This systematic review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (under identifier CRD42020199586) in August 2020.