Adenomyosis is a uterine condition where endometrial tissue, normally lining the uterus, grows into its muscular wall. While it can present challenges, it does not necessarily prevent pregnancy. Understanding adenomyosis, its impact on fertility, and available management strategies is important for individuals seeking to conceive.
What is Adenomyosis
Adenomyosis occurs when the endometrium, the tissue lining the uterus, grows into the myometrium, the muscular uterine wall. This displaced tissue responds to hormonal changes, thickening and bleeding during each menstrual cycle within the muscle. This process can lead to the uterus becoming enlarged, sometimes doubling or tripling in size.
About one-third of individuals with adenomyosis experience no symptoms. For those who do, common manifestations include severe menstrual cramps, heavy or prolonged menstrual bleeding, pelvic pain, and painful intercourse. Diagnosis often begins with clinical suspicion based on symptoms, followed by imaging techniques like transvaginal ultrasound or MRI to confirm endometrial tissue within the myometrium.
How Adenomyosis Affects Fertility
Adenomyosis can impact fertility through several mechanisms. The presence of endometrial tissue within the myometrium can alter the uterine environment, leading to inflammation. This inflammatory state may create a less hospitable setting for embryo implantation.
The condition can also cause changes in uterine contractility. The normal muscular architecture of the uterus can be disrupted, leading to dysfunctional uterine contractions or hyperperistalsis. These altered contractions may interfere with sperm and embryo transport, hindering implantation. Adenomyosis has also been associated with a thickened junctional zone, potentially impeding successful embryo implantation.
Studies suggest that adenomyosis can reduce implantation and clinical pregnancy rates in individuals undergoing in vitro fertilization (IVF). While implantation itself may not be directly affected, the condition is associated with a higher rate of miscarriage. This suggests that even if an embryo implants, the uterine environment may not sustain the pregnancy effectively.
Strategies for Conception with Adenomyosis
For individuals with adenomyosis seeking to conceive, several strategies are available, often tailored to individual circumstances. Medical management involves hormonal therapies to alleviate symptoms and improve the uterine environment. Gonadotropin-releasing hormone (GnRH) agonists can temporarily suppress ovarian function, potentially reducing adenomyotic lesions and improving pregnancy outcomes, particularly before assisted reproductive technologies. Other hormonal options like progestins may also be used to manage symptoms before conception attempts.
Surgical options, such as adenomyomectomy, involve removing adenomyotic tissue while preserving the uterus. This procedure is typically considered for focal adenomyosis (adenomyomas) and can improve fertility outcomes by restoring uterine structure. However, surgical removal of diffuse adenomyosis is complex due to the lack of a clear boundary between affected and healthy tissue, and it carries risks, including uterine wall weakening.
Assisted Reproductive Technologies (ART), such as IVF, play a role in helping individuals with adenomyosis conceive. IVF allows for the creation of embryos outside the body for uterine transfer. While adenomyosis can present challenges, a meta-analysis indicated lower IVF outcomes in affected individuals, with reduced clinical pregnancy and live birth rates and increased miscarriage rates. Careful preparation of the uterine cavity, sometimes including pre-treatment with GnRH agonists, can improve IVF success rates. Consulting fertility specialists is important to determine the most appropriate and individualized treatment plan.
Navigating Pregnancy with Adenomyosis
Once pregnancy is achieved, individuals with adenomyosis may require closer medical monitoring due to potential complications. The condition is associated with an increased risk of miscarriage, particularly in the first trimester. There is also a higher likelihood of preterm birth, where labor begins before 37 weeks of gestation.
Adenomyosis has been linked to placental issues, such as placenta previa, where the placenta covers part or all of the cervix. Other concerns include placental abruption and an increased risk of hypertensive disorders during pregnancy.
Due to these considerations, pregnancies with adenomyosis are often managed as high-risk. This necessitates close collaboration with an obstetrician to monitor and address potential complications throughout pregnancy.