Adenomyosis Infertility

Submitted by Nick on December 19, 2012

Adenomyosis refers to a condition in which the endometrial tissue, which lines the inner cavity of the uterus, moves into the outer muscular wall of the uterus, resulting in uterus enlargement.This condition often coexists with pelvic endometriosis.

For long it has been suspected that adenomyosis could cause infertility or subfertility, but due to the absence of any concrete epidemiologic study being ever carried out on this subject, it made it difficult to categorically state that adenomyosis could affect fertility.


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Today however, with the advent and progress in high resolution imaging techniques, like sonography and MRI, it is possible to link adenomyosis and infertility.

Also, indirect evidence can be gathered from reports about women becoming pregnant after being successfully treated for adenomyosis. It has also been noticed that in fertility clinics, many women have been diagnosed with adenomyosis.

Causes of adenomyosis

The exact cause for the occurrence of adenomyosis is not known, but it has been connected to any kind of damage to the uterus which may break the boundary between the endometrium (inner membrane of the uterus) and myometrium (middle layer of the uterine wall).

According to studies possible causes could include

  • Developmental origins
    Some specialists feel that adenomyosis is a congenital problem, and that it originates inside the uterus muscles during the formation of the uterus in the female fetus
  • Stem cells
    According to recent speculation, adenomyosis could be caused when the bone marrow stem cells advance into the uterus muscles.
  • Infesting tissues
    Certain theories propose that openings made during a surgery, for example during a C-section, may cause the endometrial cells to invade and infest the uterus wall.
  • Childbirth
    Some theories link adenomyosis with childbirth. As per this theory, the uterine lining gets inflamed during the postpartum period after childbirth. This causes a break in the border of the endometrial cells, leading to invasion into the uterus walls by these cells.
  • Age factor
    Some believe that adenomyosis usually occurs in women between the age of 35 and 50. This may be because, around 35, the estrogen level in women goes up due to a natural decline in the levels of progesterone. But, after 50, women do not produce as much estrogen because of menopause.

Treatment for adenomyosis infertility

Treatment of adenomyosis-associated infertility is kind of limited. There has been no study of any orderly medical routine for this purpose, but for years, different medicines have been used to try and treat this kind of infertility.

Use of GnRHa (gonadotrophin-releasing hormone agonists) was one of the first means of treatment and several cases of successful treatment with the help of GnRHa have been reported. This treatment can be administered as a standalone or along with surgery.

Severe adenomyosis was treated surgically, normally by performing a hysterectomy, but this method is obviously not suited for women who wish to retain fertility.

In recent times fertility in women diagnosed with adenomyosis has been restored with the help of a surgery called Adenomyomectomy. This surgery performed with the purpose of retaining reproductive organs and their functioning, has been seen to provide good results, with statistics laying down the pregnancy rate at approximately 50% after the surgery.

Adenomyomectomy is a fairly new technique which involves, completely removing the adenomyotic tissues and rebuilding the uterus wall. This technique was also seen to be successful in averting uterine ruptures in ensuing pregnancies.

A case study showed that 16 of 26 women who wished to conceive, and underwent adenomyomectomy, got pregnant. 14 of them were able to deliver healthy babies without incidences of uterine rupture. However, this new technique needs further study and validation.


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