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Adenomyosis. Does It Impact Fertility?

Adenomyosis is a condition that impacts the lives of as many as one-third of child-bearing aged women in the US, although some reports state as many as 70% of all women may have this excruciating condition. Adenomyosis presents with symptoms that include painful, heavy periods, abnormally lengthy periods, pronounced pelvic pain and painful intercourse. Adenomyosis also causes an enlarged uterus and may cause infertility, recurrent miscarriage or preterm delivery.

With adenomyosis, the endometrial tissue which forms in the lining of the uterus invades and grows inside the uterine wall, specifically in the myometrium which is the muscular wall of the uterus. The tissue causes the uterus to enlarge to double or even triple its normal size. When your periods become heavy or more frequent than normal you run the risk of becoming anemic.


A Diagnosis of Adenomyosis

Adenomyosis is most often diagnosed when a woman seeks medical attention for one of the symptoms, such as intense pain, irregular periods or an inability to conceive or repeated miscarriages. If they suspect adenomyosis is a possibility, your doctor will confirm diagnosis using the following tests:

  • Pelvic Exam: Your doctor may notice you have an enlarged uterus which is softer and painful when palpated.
  • Transvaginal Ultrasound: Use of sound waves to image your pelvic organs may show a thickening of the muscular wall of the uterus.
  • MRI Scan: An MRI may show a thickening of the uterine wall or enlargement of the uterus which is typically indicative of adenomyosis.
  • Biopsy: In severe cases and as a last resort a biopsy of the uterus proves adenomyosis, but can only happen after a hysterectomy (removal of the uterus).


Cause, Treatment and Risks

Because the symptoms of adenomyosis are the same as other conditions, such as endometriosis and uterine fibroids, a medical diagnosis is necessary. Most cases of adenomyosis occur in women over 35. The growth of the tissue inside the uterine wall depends on estrogen, so treatment may include hormonal medications. Doctors are looking into other treatment options as well including uterine artery embolization.


Doctors don’t know the exact origins of adenomyosis, but many researchers believe the cause of the condition could be:

  • Invasive tissue growth which occurs when cells invade the muscle of the uterine wall.
  • Uterine inflammation post childbirth may cause a break in the lining of the uterus and allow cells to invade.
  • Development of the futures in a fetus may result in abnormal placement of endometrial tissue.


The risks for developing adenomyosis include:

  • Prior uterine surgery such as D&C, Removal of uterine fibroids or a Cesarean Section.
  • Childbirth
  • Over 35, however, recently, doctors have seen an increase in adenomyosis diagnoses in younger women.


How Adenomyosis Impacts Your Fertility

Recent studies show adenomyosis frequently occurs concurrently with other conditions that impact fertility such as endometriosis, uterine polyps and fibroids. Adenomyosis on its own may interfere with implantation, receptiveness of the lining of the uterus and could possibly distort your fallopian tubes preventing fertilization. As mentioned above, if you do become pregnant you run a far greater risk for miscarriage or preterm birth than normal. That’s why it’s so important to work with your doctor if you have a diagnosis of adenomyosis.

The most successful way to conceive and carry to term is through IVF combined with GnRH agonists (Lupron). Lupron is a successful way to lower estrogen and slow the growth of the adenomyosis, improving the odds of implantation via IVF. However, because the condition carries two times the risk of miscarriage by carrying the pregnancy yourself is not always the most guaranteed outcome.

A gestational carrier, along with IVF using your eggs and your partner’s sperm, if possible, is the recommended treatment for infertility associated with adenomyosis.


Dealing with Adenomyosis

If you’ve been diagnosed with adenomyosis, you know the condition itself is life-altering. The pain and heavy bleeding make it difficult to make plans and those excruciating periods leave you wiped out. Fertility concerns seem like insult added to injury. This is the time to be as kind to yourself as possible and, by all means, seek medical attention.

Though much is still being uncovered and understood about adenomyosis within the medical community it’s essential that you find a caring and compassionate team to help you along your journey. Just as with any medical diagnosis your experience is your own and unique to you. Contact LA IVF today and together we’ll help you find the answers you seek.

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