Adenomyosis and Fertility: Risks and Solutions

How to Treat Adenomyosis and Preserve Fertility

Many women wish to become pregnant and experience the joys of motherhood but they have issues conceiving. The nuances of infertility are not fully understood but several women’s health issues have been associated with increased risks of infertility. Women often ask the question “Can adenomyosis cause infertility?” Today we are going to look a little deeper at adenomyosis, what it is, how it is diagnosed, and a treatment available that can increase the chances of getting pregnant with adenomyosis.

An Overview Of Adenomyosis

According to recently published research adenomyosis affects approximately 2 in 10 women under the age of 40 and 8 in 10 women over the age of 40. While the cause of adenomyosis is still undetermined, 70% of women with adenomyosis also have endometriosis, 50% of women also have the presence of uterine fibroids, and 35% present with endometrial hyperplasia. One of the common denominators of all these conditions is estrogen dominance.

Is Adenomyosis Always the Cause of Infertility?

Although adenomyosis can inhibit a woman’s ability to conceive, another one of the biggest factors influencing fertility statistics is that many couples are waiting longer to start families. Fertility for the average woman peaks in her late teens and into the end of her 20s. At the onset of her 30s, fertility begins to decline and by her mid-30s the decline continues but picks up the pace.

Adenomyosis is more prevalent in women over the age of 40 so one could question if her inability to conceive is due to the presence of adenomyosis or her age and the natural course of declining fertility.

Infertility Can Be a Symptom of Adenomyosis

When tissue that is normally found in the lining of the uterus (endometrial tissue) breaks through and begins to grow into the outer muscular layer of the uterus (myometrium), the condition is called adenomyosis.

This rogue tissue continues to function as it was designed, to thicken up and then slough off and bleed during menstruation each month, which can cause a host of symptoms, including but not limited to:

  • Heavy menstrual bleeding;
  • Painful menstrual cramps;
  • Abnormal menstrual cramps;
  • Pelvic pain;
  • Pain during sex;
  • Distortion of the uterus;
  • Enlargement of the uterus (can double or triple in size);
  • Infertility.

These symptoms are indicative of many other women’s health issues so at times, adequately diagnosing adenomyosis can be tricky.

I Am Having Trouble Becoming Pregnant. What Is the Best Way to Diagnose Adenomyosis?

A pelvic ultrasound examination is often used as the first-line diagnostic tool for women’s reproductive health concerns which includes adenomyosis. While this tool is readily available and present in almost every gynecology office, it has very low accuracy in detecting adenomyosis. All too often the gynecologist interpreting the ultrasound findings in an adenomyosis patient will incorrectly diagnose a woman with fibroids due to a similar uterine enlargement or miss the presence of adenomyosis entirely.

The most accurate way to diagnose adenomyosis is with a pelvic magnetic resonance imaging (MRI) exam. Magnetic resonance imaging (MRI) produces high-quality 3D images of the anatomy of the pelvis using magnetic fields and radio waves and without any radiation.

The uterus is made up of different layers. The outer layer of smooth muscle is called the myometrium and the inner lining layer is called the endometrium. Between the two layers is a region called the “junctional zone” or the “inner myometrium”. Radiologists examine this “junctional zone” and measure its thickness. The thickness of this area on a healthy uterus ranges anywhere from 2-8 mm but when adenomyosis is present, this area is 12mm or thicker. Myometrial cysts are also indicative of adenomyosis.

Uterine Fibroid Embolization in Atlanta, GA

Frequently Asked Questions About Adenomyosis and Fertility

1. How Does Adenomyosis Affect Fertility?

Since many women who have adenomyosis also have endometriosis or uterine fibroids, it is unknown whether adenomyosis is the sole culprit preventing conception.

What is known about adenomyosis that is related directly to fertility is:

  • Adenomyosis causes a thickening of the uterine junctional zone which plays a part in contractions that help transport sperm and oocytes (immature eggs) that may inhibit conception;
  • The uterus can be distorted by the growth of the adenomyosis tissue preventing the implantation of a fertilized egg.

2. Can I Get Pregnant with Adenomyosis?

It is possible to become pregnant if you are suffering from adenomyosis however, the condition is associated with elevated risks to both the mother and the baby.

It is important to note that in many cases adenomyosis is accompanied by one or more additional benign conditions of the reproductive system, which may contribute to:

  • The ability to become pregnant;
  • The potential of sustaining the pregnancy;
  • Increased risks during labor and delivery.

3. Can Adenomyosis Cause Pregnancy Complications?

Research studies published by doctors in Italy and Spain indicated that women with adenomyosis have an increased risk of adverse pregnancy outcomes. They identified issues such as hypertensive complications during pregnancy, miscarriage, pre-term labor, low birth weight, premature rupture of membranes, and malpresentation – the baby is in the wrong position for birth.

Adenomyosis can cause chronic inflammation and higher intrauterine pressure resulting in preterm labor. It can also cause uterine infections and other complications during labor and delivery including postpartum hemorrhage (bleeding).

4. Can Pregnancy Be Painful with Adenomyosis?

Yes, it is possible for a woman suffering from adenomyosis to experience the onset or an increase in pain after becoming pregnant. Like other estrogen-dominant conditions of the reproductive system, adenomyosis growth can increase during pregnancy due to the rise in hormone levels, particularly during the first trimester.

5. What Treatments for Adenomyosis Are Not Options If I Want To Preserve Fertility?

Doctors usually try to use hormone therapy or Gonadotropin-releasing hormone agonists (GnRH-a) as the first treatment for adenomyosis. This may not be a good option to keep adenomyosis at bay if you become pregnant because the effects of GnRH-a therapy on pregnant women or unborn babies have not been widely studied.

Due to the typically poor results from the medical options for adenomyosis, many women with adenomyosis have ended up with a hysterectomy. This option obviously eliminates any future fertility.

Endometrial ablation is a procedure that applies energy – usually heat, occasionally cold – to destroy the lining (endometrium) of the uterus. This procedure has been inappropriately used to treat adenomyosis and has caused the bleeding and pain symptoms to worsen in the majority of patients.

This is because adenomyosis involves the layer just beneath the lining of the uterus which lies between the lining of the uterus and uterine muscle, i.e. subendometrium. Burning the top layer endometrium results in “peeling a scab off a wound” revealing a raw, bleeding surface of adenomyosis. Patients with adenomyosis therefore should not undergo endometrial ablation.

Unfortunately, many patients with adenomyosis are not diagnosed correctly due to the relatively low-resolution pelvic ultrasound that is typically performed in the gynecologist’s office. It is one more reason that pelvic MRI should be used more often to evaluate patients with pelvic pain and heavy menstrual bleeding; particularly in patients where fibroids are not the obvious etiology of the patient’s symptoms.

6. What Is the Best Treatment for Adenomyosis If I Want to Have a Baby?

The treatment that has demonstrated the highest success in treating adenomyosis and preserving the uterus is uterine artery embolization (UAE).

UAE is a minimally invasive, non-surgical procedure and very similar to the procedure that is used to treat uterine fibroids (UFE). UAE has proven to provide a favorable outcome in treating adenomyosis. The success of UAE for adenomyosis is 75% versus 90% for fibroids. Therefore, UAE should be considered before hysterectomy in all patients suffering from adenomyosis.

While all the effects of the UAE on fertility have not been widely studied, there have been many instances of successful pregnancies reported. In a retrospective study of 398 patients ages 42 and under, who were treated for uterine fibroids or adenomyosis using the UAE procedure, 109 gave birth, and the majority at full term. All 109 babies had birth weights and lengths that were within normal limits.

7. What Can I Expect From a Pregnancy After UAE?

In many cases, the UAE treatment substantially reduces the adenomyosis tissue and women experience no issues during their pregnancy; however, they are more closely monitored to reduce the risk of complications.

Adenomyosis Pregnancy Success Stories

There has been much misinformation floating around for years regarding the association between UAE and infertility. The simple truth is that there are many biases present in the medical studies looking at UAE and fertility and more work is needed.

A small retrospective study of hospital records indicated that 86% of the participants were able to get pregnant after having uterine artery embolization.

There have been numerous successful pregnancies from women treated at the Atlanta Fibroid Center who had adenomyosis, fibroids, or both conditions. If you visit our Center you can see for yourself some of these babies on our “baby wall!”.

If you have been diagnosed with adenomyosis and want to learn more about the uterine artery embolization procedure, contact the Atlanta Fibroid Center today at (770) 953-2600. During your initial consultation, our physicians will provide you with a comprehensive overview of the procedure, answer your questions, and discuss how the UAE may be able to help you.

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