Adenomyosis and Fertility Issues
Adenomyosis silently affects many women. It is a condition that is closely related to endometriosis, and some women experience both conditions simultaneously. For some women, the condition can cause heavy bleeding and pelvic pain, but others may experience no symptoms at all. Women who are experiencing symptoms are more likely to seek medical help when trying to become pregnant to find out if these issues could be hindering conception.
Adenomyosis is often asymptomatic which makes it more challenging to diagnose but it can create fertility issues that women may not be aware they are experiencing.
Historically, adenomyosis was thought to only affect women who were well into or past their peak childbearing years and in women who have already had at least one child, so it was not even on the radar screen of being a potential hindrance to fertility. However, in recent years around 20% of the cases have been found in younger women.
How Does Adenomyosis Affect Fertility?
Adenomyosis affects the lining and muscular wall of the uterus. A healthy uterus is critical to pregnancy and the normal development of a baby. The uterus has three different layers:
- Endometrium: the layer on the inside of the uterus that prepares itself every month to nourish and house a future embryo. This is the same layer that is eliminated every month during the menstrual cycle.
- Myometrium: This is the middle layer and is made from smooth muscle cells. This layer is responsible for different types of contractions that occur for various reasons. For example, contractions each month during a woman’s period (that normally cause cramping) eliminate or shed the unneeded lining from the inner layer of the uterus. The myometrium also initiates much stronger contractions during labor and delivery.
- Serosa: The smooth protective layer on the outside of the uterus
Adenomyosis occurs when the cells from the endometrium (the innermost layer) begin to grow abnormally and break through to the myometrium or middle muscular layer. When these same rogue cells begin to grow in areas outside of the uterus the condition is known as endometriosis.
Adenomyosis Fertility Issues
The rogue cells growing in the myometrium can distort and misshape the uterus. They also cause this middle uterine layer to become much thicker than normal and it can enlarge the uterus up to three times its usual size.
Experts theorize that the distortion of the uterus may interfere with the fertilization process and the thickening of this middle layer can inhibit the embryo from successfully implanting into the endometrial lining.
There is also a link between adenomyosis and the ability to sustain a pregnancy. Research has concluded that a woman with adenomyosis has a more difficult time becoming pregnant and an increased risk of experiencing complications during pregnancy. These complications include:
- Preterm birth;
- Preterm membrane rupture;
- Small birth size.
Adenomyosis and Miscarriage
The cause of adenomyosis is still unknown, and the exact relationship between the condition and miscarriage has not been proven but experts have theories.
One theory is that the growth of adenomyosis into the muscular layer of the uterus interferes with the functionality of that uterine layer. The myometrium is responsible for different types of contractions such as the small ones that occur during a woman’s Menstrual cycle that help slough off and shed the unneeded uterine lining in the absence of a pregnancy. It is also responsible for the stronger contractions that push the baby out during labor and delivery. If the uterus is unable to control contractions or function properly it could potentially cause a miscarriage.
Another theory is the distortion of the uterus caused by the growing adenomyosis interferes with fetal development and results in miscarriage.
Can Adenomyosis Cause IVF Failure?
Yes, two research studies found that women who were undergoing IVF had reduced success with implantation and a lower number of embryos transferred. They also experienced lower clinical and ongoing pregnancy rates. Another finding was that the miscarriage rate during the first trimester was higher in the women with adenomyosis than in the control group.
The relationship between adenomyosis and infertility requires more research to ascertain causes and effective treatment options. Currently, most women are offered treatment options that are either temporary (medication) or involve a hysterectomy (the removal of the uterus) which would be counterproductive to a woman who is concerned about her fertility and is trying to become pregnant.
Is There A Treatment For Adenomyosis That Will Preserve My Fertility?
Uterine artery embolization (UAE) is a non-surgical procedure that has been found to be approximately 80% effective in treating adenomyosis. This procedure can be performed on an outpatient basis at The Atlanta Fibroid Center and no hospital stay is required.
UAE works by cutting off the blood supply that is necessary for adenomyosis to live and grow but it is done without surgery or stitches. When the patient is discharged to go home the same day the only evidence of the procedure will be a band-aid.
Contact The Atlanta Fibroid Center today to learn more about UAE and how it may help you.