Influence of nodular and severe forms of diffuse adenomyosis on reproductive function: a review of reproductive outcomes of surgical interventions and IVF
This review includes an analysis of clinical studies evaluating the effect of adenomyosis on reproductive function, as well as a review of studies on the relationship between surgical treatment options for adenomyosis and reproductive outcomes. Different studies of women populations after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) and after surgical treatment of deep adenomyosis have shown that adenomyosis in both cases has a negative effect on the reproductive outcome, although there are significant differences in these populations. In the literature, there are relatively few data on the degree of influence of the depth of the lesion on the realization of the reproductive function, however, a significant correlation was revealed between them. The positive effect of treatment with gonadotropin-releasing hormone agonists, followed by surgical treatment of adenomyosis, has also been described in several literary sources, but there have been no controlled studies on this topic. Many studies do not meet the validity criteria due to the lack of clear criteria for inclusion and exclusion from the study.The choice of the optimal treatment options for adenomyosis based on the actual data is difficult due to the lack of reliable evidence of the relationship between fertility and the degree of adenomyosis. However, it is known that adenomyosis can reduce the likelihood of successful implantation so ramatically that surgical or other treatment options are reasonably recommended. At the same time, it is necessary to assess the possible positive effect of the treatment options available in the doctor's arsenal. Thus, timely referral to specialized treatment of adenomyosis may be crucial for the successful implementation of reproductive function in patients with suspicion or with an established diagnosis of adenomyosis in combination with recurrent miscarriage, who refuse to use assisted reproductive technologies, medical institutions. This review will analyze the relationship between infertility and adenomyosis, as well as review studies of reproductive outcomes in different options for surgical treatment of adenomyosis in infertile patients.