Female Factor Infertility

One of the possible causes for female infertility: Adenomyosis


Until recently only little had been known about adenomyosis, but something that we did know is, that it is associated with severe menstrual pain, heavy bleeding, as well as an enlarged uterus. Nowadays, thanks to advances in ultrasound techniques, it is easier for specialists to diagnose adenomyosis.

This uterine alteration can cause fertility problems, affecting the successful implantation of an embryo, which leads to recurrent implantation failures.
Adenomyosis: What is it? When does it occur?

According to the World Health Organisation, 1 in 10 women between the ages of 35 and 50 suffer from adenomyosis. However, in recent years this condition has also been confirmed to appear in younger women.

Adenomyosis is a condition that occurs when tissue that covers the endometrium, the interior of the uterus, penetrates the myometrium, the muscle layer of the uterus. During menstruation, the tissue within the myometrium swells and bleeds like the lining of the uterus does.

The difference between adenomyosis and endometriosis

In more than 10 % of cases, adenomyosis appears accompanied by endometriosis, hence the importance of a thorough diagnosis. In the field of gynaecology and reproductive medicine, adenomyosis is often referred to as internal endometriosis due to their similarities.

It is important to know that a woman’s uterus has two layers to understand the difference between these two conditions:

1. The myometrium: the muscle layer of the uterus, which is responsible for uterine contractions during childbirth and menstruation.
2. The endometrium: the inner layer, that prepares the endometrium for the implantation of an embryo each cycle. If no embryo has implanted, the inner layer is shed, causing menstruation.

At first glance, adenomyosis and endometriosis are similar gynaecological conditions that affect the tissues of the uterus and the endometrial lining. However, it is important to differentiate them as two separate conditions.

Endometriosis is one of the main causes of infertility in women. It is characterised by the appearance of endometrial tissue outside the uterus, causing inflammatory lesions in other organs. It also affects being able to conceive through natural ways.

Adenomyosis, on the other hand, is the appearance of endometrial cells in the myometrium only, the layer located between the endometrium and the outer layer of the uterus (also known as the perimetrium or serosa).


What types of adenomyosis are there?

Depending on how much it has spread and its location, we differentiate between two types:

• Focal: also known as adenomyoma. It appears in the form of tumours located within the myometrium.
• Diffuse: The most common type of adenomyosis which affects a large part of the myometrium, causing the uterus to be enlargened.
We also differentiate between deep and superficial adenomyosis depending on the location of the endometrial tissue within the myometrium.

Main symptoms

Many of the symptoms that adenomyosis causes also occur in other benign gynaecological diseases (such as endometriosis, uterine polyps and uterine myomatosis). This can lead to confusions in diagnosis. Furthermore, approximately 30% of women suffering from adenomyosis may be asymptomatic.

Women suffering from adenomyosis can experience a wide range of symptoms. These are some of the most common ones:

• Dysmenorrhoea or painful menstrual periods
• dyspareunia or pain during sexual intercourse
• Chronic pelvic pain
• Metrorrhagia or non-menstrual bleeding.
• Infertility

Diagnosis of adenomyosis

Imaging techniques are crucial for a good diagnosis. The specialist will be able to diagnose an enlarged uterus caused by either diffuse or focal adenomyosis through a 2D (and eventually a 3D) transvaginal ultrasound. An MRI scan can often be necessary to confirm the diagnosis.

According to Dr Christos Roukoudis, gynaecologist at IVF-Spain, the process of diagnosing adenomyosis should begin with “a specialist suspecting symptoms. Although reaching the exact diagnosis can be a challenge, the appearance of certain symptoms can help the expert reach a diagnosis”.



Affects adenomyosis has on female fertility

It has been confirmed that this uterine disease can cause difficulties during pregnancy, leading to ectopic pregnancies or causing repeated miscarriages.  In some cases, it can also complicate the implantation of the embryo in the uterus, causing implantation failures.
Some studies show that up to 22% of women who are unable to become pregnant suffer from adenomyosis.

It is speculated, that the amount of oestrogen produced by the woman’s body may cause the growth of endometrial tissue that generates adenomyosis since this hormone is responsible for regulating the menstrual cycles and the female reproductive system.

Fertility treatments recommended for women with adenomyosis

In the cases of adenomyosis, the patient’s uterus must be adequately prepared for the treatment. It is recommended to initially perform ovarian stimulation to obtain oocytes followed by in vitro fertilisation.  The oocytes will be fertilised in the laboratory to later place the embryos with the highest chances of implantation in the woman’s uterus.

Another possibility would be to opt for egg vitrification and consider treatment of this condition at a later time.

The best option to reduce symptoms of adenomyosis may be the administration of contraceptives or oestrogen receptor drugs before fertility treatment begins.
Generally, adenomyosis does not affect the chances of success of IVF treatment. In some cases, patients should also be treated with gonadotropin-releasing hormone (GnRH) agonists, which can cause a temporary condition similar to menopause.

Why a good treatment strategy is so important

Protocols for assisted reproduction treatment at IVF-Spain Madrid are adapted to the needs of each individual patient. During the patient’s first visit we focus on obtaining an accurate diagnosis. Only in this way will we be able to determine from the start whether the existence of this condition is responsible for the patient’s infertility.

Although adenomyosis occurs in only 1% of the female population, any woman regardless of age that menstruates can suffer from adenomyosis. Many women suffer from it without even being aware of it. Adenomyosis is a condition that causes fertility problems for many women of childbearing age while its diagnosis is still as difficult to obtain as that of its “sister” endometriosis.

If you suspect you may be suffering from this condition, you can contact our team of experts or book a first visit online.  Pain impairing you from living a normal life is not normal

About the author


At ProcreaTec, we understand the road toward a healthy pregnancy is not always easy. Through this blog, we want to reach out to all who are struggling on the path of infertility to find support. If you have any questions or would like to tell us about your situation, you can comment on the posts or send us an e-mail.
If you would like to learn more about our clinic, we invite you to visit our website en.procreatec.com
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