Adenomyosis and its link to infertility

ADENOMYOSIS is just one of the often-overlooked fertility-related conditions which have silently precluded women’s ability to experience motherhood. But in recent times, following the revelation by international actress Gabrielle Union that the condition may be the culprit behind her numerous miscarriages, it has been much talked about.

Obstetrician-gynaecologist Dr Anna-Kay Taylor Christmas said that while some research suggests that there is an established link between adenomyosis and infertility in women, there is little evidence to show how exactly the condition affects fertility.

“Adenomyosis may be a contributing factor in infertility in some women. The exact way that it causes infertility is not known, but it is thought to interfere with the normal structure of the uterine wall and prevent it from moving in the normal way that encourages the sperm into the Fallopian tubes,” Dr Taylor Christmas explained.

The condition bears some similarities with endometriosis, including painful periods, and Dr Taylor Christmas pointed out that what research indicates is that the condition impairs the way that the fertilised embryo is transported or implanted into the uterus. Because of all these changes, Dr Taylor Christmas said that the condition has been associated with an increased risk of infertility, miscarriage (especially in the first trimester), as well as an increased risk of implantation failure with IVF or other assisted reproductive treatments.

In the absence of adenomyosis, Dr Taylor Christmas said that normally, the inner lining of the uterus (the endometrium) remains within the uterus and sheds every month to cause menstruation. However, in the case of adenomyosis, the lining is abnormally located within the muscular walls of the uterus (myometrium).

“In this location, it still responds to all the monthly hormonal changes and behaves as if it is in the normal location, but has nowhere to shed the blood that forms. When this happens, it leads to abnormal structure and function of the myometrium,” Dr Taylor Christmas shared.

Dr Taylor Christmas said that adenomyosis, which is completely asymptomatic in approximately one-third of women affected by it, wreaks havoc on the remaining one-third, noting that the most common symptoms they complain of are:

• Very heavy periods

• Very painful periods

• Periods that last for longer than the normal number of days

• Painful intercourse

• Chronic pelvic pain.

The condition, which Dr Taylor Christmas said can go unidentified for many years, is commonly discovered in women who are in their 40s. She said that this is also the group of women more likely to have severe symptoms.

“A diagnosis is made after taking note of symptoms and performing a thorough pelvic exam, Transvaginal ultrasound (TVS) is recommended. It is the least invasive and least expensive method to diagnose the condition without doing a surgical biopsy. The TVS can pick up the abnormal changes in the uterine wall, especially with newer machines. If further confirmation is required, especially if the TVS is not clear, then an MRI can be used to give more detail. Usually, the TVS are enough to confirm adenomyosis,” Dr Taylor Christmas outlined.

The Obgyn explained that there are a number of treatment methods that a physician can explore; however, the treatment will be dependent on factors including the patient’s age, the severity of the condition, and her future fertility and pregnancy desires.

“Treating adenomyosis with medication or surgery has been associated with an increased chance of pregnancy for women who suffer from infertility and previously were unsuccessful with IVF or other therapies. The results are better the younger the patient is, and unfortunately, pregnancy rates are much lower after treatment for women over 40 years,” Dr Taylor Christmas advised.

She advised that in the case where the patient’s hope is improved fertility, then the best treatment options are surgical resection of the adenomyosis out of the uterus in combination with medical therapy (usually a group of drugs known as GnRH agonists) which is often done laparoscopically (keyhole surgery) as well, for best results.

Since most cases of adenomyosis are asymptomatic Dr Taylor Christmas said that the key to managing the condition as well as infertility it may cause is to have it diagnosed and treated early. This is pertinent since treatment becomes more difficult with increasing age and disease severity.