Adenomyosis does not influence outcomes in oocyte recep1on
cycles
I. González-‐Foruria, D. Manau, A. Borràs, C. Ros, J. Peñarrubia, J. Ferreri, E. Vidal, F. Fàbregues, F. Carmona, J. Balasch
Introduc*on Adenomyosis:
• Benign gynaecological disease
• Invasion of basal endometrial glands and stroma into myometrium (Brosens, 1998)
• Chronic local inflamma*on
• Controversial rela*onship with fer*lity (Maheshwari, 2012; TomasseO, 2013)
• AssociaQon with inferQlity: – Ballester, 2012 – Maubon, 2010 – Thalluri, 2012 – Tremellen, 2013 – Youm, 2011
• No relaQonship with inferQlity: – Chiang, 1999 – Costello, 2011 – MarGnez Conejero, 2011
– Mijatovic, 2010 – Salim, 2012 – Benaglia, 2014
Introduc*on Adenomyosis:
Introduc*on Adenomyosis:
• Non-‐invasive tests for diagnosis
• Magne*c resonance imaging (AUC 0.91) • Ultrasound (AUC 0.88) (Maheshwari, 2012)
• Associa*on with endometriosis (DIE)
• Confounders:
• Protocol of ovarian s*mula*on
Objec*ves
• Evaluate outcomes of oocyte recep*on cycles in adenomyosis
• Assess rela*onship between adenomyosis and endometriosis and fibroids
Methods
• Prospec*ve longitudinal study, between January 2014 and December 2015
• 132 fresh oocyte recep*on cycles
• 118 pa*ents; range: 30-‐47 years old
• Adenomyosis , endometr ios is and fibroids assessment by ultrasound (RIC 5-‐9, Voluson V730Expert, GE)
Methods
• Myometrial heterogeneity
• Asimmetry of myometrial walls (>50%)
• Focal adenomyosis
• Myometrial cysts
• Echogenic linear stria*ons
• Junc*onal zone infilitra*on
• Ultrasound criteria for Adenomyosis (≥3): (Sakrel 2012, Meredith 2009, Exacoustos 2011)
Methods
• Main outcomes:
• Pregnancy rate
• Miscarriage/ectopic rate
• Associa*on with endometriosis and fibroids
All pa1ents Adenomyosis No Adenomyosis P
Nº Cycles (%) 132 27 (20.5) 105 (79.6)
Nº Pa1ents (%) 118 25 (21.0) 93 (79.0)
Age (mean, SD) 40.4 (4.0) 41.0 (3.9) 40.3 (4.0) 0.386
BMI (mean, SD) 22.2 (3.5) 22.1 (3.4) 22.2 (3.6) 0.961
MII (mean, SD) 10.9 (4.0) 12.1 (6.4) 10.6 (3.2) 0.259
Embryos (mean, SD) 8.2 (3.2) 8.4 (3.6) 8.2 (3.0) 0.762
Nº Transferred Embryos (mean, SD)
1.8 (0.5) 1.8 (0.5) 1.8 (0.5) 0.747
Results
Adenomyosis
(n= 27)
No Adenomyosis
(n= 105) Total P
Fibroids (n, %) 7 (28.0) 25 (23.4) 32 0.626
Endometriosis (n, %) 14 (56.0) 18 (16.8) 32 0. 001
OMA (n, %) 3 (12.0) 8 (7.5) 11
0.001
DIE (n, %) 11 (44.0) 10 (9.3) 21
Results
Pregnancies (n, %)
Total Adenomyosis
(n= 27)
No Adenomyosis
(n= 105) P
Endometriosis
(n= 32)
No Endometriosis
(n= 100) P
80 18 (72.0) 62 (57.9) 0.195 15 (46.9) 65 (65.0) 0.068
Miscarriages (n, %)
14 3 (16.7) 11 (17.7)
0.916
3 (20.0) 11 (16.9) 0. 777
Ectopic pregnancies (n, %)
4
2 (11.1) 2 (3.2)
0.177
2 (13.3) 2 (3.1) 0.100
Results
Pregnancies (n, %)
Total Adenomyosis + DIE
(n= 11)
Adenomyosis + OMA
(n= 3)
Adenomyosis + No Endometriosis
(n= 11)
No Adenomyosis (n= 107) P
80 5 (45.5) 2 (66.7) 11 (100.0) 62 (57.9) 0.036
Miscarriages (n, %)
Total Adenomyosis + DIE
(n= 5)
Adenomyosis + OMA
(n= 2)
Adenomyosis + No Endometriosis
(n= 11)
No Adenomyosis (n= 62) P
14 1 (20.0) 1 (50.0) 1 (9.1) 11 (17.7) 0. 567
Results
Conclusions
• Adenomyosis is associated with Endometriosis
• More relaQon with DIE
• No associaQon with fibroids
• Adenomyosis does not impair pregnancy rates
Conclusions
• Adenomyosis does not increase miscarriage or ectopic rates
• Endometriosis paQents have lower chances of pregnancy
• The worst pregnancy rates in Adenomyosis + DIE paQents
Thank you for your aaenQon
Pregnancies (n, %)
Endometriosis (n= 32) No
endometriosis (n= 100)
P
15 (46.9) 65 (65.0) 0.068
Pregnancies (n, %)
Total Adenomyosis + OMA
(n= 3)
Adenomyosis + DIE
(n= 13)
No Adenomyosis + OMA (n= 8)
No Adenomyosis + DIE (n= 8)
No endometriosis
(n= 100)
P
80 2 (66.7) 6 (46.2) 4 (50.0) 3 (37.5) 65 (65.0) 0.385