Adenomyosis: (in)fertility and the role of endometrial receptivity, a systematic review

Abstract

Objective: This review aimed to better understand how adenomyosis (AM) could alter endometrial receptivity (ER), while minimizing the interference of other pathologies such as endometriosis. Data sources: Publications listed in Pubmed, Web of Science, Scopus and CENTRAL were searched with "adenomyosis", "endometrial", "receptivity" and "trial", or equivalent terms. Guidelines, reviews, conference abstracts, editorials, opinion articles, protocols and articles without full-text were excluded. Study selection: Inclusion criteria were: adults with adenomyosis; reproductive/ biomolecular outcomes and observational/ experimental studies. Reasons for exclusion: inappropriate study design, absence of adenomyosis, AM not evaluated independently, different outcomes evaluated, no abstract available, absence of reported results. After screening, 16 articles were included. Data collection: Relevant data was extracted into an Excel spreadsheet, and two outcome tables were created. Data synthesis: ER appears to be altered in patients with adenomyosis. Our data primarily revealed lower live birth and clinical pregnancy rates in classical ART protocols compared to other regimen which seem to improve ER in subjects with AM. Molecular components recognized as crucial agents in ER related processes were also abnormally expressed and can possibly change uterine receptivity in AM. Conclusions: Adenomyosis seems to contribute to infertility by interfering with ER. However, some ART protocols reveal significantly better outcomes and suggest the use of strategy tailored to AM patients. Biomolecular changes in AM are a promising study field, leading to a deeper understanding and new infertility therapies. Interpreting literature regarding AM is still challenging, especially because of its coexistence with other pathologies and the lack of experimental studies, namely RCT's.