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Fertility-Sparing Treatment of Adenomyosis in Patients With Infertility: A Systematic Review of Current Options

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Abstract

Adenomyosis is a benign gynecological disease observed in women in their reproductive age. Recent studies have shown that adenomyosis might be a relevant factor for infertility, either impairing implantation or leading to early miscarriage. However, conservative treatment of infertility related to adenomyosis is still unclear. This study systematically reviews the literature for the reproductive outcomes of the available conservative treatments for patients with adenomyosis-associated infertility. We conducted a search in PubMed/Medline for studies in English published in the last 7 years and included 16 studies. Six studies evaluated surgical treatments of adenomyosis. When considering only spontaneous pregnancies, the overall clinical pregnancy rate was very low (18.2%). However, when using GnRH analogues for 24 weeks after surgery, the pooled spontaneous pregnancy rate was higher (40.7% vs 15.0%; P =.002). No significant difference was observed in the other outcomes. Ten studies evaluated exclusive assisted reproductive techniques for infertility related to adenomyosis and showed that the long stimulation protocol had better outcomes compared to short stimulation protocol in pregnancy rate (43.3% vs 31.8%; P =.0001), live birth (43.0% vs 23.1 %; P =.005), and miscarriage (18.5% vs 31.1 %; P <.0001).

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Authors and Affiliations

  1. Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255-I0 andar, CEP, 05403-000, São Paulo, Brazil

    Tainá Pezzin Rocha MD, Marina Paula Andres MD, Giuliano Moysés Borrelli MD & Mauricio Simões Abrão MD

  2. Gynecologic Division, BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil

    Marina Paula Andres MD & Mauricio Simões Abrão MD

Authors
  1. Tainá Pezzin Rocha MD
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  2. Marina Paula Andres MD
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  3. Giuliano Moysés Borrelli MD
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  4. Mauricio Simões Abrão MD
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Correspondence to Mauricio Simões Abrão MD.

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Rocha, T.P., Andres, M.P., Borrelli, G.M. et al. Fertility-Sparing Treatment of Adenomyosis in Patients With Infertility: A Systematic Review of Current Options. Reprod. Sci. 25, 480–486 (2018). https://doi.org/10.1177/1933719118756754

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