Puente J M, Fabris A, Patel J, Patel A, Cerrillo M, Requena A, Garcia-Velasco J A
Department of Reproductive Medicine, IVI Madrid, Av del Talgo 68, 288023, Madrid, Spain.
Department of Reproductive Medicine, IVI Madrid, Rey Juan Carlos University, Madrid, Spain.
Reprod Biol Endocrinol. 2016 Sep 20;14(1):60. doi: 10.1186/s12958-016-0185-6.
Adenomyosis is linked to infertility, but the mechanisms behind this relationship are not clearly established. Similarly, the impact of adenomyosis on ART outcome is not fully understood. Our main objective was to use ultrasound imaging to investigate adenomyosis prevalence and severity in a population of infertile women, as well as specifically among women experiencing recurrent miscarriages (RM) or repeated implantation failure (RIF) in ART.
Cross-sectional study conducted in 1015 patients undergoing ART from January 2009 to December 2013 and referred for 3D ultrasound to complete study prior to initiating an ART cycle, or after ≥3 IVF failures or ≥2 miscarriages at diagnostic imaging unit at university-affiliated private IVF unit. Adenomyosis was diagnosed in presence of globular uterine configuration, myometrial anterior-posterior asymmetry, heterogeneous myometrial echotexture, poor definition of the endometrial-myometrial interface (junction zone) or subendometrial cysts. Shape of endometrial cavity was classified in three categories: 1.-normal (triangular morphology); 2.- moderate distortion of the triangular aspect and 3.- "pseudo T-shaped" morphology.
The prevalence of adenomyosis was 24.4 % (n = 248) [29.7 % (94/316) in women aged ≥40 y.o and 22 % (154/699) in women aged <40 y.o., p = 0.003)]. Its prevalence was higher in those cases of recurrent pregnancy loss [38.2 % (26/68) vs 22.3 % (172/769), p < 0.005] and previous ART failure [34.7 % (107/308) vs 24.4 % (248/1015), p < 0.0001]. The presence of adenomyosis has been shown to be associated to endometriosis [35.1 % (34/97)]. Adenomyosis was diagnosed as a primary finding "de novo" in 80.6 % (n = 200) of the infertile patients. The impact on the uterine cavity was mild, moderate and severe in 63.7, 22.6 and 10.1 % of the cases, respectively.
Our results indicate that adenomyosis is a clinical condition with a high prevalence that may affect the reproductive results. The described severity criteria may help future validating studies for better counseling of infertile couples.
子宫腺肌病与不孕症有关，但其背后的机制尚未明确确立。同样，子宫腺肌病对辅助生殖技术（ART）结局的影响也未完全了解。我们的主要目标是利用超声成像技术调查不孕女性群体中子宫腺肌病的患病率和严重程度，特别是在经历反复流产（RM）或ART反复种植失败（RIF）的女性中。
对2009年1月至2013年12月期间接受ART治疗并转诊至大学附属私立试管婴儿中心诊断影像科进行三维超声检查以在开始ART周期前或在≥3次体外受精失败或≥2次流产后完成研究的1015例患者进行横断面研究。子宫腺肌病的诊断依据为子宫呈球形、子宫肌层前后不对称、子宫肌层回声不均匀、子宫内膜-肌层界面（交界区）界限不清或内膜下囊肿。子宫内膜腔的形态分为三类：（1）正常（三角形形态）；（2）三角形形态中度变形；（3）“假T形”形态。
子宫腺肌病的患病率为24.4%（n = 248）[≥40岁女性中为29.7%（94/316），<40岁女性中为22%（154/699），p = 0.003]。在反复妊娠丢失的病例中其患病率更高[38.2%（26/68）对22.3%（172/769），p < 0.005]，既往ART失败的病例中也是如此[34.7%（107/308）对24.4%（248/1015），p < 0.0001]。已证明子宫腺肌病的存在与子宫内膜异位症相关[35.1%（34/97）]。在80.6%（n = 200）的不孕患者中，子宫腺肌病被诊断为原发性“新发”疾病。对子宫腔的影响分别在63.7%、22.6%和10.1%的病例中为轻度、中度和重度。
我们的结果表明子宫腺肌病是一种患病率较高的临床病症，可能会影响生殖结局。所描述的严重程度标准可能有助于未来的验证研究，以便为不孕夫妇提供更好的咨询服务。
