Arlıer Sefa, Kükrer Sadık, Adıgüzel Fikriye Işıl, Nessar Ahmet Zeki, Uysal Gülsüm, Adıgüzel Cevdet, Kaplanoğlu Dilek Kaya
Adana City Hospital, Department of Obstetrics and Gynecology, University of Health Science, Adana, Turkey.
Department of Perinatology, Mersin University, Mersin, Turkey.
BMC Pregnancy Childbirth. 2025 Jun 3;25(1):650. doi: 10.1186/s12884-025-07769-9.
Adenomyosis is increasingly recognized as a significant factor affecting fertility, particularly in the context of assisted reproductive technologies (ART). This study aimed to assess the independent impact of adenomyosis on intrauterine insemination (IUI) success rates in women with unexplained infertility.
This retrospective cross-sectional study included 533 IUI cycles in 374 infertile women treated at the University of Health Science, assisted reproductive technologies center, Adana City Hospital. The study identified adenomyosis in 95 patients via 2D transvaginal Doppler ultrasonography and 3D transabdominal ultrasonography, whereas direct and indirect adenomyosis features were not detected in 279 patients. Both groups started ovulation induction on cycle day 2-3 using recombinant follicle stimulating hormone (rFSH) or letrozole combined with rFSH or rFSH combined with recombinant luteinizing hormone (rLH). Clinical and ultrasound findings were recorded systematically. IUI was performed 36 h post-human chorionic ggonadotropin (hCG) administration, with pregnancy defined as a positive β-hCG 12-14 days after IUI. Logistic regression models were used to analyze the independent effects of adenomyosis on clinical pregnancy rates, adjusting for potential confounders.
The cumulative pregnancy rate per cycle was significantly lower in women with adenomyosis (12.23%) compared to those without adenomyosis (20.81%). Adenomyosis was identified as a significant negative predictor of IUI success (OR 0.575, 95% CI: 0.335-0.998, p = 0.049).
Adenomyosis negatively affects IUI outcomes, suggesting the need for tailored fertility treatment strategies in this population. Routine assessment of adenomyosis should be considered in infertility evaluations to optimize clinical management and treatment success.
子宫腺肌病越来越被认为是影响生育的一个重要因素，尤其是在辅助生殖技术（ART）的背景下。本研究旨在评估子宫腺肌病对不明原因不孕症女性宫内人工授精（IUI）成功率的独立影响。
这项回顾性横断面研究纳入了阿达纳市医院健康科学大学辅助生殖技术中心治疗的374名不孕女性的533个IUI周期。该研究通过二维经阴道多普勒超声和三维经腹超声在95名患者中识别出子宫腺肌病，而在279名患者中未检测到子宫腺肌病的直接和间接特征。两组均在周期第2 - 3天开始使用重组促卵泡激素（rFSH）或来曲唑联合rFSH或rFSH联合重组促黄体生成素（rLH）进行促排卵。系统记录临床和超声检查结果。在注射人绒毛膜促性腺激素（hCG）后36小时进行IUI，妊娠定义为IUI后12 - 14天β - hCG阳性。使用逻辑回归模型分析子宫腺肌病对临床妊娠率的独立影响，并对潜在混杂因素进行校正。
与无子宫腺肌病的女性（20.81%）相比，有子宫腺肌病的女性每个周期的累积妊娠率显著较低（12. .23%）。子宫腺肌病被确定为IUI成功的显著负性预测因素（OR 0.575，95% CI：0.335 - 0.998，p = 0.049）。
子宫腺肌病对IUI结局有负面影响，表明该人群需要量身定制的生育治疗策略。在不孕症评估中应考虑对子宫腺肌病进行常规评估，以优化临床管理和治疗成功率。
