Adenomyosis

There is no specific protocol for adenomyosis. It would depend on your clinical situation. I suggest yo email my assistant, Patti Converse (concierge@sherivf.com) and ask her to set you up with an online consultation with me to discuss our case in detail;

Geoff Sher

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• Adenomyosis: A Guide to Symptoms, Diagnosis, and Treatment

What is Adenomyosis?

Adenomyosis is a condition where endometrial glands, which normally line the uterus (endometrium), grow into the muscular wall of the uterus (myometrium). This can cause the uterus to become enlarged, soft, and tender.

Symptoms of Adenomyosis

Women with adenomyosis may experience:

• Pelvic pain (often chronic)
• Heavy and painful periods (menorrhagia and dysmenorrhea)
• Pain during deep penetration during intercourse (dyspareunia)
• Unexplained infertility or difficulty conceiving
• Repeated miscarriages

If a woman presents with these symptoms and has an enlarged, soft, and tender uterus during a pelvic exam, adenomyosis should be suspected.

Diagnosing Adenomyosis

Diagnosing adenomyosis can be challenging because there is no single test that confirms it definitively. However, imaging studies like MRI and ultrasound (sonogram) can provide strong evidence.

Ultrasound Features Suggestive of Adenomyosis

• Generalized enlargement of the uterus
• Asymmetrical thickening of the myometrium (one side thicker than the other)
• Thickened junctional zone (>12mm) with increased blood flow
• Blurred boundary between the endometrium and myometrium
• Cysts in the myometrium
• Non-encapsulated tumors (adenomyomas) in the uterine muscle

Adenomyosis and Infertility

Adenomyosis does not directly affect egg or embryo quality, but it can cause implantation dysfunction due to changes at the endometrial-myometrial junction. Many women with adenomyosis conceive naturally, but for some, the condition can lead to infertility or recurrent pregnancy loss.

Link Between Adenomyosis and Endometriosis

• 30%–70% of women with adenomyosis also have endometriosis, a known cause of infertility.
• Endometriosis can create a toxic pelvic environment that affects egg fertilization and implantation.
• Women with suspected adenomyosis-related infertility should also be evaluated for endometriosis and immunologic implantation dysfunction (IID).

Treatment Options for Adenomyosis

Surgical Treatments

• Conservative surgery: Removing affected portions of the uterus (adenomyomas) can help, but surgery is difficult because adenomyosis does not have clear borders.
• Robot-assisted laparoscopic surgery is becoming more common for focal or nodular adenomyosis, as long as the disease is not widespread.

Medical Treatments

Three main medical treatments are used to manage adenomyosis:

1. Hormonal Therapy (GnRH Agonists)

• Medications like Buserelin or Lupron suppress estrogen and shrink adenomyosis lesions.
• Commonly used as a three-month depot injection before embryo transfer in IVF.

2. Aromatase Inhibitors (e.g., Letrozole)

• Sometimes used, but with limited success in treating adenomyosis.

3. Immunotherapy for Implantation Issues

• If immunologic implantation dysfunction (IID) is suspected, treatment may include:
• Intralipid or IVIG therapy
• Steroids
• Heparin (a blood thinner)
• These treatments are often combined with IVF for women struggling with repeated implantation failure.

Adenomyosis and Pregnancy

• Not all women with adenomyosis are infertile.
• Even with IVF, women with adenomyosis face an increased risk of miscarriage.
• Since the condition does not affect egg or embryo quality, women with severe adenomyosis-related infertility may consider gestational surrogacy as an option.

Conclusion

Adenomyosis can cause pain, heavy periods, infertility, and pregnancy loss, but it does not affect egg or embryo quality. Diagnosis relies on imaging studies like MRI and ultrasound, and treatment options range from hormonal therapy and immunotherapy to surgery. Women struggling with infertility due to adenomyosis should also be evaluated for endometriosis and immune-related implantation dysfunction to determine the best treatment approach.

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Herewith are  online links to 2  E-books recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)....... for your reading pleasure:

1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\