Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility?

Abstract

Objective: To analyze the determinants of successful pregnancy following laparoscopic adenomyomectomy.

Design: Retrospective cohort study.

Setting: A general hospital.

Patient(s): A total of 102 women who had a desire for pregnancy underwent laparoscopic adenomyomectomy from 2007 to 2012.

Intervention(s): Surgical excision of the uterine adenomyosis; statistical analysis for fertility outcomes.

Main outcome measure(s): Pregnancy rates and the results of univariable and multivariable analyses.

Result(s): When the women were divided into ≤39 years and ≥40 years age groups, clinical pregnancy rates were 41.3% and 3.7%, respectively. Factors associated with clinical pregnancy were: history of IVF treatments, posterior wall involvements, and age, with odds ratios of 6.22, 0.18, and 0.77, respectively. In the younger group, 60.8% of women with history of IVF failure showed successful pregnancy after surgery. We experienced 2 cases of placenta accreta in far advanced cases.

Conclusion(s): This study demonstrated age as a determinant in fertility outcomes. Surgery could be a beneficial treatment for women who experienced IVF treatment failures, especially at ages of ≤39 years. We could not show a clear benefit of the surgery on fertility outcomes of the group aged ≥40 years. Extremely severe adenomyosis affecting a broad range of the uterine subendomerial myometrium should be treated carefully on a pregnancy course.

Keywords: Adenomyosis; complication; pregnancy; subfertility; surgery.