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Review
. 2024 Aug 16;25(16):8937.
doi: 10.3390/ijms25168937.

The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology

Hsien-Ming Wu  1   2 , Tian-Chi Tsai  1 , Shang-Min Liu  1 , Angel Hsin-Yu Pai  1 , Liang-Hsuan Chen  1   2
Affiliations
Review

The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology

Hsien-Ming Wu et al. Int J Mol Sci. .

Abstract

Adenomyosis, endometriosis of the uterus, is associated with an increased likelihood of abnormal endometrial molecular expressions thought to impair implantation and early embryo development, resulting in disrupted fertility, including the local effects of sex steroid and pituitary hormones, immune responses, inflammatory factors, and neuroangiogenic mediators. In the recent literature, all of the proposed pathogenetic mechanisms of adenomyosis reduce endometrial receptivity and alter the adhesion molecule expression necessary for embryo implantation. The evidence so far has shown that adenomyosis causes lower pregnancy and live birth rates, higher miscarriage rates, as well as adverse obstetric and neonatal outcomes. Both pharmaceutical and surgical treatments for adenomyosis seem to have a positive impact on reproductive outcomes, leading to improved pregnancy and live birth rates. In addition, adenomyosis has negative impacts on reproductive outcomes in patients undergoing assisted reproductive technology. This association appears less significant after patients follow a long gonadotropin-releasing hormone agonist (GnRHa) protocol, which improves implantation rates. The pre-treatment of GnRHa can also be beneficial before engaging in natural conception attempts. This review aims to discover adenomyosis-associated infertility and to provide patient-specific treatment options.

Keywords: adenomyosis; assisted reproductive technology; embryo implantation; endometrial receptivity; infertility; pregnancy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The structure of the uterus. The endometrial–myometrial interface (EMI) is a mucosal–muscular interface where the endometrial basalis directly contacts the myometrium.
Figure 2
Figure 2
Theories and potential mechanisms of adenomyosis. (1) Invasion of endometrial basalis into myometrium. (2) Microtrauma of endometrial–myometrial interface. (3) De novo metaplasia from stem cells. (4) Outside-to-inside invasion induced by ectopic endometrial cells.
Figure 3
Figure 3
Pathologic mechanisms in adenomyosis-associated infertility.
See this image and copyright information in PMC

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