Does having adenomyosis increase the risk of pregnancy loss in IVF?
Adenomyosis is a condition where endometrial tissue grows into the uterine muscle, which can affect fertility and pregnancy outcomes. For women undergoing IVF, research suggests that adenomyosis increases the risk of pregnancy loss. This answer reviews what studies show about this risk and how it may vary based on the type or severity of adenomyosis.
What the research says
Multiple studies indicate that adenomyosis raises the risk of pregnancy loss in IVF. A prospective cohort study of 314 women found that those with ultrasound markers of adenomyosis had a significantly higher total pregnancy loss rate (41.0% vs 22.6%) compared to women without adenomyosis, with an adjusted odds ratio of 2.49 3. The risk was even stronger when only direct markers (like myometrial cysts) were present, with a pregnancy loss rate of 46.2% and an odds ratio of 3.12 3. Another study using machine learning on 3805 frozen embryo transfer cycles identified adenomyosis as a risk factor for first-trimester pregnancy loss, though it was not the strongest predictor 6. A narrative review also notes that most studies and meta-analyses report negative effects of adenomyosis on IVF outcomes, particularly in diffuse adenomyosis involving the junctional zone or enlarged uterus 1. Additionally, a 2025 review confirms that adenomyosis is associated with increased risk for pregnancy loss, preterm birth, and pre-eclampsia 5. The type of adenomyosis may matter: intrinsic (inner myometrium) disease may have a different impact than extrinsic (outer myometrium) disease, but both are linked to lower pregnancy rates 4. Overall, the evidence consistently points to a higher risk of pregnancy loss in women with adenomyosis undergoing IVF.
What to ask your doctor
- What type of adenomyosis do I have (diffuse, focal, intrinsic, extrinsic) and how might it affect my IVF outcomes?
- Should I consider any additional monitoring or treatments, such as GnRH analogues, before starting an IVF cycle?
- Are there specific ultrasound markers of adenomyosis that could predict my risk of pregnancy loss?
- Would a frozen embryo transfer cycle be recommended over a fresh cycle for my situation?
- What is my overall chance of live birth given my adenomyosis diagnosis and other personal factors?
This question is drawn from common patient questions about OB/GYN & Women's Health and answered using cited medical research. We do not provide individualized advice.