How does adenomyosis affect my chances of a live birth during IVF?
Adenomyosis is a condition where the tissue that normally lines the uterus grows into the muscular wall of the uterus. This can affect fertility and the success of IVF. Research shows that adenomyosis generally lowers the chance of a live birth after IVF and increases the risk of pregnancy loss. The impact is stronger in certain types of adenomyosis, such as when there are direct markers on ultrasound or when the disease is diffuse and involves the junctional zone of the uterus.
What the research says
Multiple studies confirm that adenomyosis negatively affects IVF outcomes. A 2025 matched control study found that women with adenomyosis had significantly lower live birth rates after IVF/ICSI compared to women without adenomyosis, even when matched for age and embryo quality 5. A prospective cohort study using ultrasound markers reported that adenomyosis was linked to a lower live birth rate (28.9% vs 40.3%) and a significantly higher pregnancy loss rate (41.0% vs 22.6%) 3. The negative effect was even stronger when only direct ultrasound markers (like myometrial cysts) were present, with live birth dropping to 22.2% 3.
A narrative review of 91 studies concluded that most research shows adenomyosis harms IVF outcomes, especially diffuse adenomyosis involving the junctional zone, an enlarged uterus, or severe disease 1. Another review focusing on adenomyosis location found that both intrinsic (inner myometrium) and extrinsic (outer myometrium) types reduce live birth rates, but the evidence is mixed on which type has a worse effect 4.
Adenomyosis also worsens outcomes for women with endometriosis. A 2022 study found that among women with endometriosis, those who also had adenomyosis on MRI had lower live birth rates after ART, particularly if they had T2 high-signal intensity spots in the myometrium 7. Notably, a large study on recurrent implantation failure excluded women with adenomyosis, suggesting it is considered a known factor that impairs implantation 6.
What to ask your doctor
- What type of adenomyosis do I have (diffuse or focal, intrinsic or extrinsic) and how might it affect my IVF success?
- Should I have an MRI or specialized ultrasound to better assess my adenomyosis before starting IVF?
- Would a frozen embryo transfer cycle be better for me than a fresh transfer?
- Are there any treatments, such as GnRH analogues, that could improve my chances before IVF?
- How does my adenomyosis affect the risk of miscarriage, and what monitoring would you recommend?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.