How does the location of adenomyosis impact my fertility outcomes?
Adenomyosis is a condition where the tissue that normally lines the uterus grows into the muscle wall. Its location within the uterus can affect fertility and the success of treatments like IVF. Research suggests that the type and location of adenomyosis — whether it is in the inner or outer muscle layer, or whether it is focal or diffuse — may influence your chances of getting pregnant and having a live birth.
What the research says
A 2024 systematic review found that the location of adenomyosis matters for fertility outcomes 4. Intrinsic adenomyosis (affecting the inner myometrium) was associated with worse pregnancy outcomes compared to extrinsic adenomyosis (affecting the outer myometrium) 4. Specifically, women with intrinsic disease had lower clinical pregnancy and live birth rates after assisted reproduction 4. Another study using ultrasound markers showed that direct markers of adenomyosis (like myometrial cysts) — which often indicate deeper or more diffuse disease — were linked to a significantly lower live birth rate (22.2% vs. 40.3% in controls) and a higher pregnancy loss rate (41.0% vs. 22.6%) 3. The same study noted that indirect markers (like globular enlargement) did not show as strong an association 3. A narrative review also reported that diffuse adenomyosis involving the junctional zone (the inner layer of the uterine muscle) and an enlarged uterus have a negative impact on IVF outcomes 1. For women considering treatment, MRI-guided focused ultrasound (MRgFUS) can reduce lesion size and symptoms, and it does not appear to harm ovarian reserve 26. However, the effect of MRgFUS on fertility specifically is still being studied 5.
What to ask your doctor
- What type of adenomyosis do I have — intrinsic or extrinsic, focal or diffuse?
- Based on the location of my adenomyosis, what are my expected chances of live birth with IVF?
- Would an MRI or specialized ultrasound help better define the location and extent of my adenomyosis?
- Could treatments like MRgFUS improve my fertility outcomes, and are they an option for me?
- How does the location of my adenomyosis affect the risk of pregnancy loss?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.