Some women with adenomyosis still have healthy pregnancies after IVF. But new research suggests the specific signs seen on ultrasound may matter more than the diagnosis itself.
Doctors now say the type of adenomyosis features on a scan could predict success or struggle during fertility treatment.
Adenomyosis is a condition where tissue similar to the uterine lining grows into the muscle wall of the uterus. It can cause heavy bleeding, painful periods, and fertility challenges. It affects an estimated 1 in 10 women, though many cases are mild and go undiagnosed.
Until recently, adenomyosis was often treated as a single diagnosis. But this study suggests that not all adenomyosis behaves the same way during IVF.
Here's the twist: the same diagnosis can look very different on ultrasound. And those differences may change the odds of having a baby.
What Ultrasound Can Tell Us
Doctors use transvaginal ultrasound to look for adenomyosis. The MUSA criteria (Morphological Uterus System Assessment) describe two main types of findings.
Direct markers show up as clear changes inside the muscle. These include small fluid-filled cysts, bright white spots, and thin lines within the uterine wall.
Indirect markers are more general changes. These include an enlarged, globular uterus, uneven thickening of the walls, and a blurred border between layers.
Think of it like this: direct markers are specific clues pointing to the problem. Indirect markers are more like general hints that something might be off.
The Study at a Glance
Researchers followed 314 women aged 18 to 39 who were undergoing their first IVF or ICSI cycle. All had standardized ultrasounds before treatment.
About 76 women had adenomyosis. Of those, 54 showed direct markers and 22 showed only indirect markers.
The study tracked live births per embryo transfer and total pregnancy loss among those who had a positive pregnancy test.
Overall, adenomyosis was linked to lower live birth rates and higher pregnancy loss. But the pattern became much clearer when looking at direct markers specifically.
Women with any adenomyosis had a 28.9% live birth rate compared to 40.3% in women without adenomyosis. After adjusting for age, BMI, and embryo stage, the odds were lower but not statistically significant.
But when focusing only on women with direct markers, the live birth rate dropped to 22.2%. That represents a 58% reduction in odds of a live birth compared to women without adenomyosis.
Pregnancy loss told an even starker story. Overall, 41% of pregnancies in the adenomyosis group were lost after a positive test, compared to 22.6% in the control group.
For women with direct markers, the loss rate jumped to 48%. That's nearly a four-fold increased risk after adjustments.
This doesn't mean every woman with direct markers will face these odds.
Why Direct Markers May Matter More
The researchers found that 71% of women with adenomyosis had direct markers. This suggests a distinct subgroup with more active disease.
Direct markers may indicate more inflammation or structural disruption within the uterine muscle. This could interfere with embryo implantation or early placental development.
Even when doctors transferred blastocysts—more developed embryos that usually have better success rates—the negative effect of direct markers remained.
What This Means for IVF Planning
This research suggests that the type of adenomyosis seen on ultrasound matters. Women with direct markers may benefit from closer monitoring and different treatment strategies.
Doctors might consider more aggressive management or different protocols. Patients should discuss their ultrasound findings in detail with their fertility specialist.
But this is not a reason to panic or abandon treatment plans. Many women with adenomyosis still achieve successful pregnancies.
Limitations and Real-World Context
This was a single-center study with 314 participants. While prospective design is strong, larger, multi-center studies are needed to confirm these findings.
The study only included first IVF cycles, so results may differ for women who have had previous treatments. The researchers also adjusted for key factors, but other unmeasured variables could play a role.
Most importantly, this research shows an association, not a cause. Ultrasound markers may help predict outcomes, but they don't guarantee them.
What Happens Next
The next step is larger studies that include diverse populations and different treatment protocols. Researchers will also look at whether changing treatment based on marker type improves outcomes.
For now, this study offers valuable information for counseling women with adenomyosis undergoing IVF. It highlights the importance of detailed ultrasound assessment and personalized treatment planning.
If you have adenomyosis and are planning IVF, ask your doctor to review your ultrasound findings in detail. Understanding your specific situation can help you make informed decisions about your treatment path.