Reproductive Outcomes after Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis: a Systematic Review

Publication date: Available online 2 January 2018 Source:Journal of Minimally Invasive Gynecology Author(s): Justin Tan, Sophie Moriarty, Omur Taskin, Catherine Allaire, Christina Williams, Paul Yong, Mohamed A. Bedaiwy Among the variety of treatment options to improve reproductive outcomes for infertile women with adenomyosis (AD), uterine conserving surgery has demonstrated varying success. Hence, we conducted a systematic review around the topic of fertility-sparing surgery across 18 studies and 1396 infertile women with focal and diffuse AD. Patients with focal AD demonstrated mean pregnancy and miscarriage rates of 52.7% (range:14.3-77.5%) and 21.1% (range:0-44.4%), respectively, while patients with diffuse AD had a mean pregnancy and miscarriage rate of 34.1% (range:9.4-100%) and 21.7% (range:12.5-33.3%), respectively. Uterine rupture and preterm birth was observed in 6.8% (3/44) and 4.5% (2/44) of pregnant patients with diffuse AD vs. 0% (0/35) and 10.9% (12/110) of patients with focal AD, respectively. No significant differences were observed between natural conception vs. ART with or without GnRHa pre-treatment. Overall, patients with focal AD appeared to have higher pregnancy rates after conservative surgery compared to diffuse AD, while a higher incidence of uterine rupture was reported after surgery for diffuse AD. However, significant heterogeneity precludes any direct comparison and prospective controlled trials are required to further elucidate the ben...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research