Fertility Problems and Pregnancy Complications: Are They Coming From the Same Root Theory?

Endometriosis and adenomyosis share similar ancestors when it comes to fertility and pregnancy problems

Key Points

Highlights:

• The authors reviewed articles between 1940-2020 to summarize fertility and pregnancy complications of endometriosis and adenomyosis.

Importance:

• It is a wide review paper searching a large data of 70 years on the pregnancy and fertility-related complications of adenomyosis and endometriosis.

What's done here:

• The words for “adenomyosis”, “deep infiltrating endometriosis”, “deep endometriosis” and “rectovaginal endometriosis”, as well as “prematurity”, “premature birth”, “cesarean section”, “mode of delivery”, “pregnancy complications”, “pregnancy outcome” and “prenatal care” have been searched.
• PubMed, Scopus, and Web of Science have been searched for studies in English, French, German, or Spanish.
• Pregnancy outcomes, fertility rates, and all complications reported have been analyzed.

Key Results:

• After exclusion 20 studies have met the inclusion criteria.
• 3 meta-analyses, 2 reviews, 3 prospective and 2 retrospective cohort studies, and 3 retrospective case-control studies which included approximately 550 patients and almost 100,000 controls have been analyzed.
• For DIE, 2 reviews, 4 retrospective case-control studies, and one retrospective cohort study on obstetric complications, covering a total of 217 patients with DIE and 2336 controls without DIE have been analyzed.
• The analysis revealed that women with DIE and adenomyosis seem to have an increased risk for preterm birth, C-Section, placental malposition and insertion disorders, placental abruption, gestational hypertension, and preeclampsia.
• The authors hypothesized that these complications are related to inflammatory processes and changes within the junctional zone of the uterine lining.
• The authors also defined archimetrosis: as the seizure on the junctional zone related to microtraumas caused by uterine contractions, which might be the leading factor of adenomyosis and endometriosis formation. And also, might have guilt about fertility and pregnancy-related complications.

Limitations:

• The heterogeneity between diagnostic and definitive methods of endometriosis and adenomyosis also the lack of laparoscopy and tissue diagnosis on defining the control groups limits the statistical result confidence.

Lay Summary

Endometriosis and adenomyosis are bad sisters causing not only infertility but also when pregnancy is achieved, complications related to the disease.

In the review paper written by Gruber et al, it is described that adenomyosis and endometriosis come from the same root theory named "archimetrosis". The theory has been explained as a cessation of the junctional zone caused by microtraumas on the uterine lining leads to adenomyosis and endometriosis. Also, the complications are told to be related to the results of these microtraumas.

In the window of this theory, the authors made a literature search to name the complication rates. The words for “adenomyosis”, “deep infiltrating endometriosis”, “deep endometriosis” and “rectovaginal endometriosis”, as well as “prematurity”, “premature birth”, “cesarean section”, “mode of delivery”, “pregnancy complications”, “pregnancy outcome” and “prenatal care” have been searched.PubMed, Scopus, and Web of Science have been searched for studies in English, French, German or Spanish between 1940 and 2020. Pregnancy outcomes, fertility rates, and all complications reported have been analyzed. After exclusion, 20 studies have met the inclusion criteria that contain a total of approximately 550 patients with adenomyosis and almost 100,000 controls; for DIE, covering a total of 217 patients and 2336 controls have been analyzed.

The analysis revealed that women with deep infiltrating endometriosis and adenomyosis seem to have an increased risk for preterm birth, Cesarean-section, placental malposition and insertion disorders, placental abruption, gestational hypertension, and preeclampsia.

The authors hypothesized that these complications are related to inflammatory processes and changes within the junctional zone of the uterine lining. The authors also defined archimetrosis: as the seizure on the junctional zone related to microtraumas caused by uterine contractions, which might be the leading factor of adenomyosis and endometriosis formation. And also, might have guilt about fertility and pregnancy-related complications. Even there are limitations coming from the review paper writing nature as heterogeneity between studies and disease definitions the study still reveals an important perspective that clinicians should be extremely careful when following up pregnancies of endometriotic patients. The original paper is published in "Journal of Clinical Medicine".

Research Source: https://pubmed.ncbi.nlm.nih.gov/35011898/