Ultrasonographic signs of adenomyosis, surgery and infertility in endometriosis patients

What does ultrasonography show in infertile patients with coexisting endometriosis and adenomyosis?

Key Points

Highlights:

• Previous reports showed that the presence of coexisting adenomyosis and endometriosis is a common condition in patients with infertility, and ultrasonography is one of the main methods for diagnosing adenomyosis and endometriosis.

Importance:

• The presence of sonographic signs of adenomyosis may be an indicator of surgical management and the presence of infertility in endometriosis patients, regardless of the severity of endometriosis.

What's done here:

• The differences of ultrasonographic findings of patients who underwent conservative management or laparoscopic surgery, coexisting adenomyosis signs bytransvaginal ultrasonography (TVUS) and predictive factors for infertility were examined.
• All patients underwent 2D/3D- transvaginal ultrasonography. Demographic characteristics, age, BMI, symptoms, previous disorders, history for surgery, fertility, symptoms, CA-125 level, and TVUS findings were recorded.
• Adenomyosis was confirmed according to the presence of at least three following criteria:
  • The presence of asymmetrical myometrial wall thickening, parallel shadowing, myometrial cysts, hyperechoic islands, linear striations, and localized adenomyomas.
• Patients who were treated conservatively and patients who underwent laparoscopic surgery have been compared retrospectively according to patients’ demographic properties and TVUS findings.

Key Results:

• A total of 244 women who underwent surgery were compared to 158 women who were managed conservatively. All demographic properties were similar between groups except parous rate.
• The mean CA-125 level was higher in the surgery group, the difference was statically significant (p= 0.02).
• The presence of adenomyosis signs by TVU was significantly higher in patients who underwent laparoscopic surgery.
• Univariate regression analysis revealed that having more than three ultrasonographic findings was associated with higher age and previous cesarean section, and having more than five ultrasonographic findings was associated with infertility, history of previous in vitro fertilization therapy (IVF), and the number of IVF cycles.

Limitations:

• The retrospective nature, the results being from a single center, unknown experience on TVUS are limitations of the study.
• The rates of concomitant endometriosis and its effects on the results have not been analyzed.

Lay Summary

Adenomyosis is simply defined as the presence of endometrial glands and stroma within the uterine myometrium and is related to severe menstrual bleeding, pain, and infertility. Previous reports demonstrated the coexisting of endometriosis and adenomyosis is common.

In the present study, Dr. Eisenberg group investigated the differences of transvaginal ultrasonographic findings of patients for coexisting adenomyosis in endometriosis patients who underwent conservative management and laparoscopic surgery, and predictive factors for infertility. The results were recently published in the "Journal of Clinical Medicine".

When the demographic features of a total of 244 women who underwent surgery were compared to 158 women who were managed conservatively; the parous rate and CA-125 levels were found significantly higher in patients who underwent surgery.

Moreover, the ratio of asymmetrical myometrial thickening, myometrial cysts, parallel shadowing, hyperechoic islands, and the irregular endometrial-myometrial junction was significantly higher in patients who underwent laparoscopic surgery. In addition, authors stated that the presence of more than three ultrasonographic findings was associated with higher age and previous cesarean section, and having more than five ultrasonographic findings was associated with infertility, previous in vitro fertilization therapy (IVF), and the number of IVF cycles.

The authors concluded that ultrasonographic findings of adenomyosis should also be considered while making decisions about fertility programs for endometriosis patients.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34072021/