Journal: Obstetrics and Gynecology International, 2012
Authors: Campo S, Campo V, Benagiano G.
Study from: Catholic University of Sacred Heart, Roma, Italy.
Problem: Adenomyosis is a benign condition where the uterine lining cells grow deep into the uterine muscle wall. For many years, adenomyosis has been suspected of causing infertility in women. In the past, the diagnosis of adenomyosis has only been possible based on a pathologist’ examining the uterine muscle and lining cells after a hysterectomy, so fertility could never be measured. Now MRI (and probably 3-D ultrasound) allows the diagnosis of adenomyosis without hysterectomy and, therefore, scientific investigation of this condition has increased dramatically.
Study: The authors reviewed the new research and they present multiple reasons why adenomyosis might cause infertility.
Results: The evidence that adenomyosis causes infertility includes:
- In women with adenomyosis, the muscles cells in the uterine wall swell and they function differently than normal uterine muscle cells.
- In women with adenomyosis, the lining cells of the uterus do not go through normal changes during the menstrual cycle.
- In women with adenomyosis, the uterine lining cells cause inflammation in the muscle wall which interferes with the movement of the fertilized egg inside the uterus.
- In women with adenomyosis, there are changes in the uterine lining cells that interfere with implantation of the fertilized embryo.
- Surgical removal of adenomyosis or medical treatment with GnRH agonists (Lupron) increases the chance of pregnancy.
Dr. Parker’s Comments: In order to prove that adenomyosis causes infertility, a large group of women would need to have an MRI before trying to get pregnant and the percent of women who get pregnant with adenomyosis would need to be compared with the percentage of women who do not have adenomyosis. Since that type of study has never been done, it is currently impossible to prove that adenomyosis can lead to infertility. However, now that women with adenomyosis can be diagnosed by MRI, careful examination of the cellular changes of the uterus suggests that there are many reasons why adenomyosis could cause infertility.
These new studies will also be very important in helping scientists figure out what type of treatments might cure adenomyosis, or better yet, prevent it from developing at all.
