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Correlation of adenomyosis features to live birth rates after the first IVF/ICSI treatment, when using the revised Morphological Uterus Sonographic Assessment group definitions

Alson, Sara LU orcid ; Henic, Emir LU ; Hansson, Stefan LU orcid and Sladkevicius, Povilas LU orcid (2024) In Acta Obstetricia et Gynecologica Scandinavica 103(12). p.2540-2553
Abstract
Introduction
Data regarding the impact of adenomyosis on the outcomes after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment are conflicting. Standardized diagnostic criteria are prerequisites for studying a potential association between adenomyosis and IVF/ICSI treatment outcomes. This study aims to examine the cumulative live birth rate (CLBR) after the first IVF/ICSI treatment in women with or without direct or indirect features of adenomyosis, using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions.

Material and Methods
This was a prospective cohort study of 1037 women aged 25–≤39 years, undergoing their first IVF/ICSI treatment between January 2019 and... (More)
Introduction
Data regarding the impact of adenomyosis on the outcomes after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment are conflicting. Standardized diagnostic criteria are prerequisites for studying a potential association between adenomyosis and IVF/ICSI treatment outcomes. This study aims to examine the cumulative live birth rate (CLBR) after the first IVF/ICSI treatment in women with or without direct or indirect features of adenomyosis, using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions.

Material and Methods
This was a prospective cohort study of 1037 women aged 25–≤39 years, undergoing their first IVF/ICSI treatment between January 2019 and October 2022. The presence of MUSA features of adenomyosis was assessed prior to treatment start.

Results
The CLBR after the first IVF/ICSI treatment was 424/1037 (40.9%, 95% CI, 37.9–43.8) in the total cohort. Women with direct features of adenomyosis had lower CLBR, 25/102 (24.5%; 95% CI, 17.5–31.5) than women without, 399/935 (42.7%; 95% CI, 39.5–45.8), p < 0.001. The adjusted relative risk (aRR) for live birth for women with direct features of adenomyosis compared to women without was 0.62 (95% CI, 0.43–0.88), p = 0.007. Direct features were associated with a higher risk of miscarriage after frozen embryo transfer, aRR 2.88 (95% CI, 1.49–5.57), p = 0.002. Women with indirect features had a lower CLBR [50/188 (26.6%, 95% CI, 20.3–32.9)] than women without [399/935, (42.7%, 95% CI, 39.5–45.8)], aRR 0.58 (95% CI, 0.45–0.75), p < 0.001. For features located in the inner myometrium, the aRR for live birth was 0.29 (95% CI 0.11–0.74), p = 0.010 and for the outer myometrium 2.61 (95% CI 1.42–4.8), p = 0.002. An interrupted junctional zone was the single feature that impacted CLBR the most.

Conclusions
The presence of direct or indirect MUSA features of adenomyosis correlates to reduced live birth rates in women undergoing their first IVF/ICSI treatment. Features located in the inner myometrium, particularly an interrupted junctional zone, reduced the chance of live birth the most, whereas location in the outer myometrium was associated with higher chances of live birth. Systematic ultrasound examinations should be considered for women scheduled for IVF/ICSI treatment, for adequate counseling on the chances of successful treatment. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adenomyosis, live birth rate, ultrasound, IVF/ICSI, assisted reproductive treatment, morphological uterus sonographic assessment group (MUSA)
in
Acta Obstetricia et Gynecologica Scandinavica
volume
103
issue
12
pages
2540 - 2553
publisher
Wiley-Blackwell
external identifiers
  • pmid:39382305
  • scopus:85205872056
ISSN
1600-0412
DOI
10.1111/aogs.14986
project
Deep infiltrating endometriosis (DIE) diagnosed by ultrasound in subfertile women - effect on Anti-Müllerian Hormone (AMH), antral follicle count (AFC) and fertility treatment outcome.
language
English
LU publication?
yes
id
9e412206-b3f1-41e0-8642-472627d13955
date added to LUP
2024-10-09 21:26:52
date last changed
2025-04-04 14:23:19
@article{9e412206-b3f1-41e0-8642-472627d13955,
  abstract     = {{Introduction<br/>Data regarding the impact of adenomyosis on the outcomes after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment are conflicting. Standardized diagnostic criteria are prerequisites for studying a potential association between adenomyosis and IVF/ICSI treatment outcomes. This study aims to examine the cumulative live birth rate (CLBR) after the first IVF/ICSI treatment in women with or without direct or indirect features of adenomyosis, using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions.<br/><br/>Material and Methods<br/>This was a prospective cohort study of 1037 women aged 25–≤39 years, undergoing their first IVF/ICSI treatment between January 2019 and October 2022. The presence of MUSA features of adenomyosis was assessed prior to treatment start.<br/><br/>Results<br/>The CLBR after the first IVF/ICSI treatment was 424/1037 (40.9%, 95% CI, 37.9–43.8) in the total cohort. Women with direct features of adenomyosis had lower CLBR, 25/102 (24.5%; 95% CI, 17.5–31.5) than women without, 399/935 (42.7%; 95% CI, 39.5–45.8), p &lt; 0.001. The adjusted relative risk (aRR) for live birth for women with direct features of adenomyosis compared to women without was 0.62 (95% CI, 0.43–0.88), p = 0.007. Direct features were associated with a higher risk of miscarriage after frozen embryo transfer, aRR 2.88 (95% CI, 1.49–5.57), p = 0.002. Women with indirect features had a lower CLBR [50/188 (26.6%, 95% CI, 20.3–32.9)] than women without [399/935, (42.7%, 95% CI, 39.5–45.8)], aRR 0.58 (95% CI, 0.45–0.75), p &lt; 0.001. For features located in the inner myometrium, the aRR for live birth was 0.29 (95% CI 0.11–0.74), p = 0.010 and for the outer myometrium 2.61 (95% CI 1.42–4.8), p = 0.002. An interrupted junctional zone was the single feature that impacted CLBR the most.<br/><br/>Conclusions<br/>The presence of direct or indirect MUSA features of adenomyosis correlates to reduced live birth rates in women undergoing their first IVF/ICSI treatment. Features located in the inner myometrium, particularly an interrupted junctional zone, reduced the chance of live birth the most, whereas location in the outer myometrium was associated with higher chances of live birth. Systematic ultrasound examinations should be considered for women scheduled for IVF/ICSI treatment, for adequate counseling on the chances of successful treatment.}},
  author       = {{Alson, Sara and Henic, Emir and Hansson, Stefan and Sladkevicius, Povilas}},
  issn         = {{1600-0412}},
  keywords     = {{Adenomyosis; live birth rate; ultrasound; IVF/ICSI; assisted reproductive treatment; morphological uterus sonographic assessment group (MUSA)}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{12}},
  pages        = {{2540--2553}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Obstetricia et Gynecologica Scandinavica}},
  title        = {{Correlation of adenomyosis features to live birth rates after the first IVF/ICSI treatment, when using the revised Morphological Uterus Sonographic Assessment group definitions}},
  url          = {{http://dx.doi.org/10.1111/aogs.14986}},
  doi          = {{10.1111/aogs.14986}},
  volume       = {{103}},
  year         = {{2024}},
}