Fertility Considerations
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How adenomyosis affects fertility and pregnancy, with evidence-based guidance on diagnosis, treatment strategies, IVF outcomes, and fertility preservation to help you plan timing and next steps with your care team.
Overview
Adenomyosis can make conception and pregnancy more challenging by disrupting the uterine muscle and the junctional zone, which coordinate implantation and early placentation. Many people also have endometriosis, but the focus here is how adenomyosis—especially a thickened junctional zone and abnormal uterine contractions—can reduce implantation rates and raise miscarriage and preterm birth risks. Learn how disease pattern and extent influence planning, and when to consider expedited referral to a fertility specialist.
Expect practical guidance on using high‑quality MRI and ultrasound to stage disease and tailor care, including differences between focal adenomyoma and diffuse involvement. Explore evidence‑based strategies such as short courses of preconception suppression before frozen embryo transfer, when surgery may help focal disease, and when IVF is preferred over IUI or expectant management. Links to related topics clarify next steps, including imaging details in Imaging & Diagnosis (MRI, Ultrasound), pattern‑specific care in Focal Adenomyosis and Diffuse Adenomyosis, and uterus‑sparing procedures in Surgical Options. For coexisting endometriosis or ART protocol questions, see IVF & ART for broader fertility planning perspectives.
How does adenomyosis affect chances of pregnancy and miscarriage risk?
Adenomyosis can lower implantation rates and increase early miscarriage because the junctional zone and uterine contractions become disorganized, making it harder for an embryo to attach and remain stable. Risk tends to rise with more diffuse disease and larger uterine enlargement, and coexisting endometriosis can compound the effect.
Is IVF recommended over IUI or timed intercourse when adenomyosis is present?
For moderate to severe adenomyosis, IVF with frozen embryo transfer often outperforms IUI because it bypasses impaired tubal transport and allows pre‑transfer uterine preparation. Younger patients with mild, focal disease may still conceive naturally; individualized plans should incorporate age, disease pattern, and results from Imaging & Diagnosis (MRI, Ultrasound).
Should I consider surgery for adenomyosis before trying to conceive?
Surgery can help when a focal adenomyoma distorts the cavity or causes significant pain or bleeding, and may improve fertility in select cases. Diffuse adenomyosis is harder to treat surgically and carries uterine integrity considerations; discuss risks, healing time, and delivery planning within Surgical Options and the nuances in Focal Adenomyosis and Diffuse Adenomyosis.
Does pre‑treatment with medication improve IVF or FET outcomes?
Many centers use 2–3 months of suppression (often with a GnRH agonist or other progestin‑dominant approaches) before frozen embryo transfer to reduce inflammation and normalize uterine contractility. The regimen and duration are tailored to symptoms, imaging severity, and side‑effect tolerance, with add‑back therapy considered for comfort.
When should I think about egg freezing or fertility preservation?
Adenomyosis itself does not lower egg supply, but time, age, and coexisting endometriosis may. If treatment or recovery will delay trying to conceive—or if you are in your mid‑30s or older—discuss egg or embryo freezing as a proactive step alongside ART planning in IVF & ART.
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