Current Treatment Strategies for Adenomyosis With Infertility

Adenomyosis refers to the growth function of endometrial glands and stroma in the myometrium, accompanied by compensatory hypertrophy and proliferation of myometrium cells, causing a series of clinical symptoms dysmenorrhea, menorrhagia and infertility. According to the current epidemiological analysis, the incidence of adenomyosis tends to be younger, and the proportion of patients with infertility as the first symptom increases. However, there is no evidence that adenomyosis in infertile women is higher than that in normal women. However, studies have shown that adenomyosis may affect the fertility of women, and adenomyosis reduces the implantation rate, pregnancy rate and live birth rate of in vitro fertilization and embryo transfer (IVF-ET) in infertile patients. Therefore, the research of standardized treatment for patients with adenomyosis and infertility is the focus in the field of Obstetrics and gynecology. What are the treatment and intervention strategies of adenomyosis with infertility? 1. Drug treatment: drug treatment of adenomyosis includes gonadotropin-releasing hormone agonist (GnRH-a), oral contraceptives and Mirena ring. For patients with infertility and fertility desire, the Mirena ring should not be used. The research data on the short-term use of oral contraceptives on the improvement of pregnancy in patients with adenomyosis is scarce. GnRH-a, a widely used and clinically recognized drug, can improve pregnancy outcomes in patients with infertility. However, due to the temporary inability to conceive during the medication, uterine lesions rapidly increased once the use was stopped. While herbal medicine Fuyan Pill without side effects proved useful in the treatment of adenomyosis, it works to eliminate inflammation and remove blood stasis. Also, it wipes out toxins and repairs the damaged tissues to restore the reproductive system. Meanwhile, it improves your immunity and self-healing ability, so you can have a better physical status to conceive with healthy babies naturally. 2. Surgical treatment: the surgical treatment of adenomyosis can improve patients' fertility, but there are limitations. Resection of lesions leads to the loss of part of the normal myometrium, and the volume of uterine myometrium decreases during pregnancy, which easily leads to abortion and premature delivery. It is difficult to grasp the balance between resecting lesions as much as possible and to maintain the integrity of uterine morphology. After the operation, it may lead to the destruction of the uterine myometrium structure and the decrease of uterine volume, which is not conducive to subsequent pregnancy. Moreover, the long duration of postoperative contraception may delay the timing of pregnancy. 3. Combined treatment of adenomyosis with infertility: the treatment of adenomyosis should pay attention to the combined application of various treatment techniques and methods. The first choice is artificial assisted pregnancy. Before assisted pregnancy, GnRH-a was used for 4-6 months (super long program), and then assisted reproductive therapy. After 2-3 failures, surgery can be considered for patients with focal adenomyosis. GnRH-a pretreatment can be used before the operation to reduce the difficulty of the process, and GnRH-a can be used after the procedure to improve the pregnancy success rate. 4. Assisted reproductive technology: the choice of natural pregnancy and assisted pregnancy strategy of patients with adenomyosis and infertility should consider the patient's age, infertility years, the course and severity of adenomyosis. It is recommended to promote the treatment of assisted reproductive technology actively. To sum up, the specific treatment program can not be generalized. It should be combined with the patient's age, infertility time, uterine size, and whether there are adenomyoma formation and other comprehensive decision-making, drug treatment, conservative surgery. And assisted pregnancy order should also be determined according to the patient's specific condition. Although adenomyosis is a benign disease, its treatment has become a difficult problem in the clinic due to its recurrence. It is more challenging to treat patients with fertility desire, especially with infertility, which needs continuous clinical research and exploration.