Español 
Français 
Deutsch 
Italiano 
Nederlands 
International 
Adenomyosis and assisted reproduction: diagnosis, classification and personalised treatment
Adenomyosis is a benign uterine pathologies in which endometrium-like tissue is found within the uterine muscle, known as the myometrium. Although it can occur in isolation, it can also coexist with other gynaecological conditions such as endometriosis.
We spoke to Dr Sergio Rogel Cayetano, an expert in reproductive medicine, about why adenomyosis affects fertility and can be a cause of female infertility.
- Adenomyosis: What is it?
- Adenomyosis and endometriosis: what are the differences?
- How does adenomyosis affect fertility?
- Symptoms of adenomyosis
- How is adenomyosis diagnosed? Tests for adenomyosis:
- Is there a cure for adenomyosis? Treatment of adenomyosis prior to embryo transfer
- Frequently asked questions about adenomyosis and assisted reproduction
- Do you have adenomyosis and are you trying to get pregnant?
- Our fertility treatments
- The best fertility clinics in Spain
Adenomyosis: What is it?
Adenomyosis is a benign uterine pathologies in which tissue similar to the endometrium is found within the uterine muscle, known as the myometrium. Although it can occur on its own, it can also co-exist with other gynaecological conditions such as endometriosis.
Adenomyosis and endometriosis: what are the differences?
Endometriosis and adenomyosis are distinct conditions; they are not the same thing.
In endometriosis, endometrium-like tissue is found outside the uterus, for example, on the ovaries, the fallopian tubes or in the pelvic cavity.
In contrast, in adenomyosis, this tissue grows within the myometrium, the muscular layer of the uterine wall.
Both conditions can coexist in the same patient, so it is important to carry out a proper medical assessment to establish the diagnosis.
How does adenomyosis affect fertility?
In terms of fertility, adenomyosis can affect embryo implantation, increase the risk of miscarriage or complicate the course of pregnancy, particularly when it affects the junction between the endometrium and the myometrium.
Adenomyosis can make it difficult to conceive for the following reasons:
- Changes in the shape and size of the uterus.
- Abnormal uterine contractions that may interfere with the transport of sperm and the embryo.
- Reduced endometrial receptivity, which can hinder implantation.
Furthermore, uterine adenomyosis has been associated with an increased risk of:
- Implantation failure.
- Spontaneous miscarriage or recurrent miscarriage.
- Ectopic pregnancy.
Adenomyosis may also co-exist with endometriosis or fibroids, and therefore requires an individualised assessment. For this reason, at Vida Fertility we do not treat adenomyosis as a mere ultrasound finding, but as a condition that must be assessed on a case-by-case basis before planning IVF, an embryo transfer or any assisted reproduction treatment.
Symptoms of adenomyosis
Adenomyosis does not always cause discomfort. Some women have no symptoms or only very mild ones, whilst others experience symptoms that can significantly affect their wellbeing and quality of life.
The most common symptoms are:
- Very painful periods (dysmenorrhoea).
- Heavy periods or periods lasting longer than usual (menorrhagia).
- Anaemia as a result of heavy menstrual bleeding.
- Pain during sexual intercourse (dyspareunia).
- Bleeding between periods.
- Pelvic or lower back pain.
- Difficulty conceiving.
- Assessment of uterine volume.
- Examination of the endometrium-myometrium junction.
- Identification of myometrial cysts or lesions consistent with adenomyosis.
The severity of symptoms can vary from one woman to another and does not always reflect the extent of adenomyosis.
After menopause, symptoms usually subside due to the decrease in hormonal activity.
However, in the event of very painful periods, heavy bleeding or reproductive problems, it is advisable to seek a gynaecological assessment to identify the cause and determine the most appropriate treatment.
How is adenomyosis diagnosed? Tests for adenomyosis:
The first step is to undergo a specialist gynaecological assessment. Depending on the individual case, the assessment may include:
- Transvaginal ultrasound.
- Magnetic resonance imaging (MRI).
- Hysteroscopy, hysterosalpingography, endometrial biopsy.
- Review of previous treatments, implantation failures, recurrent miscarriages or previous IVF attempts.
According to Dr Rogel, “A review of previous treatments and the patient’s response may lead us to suspect the presence of adenomyosis, as may symptoms such as heavy menstrual bleeding or pelvic pain. However, these factors are merely signs of suspicion and do not, on their own, confirm the diagnosis; they must be supplemented by imaging tests and a specialist gynaecological assessment.”
These are some of the methods used to diagnose adenomyosis; however, in some cases, further tests may be requested, at the doctor’s discretion.
Is there a cure for adenomyosis? Treatment of adenomyosis prior to embryo transfer
Treatment for adenomyosis must be tailored to the individual. Not all patients require the same approach, and not all cases have the same impact on fertility.
At Vida Fertility, the medical protocol may include different strategies depending on the severity, symptoms, the patient’s age, available embryos, ovarian reserve, history of IVF and the type of transfer planned.
Options that the medical team may consider include:
- Hormone treatment prior to IVF to reduce the activity of adenomyosis.
- Protocols using GnRH analogues or antagonists in selected cases.
- Combination treatments in patients with severe adenomyosis, a history of implantation failure or persistent hyperoestrogenism.
- Surgical or hysteroscopic assessment of focal, cystic or refractory lesions, provided this offers a reproductive benefit.
The aim is not to apply a standard protocol to all patients, but to improve uterine conditions prior to transfer and, where possible, to reduce factors that may hinder implantation or the progression of pregnancy.
Adenomyosis in IVF patients
In patients with adenomyosis who are about to begin an IVF cycle, treatment must be tailored to the extent of the disease, symptoms and reproductive history.
Preparation prior to embryo transfer may include medication to temporarily reduce hormonal activity and the inflammation associated with adenomyosis.
Recent studies are investigating whether combining pituitary suppression with treatments that modulate the action of oestrogens could improve the uterine response and promote pregnancy.
However, these strategies are not suitable for all patients and must be assessed on a case-by-case basis.
Adenomyosis and implantation failure
The latest research on adenomyosis specifically links alterations in the junction between the endometrium and the myometrium to a possible reduction in endometrial receptivity.
Therefore, in cases of recurrent implantation failure (including instances where pregnancy is not achieved following the transfer of euploid embryos), it is advisable to investigate the presence and extent of adenomyosis.
Treatment may be medical and, in selected cases, surgical. The decision must take into account symptoms, ultrasound findings, age, reproductive history and the planned fertility treatment.
An accurate diagnosis enables the uterus to be prepared and embryo transfer to be planned on an individualised basis, although no treatment can guarantee implantation.
Frequently asked questions about adenomyosis and assisted reproduction
Dr Sergio Rogel answers:
Can you get pregnant if you have adenomyosis?
Yes, you can get pregnant with adenomyosis. However, adenomyosis can affect embryo implantation, increase the risk of miscarriage or complicate the course of pregnancy, particularly when it affects the junction between the endometrium and the myometrium.
Its impact depends on the extent, location, symptoms and reproductive history of each patient.
Is it necessary to treat adenomyosis before an embryo transfer?
Not always, but in patients with moderate or severe adenomyosis, significant symptoms, recurrent miscarriages or previous implantation failures, the medical team may recommend prior treatment to improve uterine conditions before the transfer.
What is the best treatment for adenomyosis if I want to get pregnant?
There is no single treatment that works for all patients. The strategy may include hormonal therapy, personalized endometrial preparation, delayed transfer, surgery in selected cases, or combined protocols. The decision depends on the severity of the adenomyosis, the patient’s age, ovarian reserve, available embryos, and fertility history.
Do you have adenomyosis and are you trying to get pregnant?
If you’ve been diagnosed with adenomyosis and have been trying to get pregnant for some time without success, it’s advisable to undergo a specialized evaluation before starting fertility treatment.
At Vida Fertility, we take a personalized approach to your case to assess the impact of adenomyosis on your fertility.
Schedule your first consultation and tell us about your situation. Our medical team will guide you through the next steps.
Vida Fertility Events
At Vida Fertility, we believe that feeling informed is the first step towards a more confident fertility journey.
Through our events, talks and private consultations, we help patients understand their options, ask questions and receive personalised guidance from our fertility specialists in Spain.
Discover our upcoming events and meet the Vida Fertility team.
Ask for a consultation
You may also like
Last news
Testimonials
The best fertility clinics in Spain
📍 C/ Palermo 15, Hortaleza, 28043 Madrid
📞 Phone number: +34 919 29 83 23
🕒 Opening hours: Monday to Friday from 8am to 7pm
📍 Av. Óscar Esplá 1, Bajo, 03008 Alicante
📞 Phone number: +34 919 29 83 23
🕒 Opening hours: Monday to Friday from 8am to 7pm
ℹ️ The information published on Vida Fertility is reviewed by our fertility specialists and medical team, following up-to-date scientific criteria and evidence-based medicine. Our team is a member at scientific societies such as SEF, ESHRE and SEGO.