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Reproductive Surgery Uterine Surgery

Clinical efficacy of a novel method of fertility-preserving adenomyomectomy in infertile women with diffuse adenomyosis

Yoon SH, Lee GJ, Cho HJ, Kwon H, Yun BS, Lee CH, Park HS, Roh JW

Published March 31, 2023 Medicine (Baltimore)
DOI 10.1097/MD.0000000000033266 PMID 37000061 PMC PMC10063302

RRM Academy Synopsis

Adenomyosis surgery was followed by pregnancy in 18 of 33 women

About 5 out of 10 women in the trial who tried to conceive became pregnant after surgery. The operation spares the uterus. The single-group prospective trial in South Korea treated diffuse adenomyosis. About 3 out of 10 of those women had a viable pregnancy. Period pain scores fell sharply six months after surgery.

About 5 in 10 women who tried to conceive became pregnant after fertility-preserving surgery
About 5 in 10 women who tried to conceive became pregnant after fertility-preserving surgery. Source: Yoon SH et al., 2023, PMID 37000061.
Study at a glance, single-group prospective trial: Adenomyosis surgery was followed by pregnancy in 18 of 33 women
Study at a glance, single-group prospective trial of 50 infertile women: Adenomyosis surgery was followed by pregnancy in 18 of 33 women. Source: Yoon SH et al., 2023, PMID 37000061.

Key Findings

  • Of 50 infertile women enrolled, 45 had the surgery. Afterward, 33 tried to conceive, and 18 (54.5%) became pregnant by natural means, IVF embryo transfer, or thawed embryo transfer.
  • Ten of the 33 women (30.3%) had a viable pregnancy. The trial counted 13 live births, including 2 twin pregnancies and 1 woman who gave birth twice.
  • Painful-period (dysmenorrhea) scores on the numeric rating scale fell from 7.28 ± 2.30 to 1.56 ± 1.30 six months after surgery (P < .001).
  • Menstrual blood loss fell from 140.44 ± 91.68 to 66.33 ± 65.85 mL (P < .05).
  • Four women had postoperative complications: uterine shrinkage, premature ovarian insufficiency, ureter fistula, and subfascial hematoma. No uterine rupture occurred around delivery.

Interpretation

This prospective cohort study followed women with diffuse adenomyosis at one hospital in South Korea. Drug treatment or repeated IVF attempts had failed in these women, and clinicians traced their infertility to adenomyosis. Surgeons removed the diseased tissue while preserving the uterus. Women received GnRHa, a hormone-lowering drug, around surgery, and progestin during pregnancy. Pregnancies followed by natural conception, fresh IVF transfer, and thawed embryo transfer, with dysmenorrhea and menstrual blood loss both falling sharply afterward. The authors note the study's small sample size and plan a randomized trial. The findings support larger studies of fertility-preserving adenomyosis surgery.

RRM Context

Restorative reproductive medicine seeks the cause of infertility and treats it. Clinicians here traced infertility to adenomyosis and removed the diseased tissue through excision. The uterus stayed in place. Imaging can reveal this cause. Until then, the infertility is undiagnosed.

Our editorial summary of this paper, not the article's abstract.

Abstract

Beneficial and detrimental effect of surgical adenomyomectomy is still controversial in infertile women with severely diffuse adenomyosis. The primary objective of this study was to assess whether a novel method of fertility-preserving adenomyomectomy could improve pregnancy rates. The secondary objective was to evaluate whether it could improve dysmenorrhea and menorrhagia symptoms in infertile patients with severe adenomyosis. A prospective clinical trial was conducted between December 2007 and September 2016. Fifty women with infertility due to adenomyosis were enrolled in this study after clinical assessments by infertility experts. A novel method of fertility-preserving adenomyomectomy was performed on 45 of 50 patients. The procedure included T- or transverse H-incision of the uterine serosa followed by preparation of the serosal flap, excision of the adenomyotic tissue using argon laser under ultrasonographic monitoring, and a novel technique of suturing between the residual myometrium and serosal flap. After the adenomyomectomy, the changes in the amount of menstrual blood, relief of dysmenorrhea, pregnancy outcomes, clinical characteristics, and surgical features were recorded and analyzed. All patients obtained dysmenorrhea relief 6 months postoperatively (numeric rating scale [NRS]; 7.28 ± 2.30 vs 1.56 ± 1.30, P < .001). The amount of menstrual blood decreased significantly (140.44 ± 91.68 vs 66.33 ± 65.85 mL, P < .05). Of the 33 patients who attempted pregnancy postoperatively, 18 (54.5%) conceived either by natural means, in vitro fertilization and embryo transfer (IVF-ET), or thawing embryo transfer. Miscarriage occurred in 8 patients, while 10 (30.3%) had viable pregnancies. This novel method of adenomyomectomy resulted in improved pregnancy rates, as well as relief of dysmenorrhea and menorrhagia. This operation is effective in preserving fertility potential in infertile women with diffuse adenomyosis.

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Related research

Reproductive Surgery › Uterine Surgery › Myomectomy · Uterine and Pelvic Conditions › Adenomyosis › Adenomyosis Management · Infertility › Uterine Factor › Fibroids and Polyps
Sang Ho Yoon, Grace J Lee, Hye Jung Cho, Hayan Kwon, Bo Seong Yun, Chae Hyeong Lee, Hyun Soo Park, Ju-Won Roh
S Yoon, G Lee, H Cho, H Kwon, B Yun, C Lee, H Park, J Roh
PMID 37000061 37000061 DOI 10.1097/MD.0000000000033266 10.1097/MD.0000000000033266 Yoon et al. 2023, Yoon 2023

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