Sifting Through the Diagnosis: Understanding Adenomyosis and Fertility - To Treat or Not to Treat?
June 23, 2023

Many infertile women will find that when they do a routine vaginal ultrasound scan, the doctor will tell them that they have adenomyosis. This is an especially common diagnosis if they happen to have endometriosis as well, as the two are often associated. Most patients are not sure how they should deal with this adenomyosis. Now, we need to understand that adenomyosis is a wide spectrum of diseases and that a lot of fertile women will have adenomyosis, which is a purely incidental finding, which doesn't affect their fertility at all, because the baby grows within the uterine cavity, whereas adenomyosis is found inside the wall of the uterus (the uterine muscle ) and will not affect pregnancy at all. However, it's very difficult to predict what the effect of adenomyosis is, and because gynecologists love doing surgery, and they enjoy making a diagnosis and finding something to treat, a lot of them become extremely trigger-happy, and when they find patients whose ultrasound report says they have adenomyosis, even if it's quite small, or especially if it forms a nodule, they will often advise surgical excision of the adenomyosis (what is called an adenomyoma). Now this may be fun surgery for the doctor, but it is usually not a good idea for the patient for two reasons. Firstly, the surgery doesn't increase fertility at all, because the adenomyosis was just an incidental finding, which didn't affect your fertility in the first place, and should have been left alone. When you get pregnant, the wall of the uterus will stretch automatically and naturally as the baby grows, and will not affect your pregnancy at all! In fact, the doctor will not even be able to see the adenomyosis once you get pregnant! Secondly, the scarring that the surgery leaves behind will often end up reducing your chance of getting pregnant, even if you do decide to do IVF later on, which is why if it's minimal adenomyosis, it's better to ignore it – especially If it isn’t affecting your uterine cavity!

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.