Do We Try IVF First or Have Surgery to Deal with Adenomyosis Instead?

I believe that many women have the experience of dysmenorrhea; but, it doesn’t mean that it is endometriosis, especially adenomyosis. At the fertility stage, if you are diagnosed with adenomyosis, doctors always say "pregnant is the best treatment."
Consultation
2020-12-17
Author: Stork Fertility Center

 

I believe that many women have the experience of dysmenorrhea; but, it doesn’t mean that it is endometriosis, especially adenomyosis. At the fertility stage, if you are diagnosed with adenomyosis, doctors always say "pregnant is the best treatment."
We all know that In VitroFertilization (IVF) is the fastest and most promising way to be pregnant.
However, which is priority?

Do we try IVF first or have surgery to deal with adenomyosis instead?

Many people get the information whether from doctors or the internet have positive and negative opinions. As opinions vary, no unanimous conclusion can be drawn. Therefore, before making any decisions, you should understand the pros and cons of two options.

What is adenomyosis?

We must understand the endometriosis first. As the name implies, it means that the endometrial tissue is present entirely outside the uterus. The name of the disease we are familiar with is chocolate cyst. That is endometrial tissue abnormally attaches and grows in the ovaries and responds to monthly hormones. This tissue bleeds and fills the interior of these cysts with un-clotted blood. In contrast, the adenomyosis is a gynecologic medical condition characterized by the abnormal presence of endometrial tissue within the myometrium (the thick, muscular layer of the uterus).

Why does the endometrial tissue run into the myometrium? The real pathogenesis is not completely certain. Some studies indicate that the endometrial tissue may be squeezed into myometrium due to too much intrauterine pressure during delivering the baby or artificial abortion. But this is not the case; many patients had not been pregnant. Some even don’t have any sexual experience.

For patients with adenomyosis, the myometrium is filled with diffuse endometriotic lesions. Therefore, the uterus will become larger, and in severe cases it can be several times larger than the normal uterus.

And it will cause intensive contraction of the myometrium, which will make the blastocyst difficult to implant, or easy to abort and premature birth after pregnancy.

If choosing to treat adenomyosis with surgery, the basic principle is to "cut the roots of lesions in the myometrium” and excise it as much as possible so that the uterus can be completely "shaped" to the size of the normal uterus. However, leaving the broken uterus after surgery not only may cause the uterine cavity to deform, but also result in the blastocyst cannot be implanted successfully. It is also easy to hurt the ovarian function, result in a decrease in the number and quality of the oocytes, and affect the future treatment of IVF; Even, it may increase the risk of uterine rupture during pregnancy and threaten the mother and child's life. But, if excessively preserving the function of the uterus during the surgery, the symptoms cannot be completely cured. The pregnancy rate of doing IVF cannot be increased, and also wasting the time and health cost of the patient.

For women who are seeking pregnancy

The treatment must be different depending on the degree of symptoms and personal conditions. If the ovarian function is normal, in other words, the index of Anti-Mullerian Hormone (AMH) is above 2, and the age is below 38, you can consider the surgical reduction of the uterus, then treating it with the GnRH agonist such as Leuplin for 3 to 6 months, and then doing the IVF immediately. On the other hand, if the ovarian function has already been declining, we should undergo oocytes-retrieval several times to collect enough oocytes or blastocyst and then treat with surgery and injections. After the uterus is restored, we can have blastocyst transfer to increase the pregnancy rate.

Adenomyosis has a great influence on women at the fertility stage, which not only reduces the pregnancy rate but also seriously affects the quality of life. No matter to do the surgery at first or to try IVF, these two methods have their own pros and cons. It is necessary for patients to have a thorough communication with the doctor before making the decision on the strategy of treatment. And if you directly choose to try IVF rather than do the surgery, you may achieve the purpose of pregnancy. However, the pregnancy rate is low; it is easy to abort, and it is even possible to have a premature birth. Therefore, women who have adenomyosis only need to cooperate with the diagnosis and treatment of professional doctors. With strong perseverance and determination, I believe that you can overcome adenomyosis and welcome the happiness of pregnancy.

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