How Does Adenomyosis Affect Fertility and Egg Freezing?

What are the symptoms of adenomyosis?

Adenomyosis is usually associated with symptoms such as:

• Abnormal bleeding
• Dysmenorrhea or heavy menstrual bleeding
• Menorrhagia or prolonged menstrual bleeding
• Chronic pelvic pain
• Dyspareunia or painful sexual intercourse
• Infertility 

But these symptoms are also what makes the diagnosis a bit difficult, as these are similar to the symptoms associated with fibroids and endometriosis. 

And interestingly, there is a strong association between adenomyosis and endometriosis, with both conditions found in 54-90% of cases. 

How Does Adenomyosis Affect Fertility?

While we're still learning about the exact mechanisms, there are some research-backed reasons why adenomyosis might be impacting fertility. 

It's like having a garden where the soil conditions aren't quite right for seeds to grow! 🌱

Here’s some reasons why adenomyosis might serve as a barrier while TTC (trying to conceive):  

1. Altered Uterine Movement

Before this, a small recap 📺: Remember how the egg, once released, waits at the fallopian tube for sperm to swim and reach it?

Turns out the uterus naturally has subtle movements that help sperm travel. Once the egg is fertilised and grows into an embryo, these movements also support its travel till the uterus for implantation. 

But here’s where adenomyosis can be a barrier. This condition can disrupt these movements through what scientists call "uterine hyperperistalsis" - essentially, irregular uterine contractions, causing a barrier for sperm to travel till the egg.

2. Impaired Implantation

Essentially once the egg is fertilised at the fallopian tube, the next step is for the fertilised cells to divide and form an embryo (containing 70-120 cells) and implant in its new home, the uterus 🏠. 

But research has shown that adenomyosis can affect important factors needed for successful embryo implantation. 

For example, proteins like HOXA10 and LIF, which are crucial for embryo attachment, are reduced in women with adenomyosis. 

3. Changes in the Uterine Environment

Adenomyosis creates an inflammatory environment in the uterus and can alter hormone responses. These changes make it more difficult for an embryo to implant and grow.

Does Adenomyosis Cause Infertility?

This is a bit of a tricky question - however there are studies that indicate how adenomyosis may be linked to infertility. 

• A study by Kunz et al (2005) showed that adenomyosis was more common in women who had endometriosis, causing infertility 
• The same study had another analysis where they checked the junctional zone thickness for different age groups from 17 till >34. Their findings indicated that the incidence of adenomyosis increases with age, especially post 35 years.
• Studies also show a higher incidence of miscarriage with adenomyosis when trying to conceive naturally

Ultimately, the relationship between adenomyosis and fertility isn't completely clear- but these studies indicate a connection between adenomyosis and how it may impair specific steps of the fertilisation process. 

How is Adenomyosis Diagnosed?

Given that the symptoms of adenomyosis do overlap with conditions such as endometriosis or fibroids, two main imaging techniques (and a blood test) are used to specifically diagnose adenomyosis:

1. Transvaginal Ultrasound

This is usually the first diagnostic step. During this procedure, your doctor will insert a small, wand-shaped transducer into your vagina that creates sound waves to produce images of your uterus. What they're looking for is:

• An enlarged, more globular uterus than normal
• Blurring between endometrium (lining) and myometrium (muscle)
• "Island-like" areas of invaded endometrial tissue

This method is widely available, doesn't expose you to radiation, and is relatively affordable. The downside is that it might miss milder cases, and the quality of results depends heavily on the technician's experience.

2. Magnetic Resonance Imaging

For a more definitive diagnosis, your doctor might recommend an MRI, which provides much clearer and more detailed images. 

During an MRI, you'll lie on a table that slides into a tunnel-shaped machine. It can be a bit intimidating, but it's painless and gives your doctor the best view of what's happening inside. 

The MRI lets doctors examine something called the junctional zone—the border between your endometrial lining and muscle wall.

In healthy uteruses, this zone is typically no thicker than 5mm. When it measures 12mm or more, that's an indicator of adenomyosis. Your doctor will also look for irregularities or disruptions in this zone, along with bright spots on certain image types that suggest endometrial tissue invasion.

While MRI is the gold standard for non-invasive diagnosis, it comes with a higher price tag and may not be available everywhere.

3. CA-125 levels

Some doctors might also check your CA-125 levels through a blood test. While this isn't specific to adenomyosis (it's elevated in various conditions), it can support the diagnosis when combined with imaging findings. 

Can I Freeze My Eggs if I Have Adenomyosis?

In short: absolutely! 🎯

Women with adenomyosis can definitely freeze their eggs. While adenomyosis can make things a bit more complex, there are modified egg-freezing protocols and other treatments that help women with this condition preserve their fertility.

Is Egg Freezing Different for Women With Adenomyosis?

The core process - retrieving and freezing eggs - stays pretty much the same. But there are some special tweaks your doctor might make to help you get the best possible results:

1. Downregulated Pre-Treatment Protocols

Think of this like preparing your garden before planting seeds! 🌱

Your doctor might suggest using medications called GnRH agonists before starting the egg-freezing process. These help calm down the adenomyosis symptoms and reduce inflammation, potentially giving your future embryos a better environment to grow in.

2. Freeze-All Strategy

While it sounds fancy, the freeze-all strategy is basically preferring to freeze all eggs (like we do with egg freezing) and a frozen embryo transfer over a fresh embryo transfer. During a fresh embryo transfer, after egg retrieval, the embryo isn’t frozen and is transferred to the uterus about 5-7 days later. But with egg freezing and frozen embryo transfers, the uterus is first primed, and the transfer is planned later.

Especially for women with adenomyosis, research shows that freezing all eggs (instead of doing a fresh transfer right away) can significantly boost success rates. One study found that women who froze their embryos had a 44.1% live birth rate compared to 30.6% with fresh transfers. That's quite a difference!

3. Modified Medication Protocols

Given the symptoms of adenomyosis, your egg-freezing protocol might be modified, or your doctor may take these approaches:

Long protocol

Your doctor might recommend this to improve follicular growth and to avoid hormonal fluctuations that could increase adenomyosis symptoms. As per studies, this protocol tends to yield better pregnancy outcomes due to these reasons. 

Short protocol

Your doctor may recommend this if there’s a risk of poor ovarian response or if there’s a history of fewer eggs retrieved with previous cycles.  It's also great for women who want to avoid some of the side effects that can come with longer treatment plans. 

Ultimately, both protocols have their benefits - it really comes down to what works best for your body and your specific situation. It’s up to you and your doctor to decide which path makes the most sense for you.

Can I Get Pregnant with Adenomyosis?

The short answer is yes—you absolutely can get pregnant with adenomyosis. The longer answer is that it might be more challenging, and pregnancy might come with some additional monitoring and challenges.

If you're trying to conceive naturally with adenomyosis, you might face some specific challenges, such as:

• Abnormal contractions of your uterus (called hyperperistalsis), which might interfere with sperm transport—essentially making it harder for sperm to reach your fallopian tubes where fertilization happens
• Adenomyotic lesions in the uterus which might lead to higher incidence of first-trimester miscarriage, preterm labour or placental abnormalities 
• The changes in your endometrium might shorten the window of time when an embryo can successfully implant. 
• There might be higher miscarriage rates with IVF/ICSI cycles 
• Lastly, the inflammatory environment created by adenomyosis can also be less welcoming to a fertilized egg

These factors can make natural conception more difficult but not impossible.

But, there are treatments and protocols that can help manage these conditions and improve outcomes. These can temporarily suppress the effects of adenomyosis and improve chances of success.

Get Access to Expert Gynaecological Care in the UK, via Amilis Fertility

About 751,000 women are waiting for gynaecological care in the UK, of which 30,000 women have been waiting more than a year for an appointment.

Be it egg freezing, getting an ultrasound appointment or even getting a hormone panel done.

This not only prolongs a diagnosis but also affects our reproductive health and how the symptoms affect our daily life.

So at Amilis, we’re changing this narrative to make reproductive care accessible and affordable in the UK.

Here’s how:

• Match with fertility specialists and expert doctors for your needs, with no waiting times
• Wondering if you have adenomyosis symptoms or want to get it checked? Book a free consultation with our expert doctors, from best fertility clinics across the UK
• Have adenomyosis and want to freeze your eggs? Get discounted rates on consultations and egg-freezing packages via Amilis 

If you’re not there yet, or are just looking to get your fertility tested:

• Get your AMH tested for just £80 (50% cheaper than fertility clinics), discounts on AFC scans and get personalised, free reports
• You can also opt for a full hormone panel at discounted costs 

When you choose to assess your fertility via Amilis, you also get a stellar support team (that’s us 👋) supporting you at every step!

Figuring out where to get started? Book a free call, or take our personalised fertility quiz to know more!

We’re bridging the healthcare gap in the UK, one day at a time 💪🏻