Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study

Abstract

Purpose

The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear.

Methods

We conducted a multicenter retrospective study of 199 premenopausal women (32–49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010–May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings—including pelvic endometriosis—with ART use and live birth.

Results

The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88–0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002–1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054–0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor.

Conclusion

Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.