1. Introduction
abortion, menstrual abnormalities, ±, uterine adenomyosis, reduced menorrhagia, infertility, dysmenorrhea, adenomyosis, muscular hypertrophic, menorrhagia, Adenomyosis
ENDOMETRIOSIS, OBSTETRICAL COMPLICATIONS, DYSMENORRHEA, ADENOMYOSIS, SECONDARY, MENORRHAGIA, ADENOMYOSIS
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, Adenomyosis is a pathological finding characterized by heterotopic growth of endometrial glands and stroma into the myometrium and is accompanied by a varying degree of muscular hypertrophic changes. Adenomyosis has been suggested to be associated with menstrual abnormalities, and affected women have compromised fertility; they often need assisted reproductive technology (ART) for reproduction.Like endometriosis, adenomyosis can impair successful pregnancy during ART, although the relation between uterine adenomyosis and infertility is not clearly defined. Adenomyosis can affect uterine or endometrial receptivity, and it leads to increased abortion rates.Several studies reported that various surgical methods, including endometrial resection, open or laparoscopic myometrial reduction by electrocautery, and excision of adenomyosis, reduced menorrhagia and dysmenorrhea as well as the need for hysterectomy in patients with adenomyosis.We modified previously reported conservative methods to facilitate effective reduction of diffuse adenomyotic lesions by including T- or transverse H-incision, utilization of an argon laser, sonographic measurement of the pathological lesion during the operation, and a novel suture technique for uterine reconstruction. We intended to improve menstrual symptoms, increase pregnancy rates, and decrease obstetrical complications after maximal reduction of pathologic adenomyotic tissue while preserving the endometrium and normal myometrial tissues. Uterus-sparing surgery appears to be an attractive option for treating adenomyosis and preserving fertility, but there is a paucity of well-designed prospective studies evaluating fertility and pregnancy outcomes after surgery.The primary objective of this study was to assess whether this novel method of adenomyomectomy could improve pregnancy rates, and secondary goal was to evaluate whether it could improve dysmenorrhea and menorrhagia symptoms in infertile patients with severe adenomyosis via a well-designed prospective trial.