Prevalence of Adenomyosis and its Ultrasound Equivalents in Infertility
Mazmanyan I. Tokhunts K. Arustamyan K. Abgaryan N., Sargsyan Sh. Adamyan M.
1 "Glasbo: Medical Center, Yerevan, Armenia
2 Department of Obstetrics, Gynecology and Reproductive Medicine, Heratsi Yerevan State Medical University, Yerevan, Armenia
3 Department of Obstetrics and Gynecology, Heratsi Yerevan State Medical University, Yerevan, Armenia
ABSTRACT
Introduction: Adenomyosis is a chronic gynecological disease characterized by the invasion of endometrioid tissue into the myometrium with subsequent hypertrophy and remodeling of the uterine wall. This condition is closely associated with subfertility, implantation disorders, and adverse reproductive outcomes. Despite advances in imaging techniques, particularly transvaginal ultrasound examination (TVUS) and magnetic resonance imaging, the diagnosis of adenomyosis in the early stages remains challenging and is often delayed for 6-8 years, leading to delays in the onset of treatment.
Aim: The purpose of this prospective study, conducted in 2022-2024, was to estimate the prevalence of adenomyosis and its ultrasound equivalents in women with infertility.
Methods: The study included 518 patients aged 20-40 years with primary or secondary infertility, repeated implantation failures and habitual pregnancy losses. All women underwent 2-dimensional and 3-dimensional TVUS. A total of 140 patients with pathologies that hindered visualization were excluded from the analysis. Adenomyosis was diagnosed in 149 patients (28.8%): 26.4% in the 20-35 age group and 35.9% in the 36-40 age group. Almost a third of women (29.5%) had a combination of adenomyosis and deep infiltrative endometriosis.
Results: The most frequent ultrasound findings were junctional zone abnormalities (100%), subendometrial lines, and myometrial cysts. Diffuse form of adenomyosis occurred most often (65.1%), while focal and mixed types were less common. Some patients had uterine cavity deformations and an S-sign, which complicated the image interpretation.
Conclusion: Adenomyosis has a high prevalence in women with infertility, and in most cases (over 70%), it is first diagnosed only during a comprehensive examination. The implementation of international “Morphological Uterus Sonographic Assessment” (MUSA) criteria and a thorough assessment of ultrasound equivalents allow increasing the accuracy and timeliness of diagnostics, which is crucial for optimizing management tactics and increasing the effectiveness of infertility treatment.
Keywords: adenomyosis, prevalence, infertility, ultrasound signs