Adenomyosis and dysmorphic uterus: is there a correlation? Analysis of reproductive outcomes after hysteroscopic metroplasty

Hysteroscopic metroplasty improves reproductive outcomes in women with a dysmorphic uterus, but the impact of adenomyosis in these patients is uncertain. We retrospectively analysed 69 women who underwent metroplasty for a dysmorphic uterus, with histological assessment of the excised tissue. Adenomyosis was more frequently identified at histology in patients with recurrent pregnancy loss compared to those with infertility/single miscarriage (54% vs. 27%, P=0.03). Following surgery, the clinical pregnancy rate in the overall cohort reached 65%, and the live birth rate (LBR) per pregnancy increased from 0% to 62% (P<0.01). Among patients with histological evidence of adenomyosis, the LBR was 43%, compared to 71% in those without adenomyosis (P=0.07). Hysteroscopic metroplasty appears to improve reproductive outcomes overall. Larger, prospective studies are needed to better define the role of adenomyosis in this patient population.