The Impact of Laparoscopic Versus Open Conservative Surgery for Adenomyosis on Subsequent In Vitro Fertilization Outcomes: A Retrospective Cohort Study

Background:With the widespread adoption of fertility-preserving conservative surgery for adenomyosis in clinical practice, the impact of different surgical approaches on subsequent reproductive outcomes has become a key clinical concern. This study aimed to investigate the impact of laparoscopic versus open conservative surgery for adenomyosis on subsequent in vitro fertilization (IVF) outcomes. Adenomyosis is a recognized cause of female infertility; yet, the optimal surgical approach for patients seeking to preserve fertility remains debated, and comparative data on their effect on subsequent IVF outcomes are limited.Methods:This single-center retrospective cohort study included 162 infertile women with adenomyosis who underwent primary conservative surgery (98 laparoscopic, 64 open) between January 2018 and December 2023. Diagnosis was confirmed by imaging and histopathology. Strict exclusion criteria were applied to minimize confounding. The primary outcome was live birth rate following postoperative IVF. Multivariate logistic regression was used to evaluate the independent effects of surgical approach and intraoperative factors on live birth.Results:Baseline characteristics were comparable between groups, except for a higher proportion of diffuse adenomyosis in the open surgery group (65.6% vs. 28.6%, p < 0.001). As expected, open surgery was associated with longer intraoperative blood loss (103 [55–140] vs. 61 [30–80] mL, p < 0.001), and larger resected lesion volume (40 [22–58] vs. 23 [12–32] cm3, p < 0.001). However, postoperative IVF parameters and pregnancy outcomes showed no significant differences. Clinical pregnancy rates (laparoscopic vs. open: 48.0% vs. 50.0%, p = 0.795) and live birth rates (36.7% vs. 37.5%, p = 0.917) were similar. Multivariate analysis confirmed that surgical approach was not an independent predictor of live birth (adjusted odds ratio [OR] = 1.05, 95% confidence interval [CI]: 0.54–2.04, p = 0.882). Intraoperative blood loss and resection volume were likewise not significantly associated with live birth.Conclusions:Within the limitations of this retrospective design, the choice between laparoscopic and open conservative surgery in infertile patients with adenomyosis was not found to significantly affect subsequent IVF live birth outcomes. Surgical decisions may therefore be guided by individual lesion characteristics and surgeon expertise, as the approach alone does not appear to compromise fertility potential based on the available evidence.