ABSTRACT Aim To evaluate pregnancy outcomes by treatment approach and assess the appropriateness and safety of surgical intervention in patients with infertility and uterine adenomyosis. Methods A retrospective analysis was conducted on patients, diagnosed with adenomyosis at our institution from 2013 to 2023, who desired conception. The study population was divided into two groups by the presence or absence of surgical intervention, and the type of adenomyosis lesions, infertility treatment modalities, and pregnancy outcomes were evaluated. For patients who underwent adenomyomectomy, operative methods, pre‐ and postoperative endometrial thickness and dysmenorrhea severity, and perinatal complications in postsurgical pregnancies, were assessed. Results Twenty‐one patients with adenomyosis (10 non‐surgical; 11 surgical) were analyzed. All patients in the non‐surgical group had focal adenomyosis lesions, and 70% achieved pregnancy through intrauterine insemination or assisted reproductive technology, with a 50% live birth rate. Most surgical patients had diffuse adenomyosis lesions and endometrial thinning in the luteal phase. Seven patients underwent triple‐flap surgery, while four underwent double‐flap surgery; 36% of surgical patients achieved pregnancy through assisted reproductive technology, with an 18% live birth rate. All patients showed improvement in postoperative dysmenorrhea and a significant increase in luteal phase endometrial thickness. No uterine rupture occurred in postsurgical pregnancies, but one patient had a late miscarriage and placenta accreta. Conclusions Aggressive management of severe uterine adenomyosis with diffuse lesions through adenomyomectomy, followed by assisted reproductive technology, may be effective. Adenomyomectomy potentially enhances fertility by improving dysmenorrhea and thin endometria. However, careful management of postoperative pregnancies is necessary, considering perinatal complications.
Mandai et al. (Sun,) studied this question.