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Obstetrics and Gynecology International
Volume 2012, Article ID 786132, 8 pages
Review Article

Infertility and Adenomyosis

1Institute of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Largo Agostino Gemelli, 00168 Roma, Italy
2Department of Gynaecology, Obstetrics and Urology, Sapienza University of Rome, Policlinico Umberto I, 00161 Roma, Italy

Received 4 August 2011; Accepted 25 November 2011

Academic Editor: Mittal Suneeta

Copyright © 2012 Sebastiano Campo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Classically, the diagnosis of adenomyosis has only been possible on a hysterectomy specimen, usually in women in their late fourth and fifth decades, and, therefore, evaluating any relationship with infertility was simply not possible. As a consequence, to this day, no epidemiologic data exists linking adenomyosis to a state of subfertility. Today, new imaging techniques have enabled a noninvasive diagnosis at a much earlier time and a number of single-case or small series reports have appeared showing that medical, surgical, or combined treatment can restore fertility in women with adenomyosis, an indirect proof of an association. At the functional level, several anomalies found in the so-called junctional zone, or inner myometrium, in adenomyosis patients have been shown to be associated with poor reproductive performance, mainly through perturbed uterine peristalsis. Additional evidence for an association comes from experimental data: in baboons, adenomyosis is associated with lifelong primary infertility, as well as to endometriosis. Finally, indirect proof comes from studies of the eutopic and ectopic endometrium in women with adenomyosis proving the existence of an altered endometrial function and receptivity. In conclusion, sufficient indirect proof exists linking adenomyosis to infertility to warrant systematic clinical studies.