ArticleArchives of gynecology and obstetrics2026
Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study.
Article in Archives of gynecology and obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear.
methodsWe conducted a multicenter retrospective study of 199 premenopausal women (32-49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010-May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings-including pelvic endometriosis-with ART use and live birth.
resultsThe extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88-0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002-1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054-0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor.
conclusionAdenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.
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