Uterotubal transport disorder in adenomyosis and endometriosis—a cause for infertility

TLDR

Uterine hyperperistalsis and dysperistalsis are common in endometriosis and may reduce fertility, and adenomyosis is also frequently present in mild to moderate cases. The study aimed to determine whether uterine peristaltic abnormalities in endometriosis are caused by the disease itself or by its adenomyotic component. In a prospective observational cohort of 41 infertile endometriosis patients with patent tubes, 85 % had adenomyosis and all underwent T2‑weighted MRI and hysterosalpingoscintigraphy to assess adenomyosis extent and uterotubal transport. Transport impairment was more common in patients with adenomyosis—especially diffuse—than in those without, indicating that the adenomyotic component largely explains reduced fertility despite.

Abstract

Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease.A prospective observational study.University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year.Forty-one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty-five subjects (85%) additionally showed signs of adenomyosis.All subjects underwent T2-weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG.Influence of adenomyosis on uterotubal transport capacity in endometriosis.In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2-weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport).Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo-ovarian anatomy.