Focal Adenomyosis and Uterine Junctional Zone Abnormalities: Predictors of Live Birth Rates in Women with Infertility and Adenomyosis Undergoing Assisted Reproduction Technologies

Abstract Purpose: Previous studies have shown that adenomyosis increases the incidence of failure and recurrent miscarriage in patients undergoing in vitro fertilization embryo transfer.This study aimed to evaluate the relationship between the MRI characteristics of women with infertility and adenomyosis and their assisted reproduction technologies outcomes. Methods: This prospective observational cohort study included 1679 women diagnosed with adenomyosis via 3D ultrasound who underwent assisted reproduction technologies at reproductive center between October 2021 and December 2023. Pelvic magnetic resonance imaging was performed, and assessments were conducted according to standard diagnostic criteria. Baseline demographics, magnetic resonance imaging manifestations, as well as parameters and outcomes of the first embryo transfer cycle were collected. Clinical and imaging predictors of live birth in patients with adenomyosis were identified. Results: In total, 1,400 women with infertility and adenomyosis underwent magnetic resonance imaging and completed assisted reproduction. The mean age of the participants was 31.84±3.56 years. Ongoing pregnancies were achieved in 815 women, representing an ongoing pregnancy rate of 58.21%, whereas 787 women had live births, indicating a live birth rate of 56.21%. Multivariable logistic regression of magnetic resonance imaging characteristics identified focal adenomyosis and junctional zone abnormalities as predictors of live birth rates. Conclusion: This study represents a large-scale prospective observational cohort study to explore the relationship between magnetic resonance imaging features of adenomyosis and clinical outcomes of assisted reproduction technologies. Focal adenomyosis and junctional zone abnormalities emerged as factors influencing live birth rates.