Adenomyoma and Hysteroscopy

Adenomyomas are benign overgrowths of the glandular endometrium within the muscular myometrium; if large, they can cause the same distortion of the endometrial cavity seen with fibroids and thus possibly contribute to menorrhagia, dysmenorrhea, infertility, recurrent pregnancy losses, recurrent implantation failures, etc. Although not very common, with introduction of non-invasive imaging techniques like MRI and 3D transvaginal ultrasound, increasing number of cases have been reported. Majority (80%) of cases were reported between the age 40 and 50 years; with increasing age of marriage and of first conceptions, more cases are being reported with subfertility. Adenomyosis prevalence was reported as high as 38.2% [1, 2]; in those with previous ART, failure is 34.7%. Not only adenomyosis has great impact on fertility treatment, with 28% reduction in the likelihood of clinical pregnancy at in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI), but presence of adenomyosis also increases the risk of miscarriage (more than double) and reduction in the likelihood of delivering a viable baby by overall 30%. This rise in miscarriage rate is observed in donor cycles too, i.e., it is independent of oocyte and embryo quality [3, 4].