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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Reproductive Endocrinology

Adenomyosis, Fertility, and Pregnancy Outcomes

At a Glance

While adenomyosis can complicate fertility by causing uterine inflammation and disrupting embryo implantation, successful pregnancies are possible. Fertility specialists often use an ultra-long GnRH agonist protocol before IVF to reduce inflammation and improve your chances of a healthy baby.

For many patients with adenomyosis, the journey to parenthood can feel heavy with uncertainty. It is important to know that while adenomyosis does introduce specific challenges to fertility and pregnancy, successful pregnancy and healthy births are entirely possible with specialized care and modern protocols [1][2].

How Adenomyosis Affects Fertility

Adenomyosis creates a complex environment in the uterus that can make it difficult for an embryo to “stick” (implant).

  • Disrupted Implantation: The junctional zone (the transition layer between the lining and the muscle) is essential for successful implantation. In adenomyosis, this zone is often thickened or irregular, which can interfere with the embryo’s ability to settle into the uterine lining [3][4].
  • The Inflammatory Cycle: The disease produces a “vicious cycle” of local inflammation and high estrogen levels within the uterine wall [5]. This inflammatory state can impair decidualization—the process where the uterine lining prepares itself to nourish a new embryo [6][7].
  • Subtype Matters: Patients with diffuse adenomyosis (spread throughout the muscle) often face greater challenges with IVF and embryo transfer compared to those with the focal subtype [8].

Improving IVF Success: The Ultra-Long Protocol

Because inflammation is a major barrier, fertility specialists often use a strategy called the ultra-long GnRH agonist protocol [2].

  • What it is: This involves taking a hormonal medication (a GnRH agonist) for 2 to 3 months before an embryo transfer [2][9].
  • How it works: This medication temporarily “shuts down” your natural hormone production, essentially putting the adenomyosis to sleep. This reduces the size of the lesions, lowers local inflammation, and can help restore the uterine lining’s receptivity to an embryo [10][11].

Pregnancy: What to Expect

Once you are pregnant, your care team will monitor you more closely because adenomyosis is associated with several statistically significant risks [12]. These risks are manageable, but being aware of them helps you and your doctor stay proactive:

  1. Preterm Birth and PROM: There is an increased risk of delivering before 37 weeks or having your water break early (Premature Rupture of Membranes) [13][14]. This is especially true if the uterus is significantly enlarged or if the placenta attaches near an adenomyotic lesion [15][16].
  2. Placental Issues: Patients with adenomyosis have higher rates of placental complications, including placenta accreta (where the placenta grows too deeply into the wall) and placental malposition [17][18].
  3. Postpartum Hemorrhage: Because the uterine muscle is thickened and scarred, it may not contract as efficiently after birth, which can lead to heavier bleeding following delivery [12][13].

A Note of Validation

It is normal to feel anxious when you hear terms like “high risk” or “reduced live birth rates” [19]. However, these statistics are averages, and they do not determine your individual outcome. With a specialized team—often including a Reproductive Endocrinologist for conception and a Maternal-Fetal Medicine (high-risk OB) specialist for pregnancy—you can navigate these risks and focus on the goal of a healthy baby [17][20].

Return to Home Page

Common questions in this guide

How does adenomyosis affect my ability to get pregnant?
Adenomyosis creates a thickened junctional zone and high levels of local inflammation in the uterus. This makes it difficult for an embryo to successfully implant and develop in the uterine lining.
What is the ultra-long GnRH agonist protocol for adenomyosis?
This IVF strategy involves taking hormonal medication for two to three months before an embryo transfer. It temporarily stops your natural hormone production to reduce uterine inflammation and adenomyosis lesion size, improving the chances of implantation.
Will I have a high-risk pregnancy if I have adenomyosis?
Yes, adenomyosis is associated with an increased risk of pregnancy complications such as preterm birth, placenta accreta, and postpartum hemorrhage. You will likely be monitored closely by a maternal-fetal medicine specialist to safely manage these risks.
Does the type of adenomyosis I have impact IVF success?
Patients with diffuse adenomyosis, which is spread throughout the uterine muscle, often face greater challenges with IVF and embryo transfer compared to those with the more localized focal adenomyosis.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my imaging, how much is my junctional zone or uterine volume likely to affect my ability to conceive?
  2. 2.Would you recommend an 'ultra-long' GnRH agonist protocol before my embryo transfer to reduce uterine inflammation?
  3. 3.If I conceive, will I be referred to a Maternal-Fetal Medicine specialist to monitor for risks like preterm birth or placenta accreta?
  4. 4.Does the location of my adenomyosis (e.g., posterior wall) increase my risk for specific pregnancy complications?
  5. 5.What is your success rate for patients with my specific subtype (diffuse or focal) of adenomyosis?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
  1. 1

    Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease.

    Puente JM, Fabris A, Patel J, et al.

    Reproductive biology and endocrinology : RB&E 2016; (14(1)):60 doi:10.1186/s12958-016-0185-6.

    PMID: 27645154
  2. 2

    Ultra-Long GnRH Agonist Protocol During IVF/ICSI Improves Pregnancy Outcomes in Women With Adenomyosis: A Retrospective Cohort Study.

    Lan J, Wu Y, Wu Z, et al.

    Frontiers in endocrinology 2021; (12()):609771 doi:10.3389/fendo.2021.609771.

    PMID: 34135858
  3. 3

    The Significance of MRI Evaluation of the Uterine Junctional Zone in the Early Diagnosis of Adenomyosis.

    Sofic A, Husic-Selimovic A, Carovac A, et al.

    Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH 2016; (24(2)):103-6 doi:10.5455/aim.2016.24.103-106.

    PMID: 27147800
  4. 4

    Two- and three-dimensional ultrasonographic features related to histopathology of the uterine endometrial-myometrial junctional zone.

    Rasmussen CK, Hansen ES, Dueholm M

    Acta obstetricia et gynecologica Scandinavica 2019; (98(2)):205-214 doi:10.1111/aogs.13484.

    PMID: 30317553
  5. 5

    Hormone receptor profile of ectopic and eutopic endometrium in adenomyosis: a systematic review.

    Maclean A, Tipple L, Newton E, Hapangama DK

    Human reproduction open 2025; (2025(1)):hoaf002 doi:10.1093/hropen/hoaf002.

    PMID: 39935764
  6. 6

    The downregulation of FKBP5 contributes to the pathogenesis of adenomyosis and is associated with impaired endometrial receptivity†.

    Wang M, Xiang Y, Zhang D, et al.

    Biology of reproduction 2025; (113(4)):794-802 doi:10.1093/biolre/ioaf126.

    PMID: 40518930
  7. 7

    Transcriptome analysis of adenomyosis eutopic endometrium reveals molecular mechanisms involved in adenomyosis-related implantation failure and pregnancy disorders.

    Juárez-Barber E, Corachán A, Carbajo-García MC, et al.

    Reproductive biology and endocrinology : RB&E 2024; (22(1)):10 doi:10.1186/s12958-023-01182-7.

    PMID: 38195505
  8. 8

    The effect of adenomyosis types on clinical outcomes of IVF embryo transfer after ultra-long GnRH agonist protocol.

    Han B, Liang T, Zhang W, et al.

    Reproductive biomedicine online 2023; (46(2)):346-351 doi:10.1016/j.rbmo.2022.09.021.

    PMID: 36549997
  9. 9

    The rate of euploid miscarriage is increased in the setting of adenomyosis.

    Stanekova V, Woodman RJ, Tremellen K

    Human reproduction open 2018; (2018(3)):hoy011 doi:10.1093/hropen/hoy011.

    PMID: 30895252
  10. 10

    Effects of pretreatment strategies on fertility outcomes in patients with adenomyosis.

    Moawad G, Youssef Y, Fruscalzo A, et al.

    Frontiers in reproductive health 2024; (6()):1484202 doi:10.3389/frph.2024.1484202.

    PMID: 39717429
  11. 11

    Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes.

    French HM, Zhang W, Movilla PR, et al.

    Current opinion in obstetrics & gynecology 2022; (34(4)):227-236 doi:10.1097/GCO.0000000000000789.

    PMID: 35895965
  12. 12

    The timing of adenomyosis diagnosis and its impact on pregnancy outcomes: a national population-based study.

    Jung YM, Wi W, Koo HS, et al.

    Obstetrics & gynecology science 2024; (67(3)):270-278 doi:10.5468/ogs.23273.

    PMID: 38404226
  13. 13

    Adenomyosis as a Potential Risk Factor for Adverse Pregnancy Outcomes: A Multicenter Case-Control Study.

    Shinohara S, Okuda Y, Hirata S, Suzuki K

    The Tohoku journal of experimental medicine 2020; (251(3)):231-239 doi:10.1620/tjem.251.231.

    PMID: 32684535
  14. 14

    Effects of adenomyosis on obstetric outcomes.

    Cozzolino M, Basile F, Pontrelli G

    Minerva ginecologica 2019; (71(2)):146-154 doi:10.23736/S0026-4784.18.04318-6.

    PMID: 30318871
  15. 15

    Association between pre-pregnancy uterine volume and preterm birth in women with adenomyosis: a retrospective cohort study.

    Guan X, Liu D, Zhou H, et al.

    BMC pregnancy and childbirth 2025; (25(1)):718 doi:10.1186/s12884-025-07845-0.

    PMID: 40610904
  16. 16

    Pregnancy and perinatal outcomes in women with different phenotypes of adenomyosis: A retrospective cohort study.

    Yang W, Liu X, Zeng L, et al.

    European journal of obstetrics, gynecology, and reproductive biology 2026; (318()):114926 doi:10.1016/j.ejogrb.2025.114926.

    PMID: 41483612
  17. 17

    Differences in the incidence of obstetric complications depending on the extent and location of adenomyosis lesions.

    Hashimoto A, Iriyama T, Sayama S, et al.

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2023; (36(2)):2226789 doi:10.1080/14767058.2023.2226789.

    PMID: 37787637
  18. 18

    Maternal and Neonatal Outcomes in Pregnancies with Adenomyosis.

    Hguig S, Czuzoj-Shulman N, Spence AR, Abenhaim HA

    Maternal and child health journal 2025; (29(9)):1284-1292 doi:10.1007/s10995-025-04138-y.

    PMID: 40634714
  19. 19

    Reduced live birth rates following ART in adenomyosis patients: a matched control study.

    Bourdon M, Mimouni A, Maignien C, et al.

    Human reproduction (Oxford, England) 2025; (40(5)):855-864 doi:10.1093/humrep/deaf052.

    PMID: 40159349
  20. 20

    The ADENO study: ADenomyosis and its Effect on Neonatal and Obstetric outcomes: a retrospective population-based study.

    Rees CO, van Vliet H, Siebers A, et al.

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    PMID: 36539028

This page discusses fertility and pregnancy outcomes related to adenomyosis for educational purposes only. Always consult your reproductive endocrinologist or maternal-fetal medicine specialist for personalized fertility and pregnancy care.

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