Characteristics of adenomyosis in secondary infertility patients on MRI and factors associated with fertility recovery after HIFU.

OBJECTIVE

To study the MRI characteristics of adenomyosis in secondary infertility patients, and to analyze the factors affecting pregnancy after High-intensity focused ultrasound (HIFU).

METHODS

Clinical data of 388 patients with adenomyosis were selected from January 2014 to December 2019 treated with HIFU They were divided into the infertility group and the control group by the presence of secondary infertility. Then the patients in the infertile group who had fertility requirements after HIFU were divided into the postoperative pregnancy group and the non-pregnant group, to assess the MRI characteristics of adenomyosis and the factors affecting infertility and to analyze the factors affecting fertility recovery after HIFU.

RESULTS

Seventeen (28.81%) of the patients in the infertile group obtained pregnancy after HIFU. Type II (exogenous) lesions, T2-weighted image(T2WI) high-signal spots more than 30, pelvic adhesions, and dysmenorrhea may be related factors affecting the conception of patients with adenomyosis, among which T2WI high-signal spots more than 30 (OR = 1.810, 95CI%: 1.071-3.058) was an independent risk factor for infertility (p < 0.05). There was no significant effect on whether fertilization in patients with pelvic adhesions, while age (OR = 0.844, 95CI%: 0.719-0.990) was an independent influence on whether pregnancy occurred after HIFU (p < 0.05), and the postoperative conception rate was high when the age was less than 37 years.

CONCLUSION

T2WI high-signal spots in lesions more than 30, type II (exogenous) lesions, pelvic adhesions, and dysmenorrhea symptoms are risk factors for secondary infertility in patients with adenomyosis. HIFU treatment has the potential to enhance fertility in some patients with uterine adenomyosis. Age serves as an independent factor significantly influencing pregnancy outcomes following HIFU surgery. Consequently, early intervention is recommended for patients with uterine adenomyosis to optimize their fertility potential.