title: Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility?
abstract: OBJECTIVE
  To analyze the determinants of successful pregnancy following laparoscopic adenomyomectomy.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A general hospital.
  
  
  METHODS
  A total of 102 women who had a desire for pregnancy underwent laparoscopic adenomyomectomy from 2007 to 2012.
  
  
  METHODS
  Surgical excision of the uterine adenomyosis; statistical analysis for fertility outcomes.
  
  
  METHODS
  Pregnancy rates and the results of univariable and multivariable analyses.
  
  
  RESULTS
  When the women were divided into ≤39 years and ≥40 years age groups, clinical pregnancy rates were 41.3% and 3.7%, respectively. Factors associated with clinical pregnancy were: history of IVF treatments, posterior wall involvements, and age, with odds ratios of 6.22, 0.18, and 0.77, respectively. In the younger group, 60.8% of women with history of IVF failure showed successful pregnancy after surgery. We experienced 2 cases of placenta accreta in far advanced cases.
  
  
  CONCLUSIONS
  This study demonstrated age as a determinant in fertility outcomes. Surgery could be a beneficial treatment for women who experienced IVF treatment failures, especially at ages of ≤39 years. We could not show a clear benefit of the surgery on fertility outcomes of the group aged ≥40 years. Extremely severe adenomyosis affecting a broad range of the uterine subendomerial myometrium should be treated carefully on a pregnancy course.
authors: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan. Electronic address: kishi@takanohara-ch.or.jp.
authors: Yohei
authors: Y
authors: Kishi
authors: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan.
authors: Maki
authors: M
authors: Yabuta
authors: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara, Japan.
authors: Fumiaki
authors: F
authors: Taniguchi
mesh_terms: D062788:Adenomyosis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D018873:Pregnancy Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*
keywords: Adenomyosis; complication; pregnancy; subfertility; surgery