title: Conservative surgical treatment of adenomyosis to improve fertility: Controversial values, indications, complications, and pregnancy outcomes.
abstract: Uterine adenomyosis was first reported in the 19(th) century and early 20(th) century; von Rokitansky described it in 1860. Since then, the general clinical, pathological, and radiologic findings and potentially useful management methods have been reviewed in many studies. Some authors commented that conservative surgical treatment is impracticable as it is not possible to isolate the adenomyotic tissue adequately; therefore, the authors suggested that hysterectomy is the only rational and complete procedure. There is more evidence supporting the advantages of conservative uterine-sparing surgery in providing not only more effective symptom relief, but also longer durable symptom control for symptomatic women with uterine adenomyosis, because the main problem secondary to uterine adenomyosis, dysmenorrhea, can be improved significantly, up to 80%. Menorrhea was also improved in more than two-thirds of patients after type I uterine-sparing surgery, and half of the patients saw benefit in symptom control after type II conservative uterine-sparing surgery. In addition, there was no negative impact on reproductive performance after conservative uterine-sparing surgery, and in fact, reproductive performance seemed to be improved compared with that after medical treatment-not only was there a higher cumulative pregnancy rate, but also a higher cumulative final successful delivery rate. However, there is no doubt that the data supporting the above-mentioned benefits for symptomatic women with uterine adenomyosis after conservative uterine-sparing surgery are limited, suggesting that the benefit may be moderate. In fact, one of the main indications for surgery is temporary pain relief in women seeking spontaneous conception. However, the effect of surgery on pain is usually only temporarily satisfactory, and the risk of complications varies according to the type of lesion extirpated. In light of this, an extensive review of this topic addressing conservative surgical treatment for adenomyosis to improve fertility, including controversial values, indications, complications, and pregnancy outcomes, might be very important, and might help physicians in managing these patients in the future.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County, Taiwan.
authors.forename: Kuan-Hao
authors.initials: KH
authors.lastname: Tsui
authors.affiliation: Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Fa-Kung
authors.initials: FK
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Kok-Min
authors.initials: KM
authors.lastname: Seow
authors.affiliation: Department of Obstetrics and Gynecology, China Medical University Hospital and China Medical University, Taichung, Taiwan.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Medical University and Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Jia-Wei
authors.initials: JW
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan.
authors.forename: Shee-Uan
authors.initials: SU
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hsiang-Tai
authors.initials: HT
authors.lastname: Chao
authors.affiliation: Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Min-Shyen
authors.initials: MS
authors.lastname: Yen
authors.affiliation: Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University Hospital, Ilan, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. Electronic address: phwang@vghtpe.gov.tw.
authors.forename: Peng-Hui
authors.initials: PH
authors.lastname: Wang
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D062788:Adenomyosis / Q000601:surgery*; D004412:Dysmenorrhea / Q000209:etiology / Q000601:surgery; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D059351:Organ Sparing Treatments; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate
keywords: adenomyosis; conservative surgical treatment; controversy