Adenomyosis does reduce fertility, though it doesn’t make pregnancy impossible. Women with adenomyosis have roughly half the live birth rate of women without it when undergoing IVF, and those who do conceive face higher risks of miscarriage and preterm delivery. The condition was once thought to affect only women who had already had children, but improved imaging has revealed it in about 7.5% of young women seeking fertility treatment.
How Adenomyosis Interferes With Getting Pregnant
Adenomyosis disrupts fertility through several overlapping mechanisms, all rooted in the fact that endometrial tissue has grown into the muscular wall of the uterus where it doesn’t belong.
The first problem is abnormal uterine contractions. Your uterus normally contracts in coordinated waves that help move sperm toward the fallopian tubes before ovulation. When adenomyosis distorts the muscle layer, these contractions become disorganized or excessively frequent. This impairs sperm transport and can also interfere with an embryo’s ability to settle into the uterine lining.
The second problem is inflammation. Adenomyosis triggers elevated levels of inflammatory molecules in the uterine lining. These molecules reduce the levels of a key protein (called HOXA10) that the uterus needs to be receptive to an embryo. The result is a uterine environment that’s less welcoming to implantation, even when fertilization has occurred normally. Adenomyosis also disrupts the balance between estrogen and progesterone signaling, which further compromises the lining’s ability to support a pregnancy.
The Numbers: Pregnancy and Live Birth Rates
The fertility impact is significant and well-documented. In one large IVF study, women with ultrasound features of adenomyosis had a cumulative live birth rate of about 26% after their first treatment cycle, compared to 47% in women with no signs of the condition. That translates to a 42% lower chance of taking home a baby from a given round of IVF.
The severity matters. A multicenter study found that clinical pregnancy rates dropped as more features of adenomyosis appeared on ultrasound: 42.7% in women without adenomyosis, 22.9% in those with four diagnostic features, and just 13% in those with seven features. Focal adenomyosis (a contained area) also carries a better prognosis than diffuse disease, which spreads throughout the uterine wall.
One particularly striking comparison looked at cumulative pregnancy rates in women with adenomyosis versus endometriosis alone. The adenomyosis group achieved a 19% cumulative pregnancy rate, while the endometriosis-only group reached 82%.
Higher Risk of Miscarriage and Preterm Birth
Getting pregnant is only part of the challenge. Women with adenomyosis who do conceive face roughly double the miscarriage rate: about 31% compared to 12% in women without the condition. One study of women using donor eggs found a miscarriage rate of 13.1% in the adenomyosis group versus 7.2% in controls, suggesting the problem lies with the uterus itself rather than egg quality.
Preterm delivery risk is also elevated. Multiple studies consistently show that women with adenomyosis are about 2.5 to 3 times more likely to deliver before 37 weeks. The risk of severe preterm delivery before 32 weeks is even higher, with one adjusted analysis showing a 3.6-fold increase. In a multicenter survey of 272 pregnant women with adenomyosis, nearly one in four (24.4%) delivered preterm.
When Endometriosis Coexists
Adenomyosis and endometriosis frequently occur together, and the combination complicates both treatment and prognosis. The two conditions don’t simply stack their effects in a predictable way. They appear to interact, and the combined impact on pregnancy outcomes differs from what you’d expect by adding together the effects of each condition alone. In women with both conditions who underwent laparoscopic surgery, the preterm birth rate was 16.5%, which was actually lower than the 24.4% rate seen in studies of adenomyosis alone, suggesting the interaction between the two diseases is complex and not always additive.
Diagnosis Is Still Imperfect
One of the biggest obstacles in understanding adenomyosis and fertility is that there’s no universally accepted way to diagnose it without removing the uterus. Transvaginal ultrasound and MRI can both detect it, but there are no standardized diagnostic criteria, and none of the proposed classification systems have been globally adopted. This means adenomyosis can be missed, overdiagnosed, or categorized inconsistently between clinics. For women trying to conceive, the type and extent of adenomyosis visible on imaging does appear to predict reproductive outcomes, making a thorough ultrasound evaluation important even if the diagnosis remains somewhat subjective.
Surgical Treatment for Fertility
For women who want to preserve their uterus, surgical excision of adenomyosis tissue (adenomyomectomy) can improve fertility, especially when the disease is focal rather than diffuse. In focal adenomyosis, pregnancy rates exceed 50% and live birth rates reach up to 70% after excisional surgery. For diffuse disease, outcomes are more modest: pregnancy rates around 34 to 43%, though live birth rates among those who do conceive can still be high.
A prospective study of 179 women who had uterus-sparing surgery reported a conception rate of 58%, a delivery rate of 47%, a miscarriage rate of 8.9%, and a preterm birth rate of 9.6%. These are considerably better outcomes than what’s seen in untreated adenomyosis, though the surgery itself carries risks, and nearly all deliveries after adenomyomectomy are by cesarean section (98% in one study) due to concerns about uterine wall integrity.
Hormonal Pretreatment Before IVF
A common strategy is to suppress the disease with hormonal medication before attempting embryo transfer. GnRH agonists, which temporarily shut down estrogen production and shrink adenomyosis tissue, are frequently used for this purpose. The logic is sound: reduce inflammation, normalize the uterine environment, and improve receptivity.
However, the evidence so far is underwhelming. A recent systematic review and meta-analysis found that GnRH agonist pretreatment before frozen embryo transfer produced live birth rates, clinical pregnancy rates, miscarriage rates, and implantation rates that were statistically comparable to skipping the pretreatment entirely. This doesn’t mean the approach is useless for every patient, but it does mean the blanket use of hormonal suppression before IVF hasn’t been shown to improve outcomes in the available data.
What This Means for Your Fertility
Adenomyosis is a real barrier to conception, but it’s not a guarantee of infertility. The condition roughly halves the odds of a live birth through IVF and increases the risks if pregnancy does occur. Your individual outlook depends heavily on whether the adenomyosis is focal or diffuse, how extensive it is, whether endometriosis is also present, and your age. Women with focal disease who undergo surgical excision have meaningfully better outcomes than those with widespread involvement of the uterine wall. For women pursuing IVF without surgery, the data suggest that the more features of adenomyosis visible on ultrasound, the lower the expected success rate.