Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study

PURPOSE: The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear. METHODS: We conducted a multicenter retrospective study of 199 premenopausal women (32-49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010-May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings-including pelvic endometriosis-with ART use and live birth. RESULTS: The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88-0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002-1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054-0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor. CONCLUSION: Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.