Adenomyosis is a condition that affects far more women than most people realise — and is diagnosed far less often than it should be. For many women, it comes with years of painful, heavy periods written off as "just how it is." And then, when fertility becomes the focus, it enters the picture in a new and more consequential way.
Understanding adenomyosis — what it does to the uterus, how it affects implantation, and what can be done about it in the context of IVF — is not simple. But it is genuinely hopeful. At Hanabusa IVF in San Diego, adenomyosis is a condition we see regularly, manage carefully, and work around with real clinical success.
What Is Adenomyosis?
Adenomyosis occurs when the tissue that normally lines the inside of the uterus — the endometrium — grows into the muscular wall of the uterus itself, called the myometrium. Unlike endometriosis, where tissue grows outside the uterus entirely, adenomyosis is contained within the uterine wall — but its effects on uterine function are significant.
The condition causes the uterine wall to thicken, stiffen, and become less uniformly contractile. The myometrium, normally a smooth, coordinated muscle, becomes disrupted by glandular tissue it was never designed to contain. Adenomyosis can be focal (concentrated in one area) or diffuse (spread throughout the myometrium) — diffuse adenomyosis is generally associated with more significant fertility impact. It frequently coexists with endometriosis, found together in a substantial proportion of women with both diagnoses.
Adenomyosis is estimated to affect between 20–35% of women — though true prevalence is hard to establish because many women are asymptomatic or undiagnosed. Among women with infertility or recurrent pregnancy loss, prevalence is significantly higher. A growing body of research links adenomyosis directly to implantation failure and early pregnancy loss.
How Does Adenomyosis Affect Fertility?
Uterine contractility disruption: Adenomyosis disrupts the coordinated contractions that help sperm reach the egg and support embryo implantation. Studies using uterine peristalsis imaging show altered, sometimes chaotic contraction patterns in adenomyotic uteri that impair both sperm transport and implantation.
Endometrial blood flow: The invading glandular tissue alters uterine vascularity — changing blood flow patterns in ways that impair endometrial lining development and receptivity to an implanting embryo.
Inflammatory microenvironment: Like endometriosis, adenomyosis creates a local inflammatory environment — elevated cytokines and altered immune cell populations — that is hostile to embryo implantation and early pregnancy.
Endometrial thinning: In some cases of adenomyosis — particularly diffuse — the endometrial lining fails to develop adequate thickness for implantation. This is one of the direct links between adenomyosis and the thin uterine lining problem that affects a meaningful proportion of IVF patients.
A 2025 meta-analysis in Gynecol Obstet Invest examined the impact of adenomyosis on IVF outcomes and found that women with adenomyosis had significantly lower clinical pregnancy rates, lower live birth rates, and higher miscarriage rates than controls — with the effect most pronounced in women with diffuse adenomyosis. The analysis also found the negative effect was larger in fresh transfer cycles than frozen — a finding with direct practical implications.
What Can Be Done? The Treatment Approach at Hanabusa IVF
Hormonal downregulation before IVF: GnRH agonist therapy — typically three to six months of medical suppression — has been shown to reduce adenomyotic activity, decrease uterine volume, and improve endometrial receptivity before a frozen embryo transfer cycle. A 2020 study in Reproductive BioMedicine Online found that GnRH agonist pretreatment significantly improved clinical pregnancy rates and live birth rates in women with adenomyosis compared to no pretreatment.
Freeze-all strategy: The evidence that adenomyosis affects fresh transfers more than frozen transfers is clinically actionable. At Hanabusa IVF, for patients with significant adenomyosis, a freeze-all approach is standard practice — removing the high oestrogen environment of the stimulation cycle from the implantation equation entirely.
Tailored endometrial preparation: Preparing the uterine lining for frozen embryo transfer in adenomyosis patients requires careful attention. The standard hormone replacement protocol may need adjustment in terms of oestrogen type, dose, and duration to achieve adequate lining thickness and receptivity.
PRP and supportive therapies: For women with adenomyosis-related thin lining or poor endometrial development, platelet-rich plasma (PRP) intrauterine infusion delivers concentrated growth factors directly to the endometrial tissue, potentially improving blood flow and lining development in cases where standard protocols are insufficient.
Surgical consideration: In selected cases of focal adenomyosis, surgical adenomyomectomy may be worth discussing. However, this remains a carefully considered decision — the evidence for surgical improvement in IVF outcomes is less robust than for hormonal management. Hanabusa evaluates each case individually.
The Coexistence with Endometriosis
Adenomyosis and endometriosis frequently coexist — and when they do, the fertility impact is compounded. The ovarian effects of endometriosis (reduced reserve, impaired egg quality) combine with the uterine effects of adenomyosis (impaired implantation, altered lining) to create a clinical picture that genuinely requires specialist management.
At Hanabusa IVF, we approach this combination systematically — addressing the ovarian side with a mini stimulation or gentle protocol that protects egg quality (discussed in the previous article: Endometriosis and IVF: Why Mini Stimulation May Give You a Better Chance), and the uterine side with the pre-treatment and endometrial preparation that the adenomyosis picture requires.
For some patients, the uterine environment remains the primary challenge even after excellent embryo quality is achieved — manifesting most commonly as a thin or poorly receptive uterine lining. That is a condition with its own distinct biology and treatment pathway, and it is the focus of the next article in this series: Thin Uterine Lining and IVF: Causes, Treatment Options, and What to Expect.
Frequently Asked Questions
Can I get pregnant naturally with adenomyosis?
Yes — many women with adenomyosis conceive naturally, particularly those with focal or mild diffuse disease. Adenomyosis is a factor in fertility, not an absolute barrier. If you have been trying to conceive without success and adenomyosis has been identified, it warrants evaluation as part of a full fertility assessment.
Does adenomyosis cause miscarriage?
The evidence suggests yes — adenomyosis is associated with a higher miscarriage rate, likely due to the altered uterine contractility and inflammatory environment affecting early implantation and placentation.
Will adenomyosis get worse with IVF stimulation?
High-dose stimulation produces elevated oestrogen, which can temporarily increase adenomyotic activity and uterine volume. This is one of the reasons the freeze-all strategy and hormonal downregulation before transfer are recommended for adenomyosis patients.
How is adenomyosis diagnosed?
The gold standard is MRI, which can characterise the extent and distribution of adenomyotic tissue with high accuracy. Transvaginal ultrasound can suggest adenomyosis but is less reliable for definitive characterisation. Hanabusa evaluates uterine anatomy thoroughly before treatment planning.
Is adenomyosis curable?
The only definitive cure is hysterectomy — not applicable for women seeking fertility. Medical management and hormonal suppression can significantly reduce symptoms and improve the uterine environment for fertility treatment, but the underlying condition persists.
Complex Doesn't Mean Impossible
Adenomyosis makes the path to pregnancy harder — but it doesn't close it. At Hanabusa IVF, we've seen what the right protocol, the right timing, and the right uterine preparation can do for women who have been told their chances are poor. The approach matters. The experience matters. And the belief that every case deserves a genuinely individualised plan — not a default protocol — matters most of all.
