Adenomyosis is a chronic progressive disease that can lead to low fertility. Therefore, patients who have fertility requirements need to pay attention to the whole process of fertility management.

For the patients with adenomyosis who are temporarily barren, once diagnosed, even if there are no clinical symptoms, they must receive drugs (such as contraceptives) intervention to delay the progress of the disease and protect fertility. The aim is to control the disease's progression to provide more opportunities for long-term fertility.

Married patients, especially the older ones, the family members or friends should explanate and try to recommend early pregnancy to get the best chance of pregnancy. For the patients with adenomyosis who are relatively older (such as > 40 years old) or with ovarian dysfunction and giving drug intervention to control the disease, we can also consider freezing the embryo to provide opportunities for their long-term fertility.

Management of patients with fertility requirements

Patients with mild adenomyosis can get a natural pregnancy, and even some severe patients can get pregnant naturally. Adenomyosis is an inflammatory immune disease like endometriosis, often accompanied by hemorheology changes and platelet quantity and quality. Therefore, patients with adenomyosis who have reproductive needs had better be treated before pregnancy.

1. Drug treatment: Although patients with adenomyosis and infertility advocate the first choice of assisted reproductive technology for pregnancy, there are still many patients not willing to implement assisted reproductive technology.

The doctor will provide hormone drugs to patients with adenomyosis who are unwilling to perform assisted reproductive technology and have good ovarian function before pregnancy. They can reduce the uterus' size to normal to improve the pregnancy rate and reduce the abortion rate.

As long-term use of antibiotics may bring some harmful effects to the body, traditional Chinese medicine is a good choice, such as Fuyan Pill. It is the patent medicine in Dr. Lee's TCM clinic.

2. IVF treatment: for patients with adenomyosis who are older (such as > 40 years old) or whose ovarian function is decreased, carry out drug treatment after frozen embryos, and then apply assisted reproductive technology.

In addition, for patients with adenomyosis who have a large uterus and serious lesions and are estimated to have failed embryo transfer, whether to perform adenomyosis focus resection or embryo transfer first should also be decided by reproductive physicians and general gynecologists after consultation.

3. Surgical treatment: Generally speaking, conservative adenomyomectomy has limited effect on improving the pregnancy rate, especially for patients over 40 years old. Therefore, conventional surgery should be performed under the circumstances of ineffective drug treatment, failure of assisted reproductive technology (especially more than two times), an estimated loss of embryo transfer or difficulty in oocyte retrieval, and good ovarian reserve function.

For the older patients with adenomyosis or decreased ovarian reserve function, the frozen embryo can be taken before the operation. Then assisted reproductive technology can be used to help pregnancy.

Because of the special pathophysiological characteristics of adenomyosis, the patients who want to give birth must cooperate with the Department of Gynecology, reproduction, and obstetrics to ensure the whole process of management of childbirth and obtain a higher clinical pregnancy rate and full-term healthy fetus.

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