The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology
Abstract
:1. Introduction
2. Pathophysiologic Aspects of Adenomyosis-Associated Infertility
2.1. Myometrium Structure and Physiology in Fecundity
2.2. Theories and Potential Mechanisms of Adenomyosis
2.2.1. Invagination Theory
2.2.2. Microtrauma of Endometrial–Myometrial Interface
2.2.3. De Novo Metaplasia Theory
2.2.4. Outside-to-Inside Invasion
2.3. Pathogenesis of Adenomyosis
2.3.1. Genetic and Epigenetic Alteration
2.3.2. Hyperestrogenism and Progesterone Resistance
2.3.3. Immune Disorder and Inflammatory Mediators
2.3.4. Neuroangiogenesis and Fibrosis
2.3.5. Pituitary Hormones and Endocrine-Disrupting Chemicals
2.3.6. Microbiota Composition
3. Pathologic Mechanisms in Adenomyosis-Associated Infertility
3.1. Oocyte Quality and Embryo Euploidy
3.2. Utero-Tubal Transport
3.3. Endometrial Receptivity
3.4. Immunotolerance and Angiogenesis
3.5. Uterine Peristaltic Wave
4. Assisted Reproductive Technology for Adenomyosis-Associated Infertility
4.1. Ovarian Stimulation Protocol
4.2. Embryo Transfer Strategy
4.2.1. Segmentation of Embryo Transfer
4.2.2. GnRHa Pre-Treatment
4.2.3. Oxytocin Antagonists
4.3. Uterus Sparing Surgery
5. Prognostic Tools for Adenomyosis-Associated Infertility
5.1. Imaging Features of Adenomyosis
5.2. Serum Marker
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Ovarian Stimulation Protocol | ||
---|---|---|
Study | Intervention | Results |
Rocha et al. (2018) [126] |
Pooled long protocols (N = 482) |
|
Hou et al. (2020) [127] |
Patients in long protocol (N = 127) Patients in ultra-long protocol (N = 362) |
|
Lan et al. (2021) [128] |
Long GnRHa protocol (N = 116) |
|
Wu et al. (2022) [130] |
Group B: fresh ET with ultra-long protocol (N = 241) Group C: fresh ET with long protocol (N = 104) |
|
Ge et al. (2023) [129] |
Total of 305 FET cycles with embryos from ultra-long (N = 98), long (N = 101), short (N = 52), and antagonist (N = 54) protocols |
|
Embryo Transfer Strategy | ||
Study | Intervention | Results |
Niu et al. (2013) [122] |
|
|
Park et al. (2016) [121] |
Group B: fresh ET with GnRHa pre-treatment (N = 105) Group C: FET with GnRHa pre-treatment (N = 43) |
|
Liang et al. (2019) [131] |
|
|
Chen et al. (2020) [132] |
|
|
Li et al. (2021) [133] |
|
|
Zhang et al. (2022) [134] |
|
|
Feng et al. (2022) [135] |
|
|
Yang et al. (2023) [136] |
(Subgroups in GnRHa-HRT protocol: one, two, and three or more GnRHa injections) |
|
Ge et al. (2023) [129] |
|
|
Li et al. (2023) [137] |
(Subgroups in downregulation group: GnRHa for 1 month, 2 months, or ≥3 months) |
|
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Wu, H.-M.; Tsai, T.-C.; Liu, S.-M.; Pai, A.H.-Y.; Chen, L.-H. The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology. Int. J. Mol. Sci. 2024, 25, 8937. https://doi.org/10.3390/ijms25168937
Wu H-M, Tsai T-C, Liu S-M, Pai AH-Y, Chen L-H. The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology. International Journal of Molecular Sciences. 2024; 25(16):8937. https://doi.org/10.3390/ijms25168937
Chicago/Turabian StyleWu, Hsien-Ming, Tian-Chi Tsai, Shang-Min Liu, Angel Hsin-Yu Pai, and Liang-Hsuan Chen. 2024. "The Current Understanding of Molecular Mechanisms in Adenomyosis-Associated Infertility and the Treatment Strategy for Assisted Reproductive Technology" International Journal of Molecular Sciences 25, no. 16: 8937. https://doi.org/10.3390/ijms25168937