This study aimed to investigate the association of adenomyosis with fertility, pregnancy and neonatal outcomes. An electronic search was conducted using the MEDLINE, PubMed and Cochrane databases up to April 2020. Seventeen observational studies were included. Adenomyosis was significantly associated with a lower clinical pregnancy rate (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.51–0.94) and higher miscarriage rate (OR 2.17; 95% CI 1.25–3.79) after treatment with assisted reproductive technology (ART). The lower clinical pregnancy rate was more significant in the subgroup of patients with short down-regulation protocols. Similar associations were recorded after age adjustment. Adenomyosis was also significantly associated with an increased risk of pre-eclampsia, preterm delivery, Caesarean section, fetal malpresentation, small for gestational age infancy and post-partum haemorrhage, which was confirmed after correction for age and mode of conception. In conclusion, adenomyosis is associated with negative effects on fertility after ART. The potentially protective role of the ultra-long down-regulation protocols needs further evaluation in randomized controlled studies. Adenomyosis is also associated (independently of the mode of conception) with adverse pregnancy and neonatal outcomes. Proper counselling prior to ART and close monitoring of pregnancy in patients with adenomyosis should be recommended.

本研究旨在调查子宫腺肌病与生育能力、妊娠和新生儿结局的关系。使用 MEDLINE、PubMed 和 Cochrane 数据库进行了电子搜索，直至 2020 年 4 月。其中包括 17 项观察性研究。辅助生殖技术治疗后，子宫腺肌症与较低的临床妊娠率（优势比 [OR] 0.69；95% 置信区间 [CI] 0.51–0.94）和较高的流产率（OR 2.17；95% CI 1.25–3.79）显着相关（艺术）。在具有短期下调方案的患者亚组中，较低的临床妊娠率更为显着。年龄调整后记录了类似的关联。子宫腺肌症还与先兆子痫、早产、剖腹产、胎儿先天畸形的风险增加显着相关。小于胎龄婴儿和产后出血，经年龄和受孕方式校正后证实。总之，子宫腺肌病与 ART 后对生育的负面影响有关。超长下调方案的潜在保护作用需要在随机对照研究中进一步评估。子宫腺肌病也与不良妊娠和新生儿结局相关（与受孕方式无关）。应建议在 ART 之前进行适当的咨询并密切监测子宫腺肌病患者的妊娠情况。超长下调方案的潜在保护作用需要在随机对照研究中进一步评估。子宫腺肌病也与不良妊娠和新生儿结局相关（与受孕方式无关）。应建议在 ART 之前进行适当的咨询并密切监测子宫腺肌病患者的妊娠情况。超长下调方案的潜在保护作用需要在随机对照研究中进一步评估。子宫腺肌病也与不良妊娠和新生儿结局相关（与受孕方式无关）。应建议在 ART 之前进行适当的咨询并密切监测子宫腺肌病患者的妊娠情况。