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How Should Adenomyosis Patients with Infertility Do?

Adenomyosis is a common gynecological inflammation in which glands and stroma of the endometrium (the inner surface epithelium of the uterus) invade the myometrium (the muscular part of the uterus), affecting the normal function of the endometrium, leading to abnormal menstrual cycles, and even infertility. 

Adenomyosis causes menstrual disorders in half of the patients. Patients may have prolonged periods and increased menstrual volume. Some patients will have the symptoms of intravenous bleeding before and after menstruation. Some severe cases can also lead to anemia in patients.
About twenty-five percent of the patients with adenomyosis can appear the symptom of dysmenorrhea, and it is a continuous deepening of the pain. The pain of the position is located in the middle of the lower abdomen, lumbosacral region and the middle pelvic region, and sometimes may radiate to the perineum, anus, and inner thighs. 
And the pain often appears during menstrual period, and it will last into the menstrual period with the increase of the illness. It's going to more and more hurt. The pain will not ease until the period is over. 
The uterus is enlarged. With the periodic endometrial stripping and stasis, the myometrium will be gradually thickened and the uterine volume will gradually increase.
How to diagnose adenomyosis?
Transvaginal ULTRASOUND (TVS) is the most commonly used imaging method for clinical diagnosis of adenomyosis, with a sensitivity of 65% ~ 81% and specificity of 65% ~ 100%, respectively.
3 D ultrasound has certain advantages in the diagnosis of adenomyosis, with higher specificity.
Uterine laparoscopy can check the shape of uterus and uterine cavity, peritoneum and deep infiltration of endometriosis, tubal patently, biopsy feasible histopathological diagnosis, and treatment at the same time. This method is especially suitable for patients with infertility adenomyosis.
Patients are wondering whether adenomyosis can affect infertility.
It will matter a lot. Patients with adenomyosis have endometriosis to the myometrium. The clinical manifestation of adenomyosis is dysmenorrhea, which tends to become progressively worse.
Adenomyosis is not a severe problem but is likely to cause much impact on fertility. If adenomyosis appears, the shape of the uterus will increase, and the uterine muscle wall is apparent in the uneven echo. And uterine blood circulation affected will lead to fertility. There will be no pregnancy, or women will have an abortion will happen after pregnancy, so patients with adenomyosis can affect fertility and lead to infertility.
How do adenomyosis patients with infertility be treated?
1. Medication
Gonadotropin-releasing hormone agonists (GnRHa) are recognized as the drug of choice.GnRH agonist can temporarily inhibit the hypothalamic pituitary gonado-ovarian axis, reduce the level of estrogen in the body, lead to uterine ectopic lesion atrophy, uterine volume reduction, and relieve symptoms. In addition, GnRHa increased endometrial receptivity.
However, the side effects of hormones on the body are large, and the damage to the body function is extremely serious. It is generally recommended to choose Fuyan Pill, which improves immunity, the resistance of the body function, and no side effects.
2. Surgical treatment
Pelvic denerneration: Open or laparoscopic presacral neuroresection (PSN) and hysterectomy (UNA) are used to treat primary and secondary dysmenorrhea. Because the sensory nerve conduction pathway of pelvic organs reaches the spine from the lower abdominal plexus located in front of the sacrum, cutting the anterior sacral nerve trunk can block the pain conduction pathway. Both procedures cut most of the cervical sensory nerve fibers and relieve uterine pain.
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