Quiz - Adenomyosis and its impact on fertility

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Comorbidities such as endometriosis can confound the picture in patients with adenomyosis, a condition that may lead to poor IVF outcomes. This quiz goes over the major takeaways from our November 2018 article, Adenomyosis and its impact on fertility.

1. Most cases of adenomyosis affect women aged: 

A. 15-19 years

B. 20-30 years

C. 31-39 years

D. 40-50 years

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Answer: D. 40-50 years
Approximately 20% of cases involve women younger than 40 and 80% are aged 40 to 50. 

2. Today, the diagnosis of adenomyosis can be suspected using: 

A. histopathologic examination on hysterectomy

B. magnetic resonance imaging

C. transvaginal ultrasound

D. All of the above

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Answer: D. All of the above
Histopathologic examination on hysterectomy specimen was the traditional route of diagnosis, but has been supplanted by imaging today that can make the diagnosis with 80% to 90% accuracy without the need for excisional surgery. 

3. The consensus for diagnosis of adenomyosis is when the junctional zone (subendometrial myometrium) thickness is:
A. 2-4 mm
B. > 6 mm
C. > 12 mm
D. > 20 mm

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Answer: C. > 12 mm
Greater than 12 mm is the diagnostic threshold, but the disorder can be suspected when thickness is between 8 and 12 mm.

4. Adenomyosis is comorbid with pelvic endometriosis in over half of cases.
A.True
B.False

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Answer: A. True 
There is a significant association between pelvic endometriosis and adenomyosis, with estimates indicating that it occurs in 54% to 90% of cases.

5. In women undergoing in vitro fertilization, adenomyosis has a detrimental effect on clinical outcomes, reducing:

A.rates of implantation

B. clinical pregnancies per cycle

C. live births

D. all of the above

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Answer D. all of the above
In addition to rates of implantation, clinical pregnancies per cycle, and live births, adenomyosis also affects clinical pregnancies per embryo transfer, and ongoing pregnancy rates after IVF.

6. Proposed mechanisms of infertility in patients with adenomyosis focus on which of the following pathways?

A.folliculogenesis

B.oocyte quality and function

C.uterotubal transport

D.all of the above

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Answer: C. uterotubal transport 
Adenomyosis does not appear to affect folliculogenesis or oocyte quality/function, but it does appear to affect endometrial receptivity and implantation in addition to uterotubal transport. 

7. For patients with severe adenomyosis who want to retain fertility, a large prospective study showed that __________ was most effective. 

A.Oral contraceptive treatment

B.Gonadotrophin-releasing hormone agonist (GnRH-a) treatment 

C.Conservative surgery

D. GnRH-a treatment plus conservative surgery

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Answer D. GnRH-a treatment plus conservative surgery
Combined GnRH-a treatment and conservative surgery, such as laparoscopic cytoreductive surgery, has been shown to lower symptom relapse rates and yield a trend toward improved reproductive outcomes.