Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation

Objective: To evaluate the effect of adenomyosis on endometrial gene expression and its correlation with clinical outcome. Design: Transcriptomic analysis of the endometrium of women with adenomyosis during the window of implantation. Retrospective matched cohort study of the impact of adenomyosis on oocyte donation (OD) outcome. Setting: University-affiliated infertility clinic (2005-2009). Patient(s): Endometrial samples were analyzed using microarrays in women with adenomyosis and healthy controls. The clinical study included three groups: adenomyosis, endometriosis, and control. Intervention(s): Endometrial biopsies in natural cycles 7 days after the LH peak; controlled ovarian stimulation in donors; ET in recipients after replacement therapy. Main Outcome Measure(s): Differentially expressed genes; implantation, pregnancy, miscarriage, and term pregnancy rates in OD. Result(s): There is a similar endometrial gene expression pattern in both the adenomyosis group and controls, and nonparametric tests revealed 34 dysregulated genes in adenomyosis patients but none belonged to the group of window of implantation genes. Implantation in OD did not differ among the three groups. However, miscarriage was significantly higher in the adenomyosis group vs. the adenomyosis + endometriosis and control groups. Term pregnancy rate was also significantly lower in the adenomyosis group compared with others. Conclusion(s): Clinical and molecular data show that implantation is not affected by adenomyosis, but the higher miscarriage rates associated with this condition lead to lower term pregnancy rates, indicating a clear negative effect on the final outcome of OD. (Fertil Steril (R) 2011; 96: 943-50. (C)2011 by American Society for Reproductive Medicine.)