Adenomyosis IVF: what to know before you begin

IVF with adenomyosis isn’t always straightforward – but with expert care and a team at the frontline, the outlook can be positive, and well-supported. 

If you’ve recently been diagnosed or are navigating IVF with this condition in the mix, you’re not alone – and you’re not out of options. Adenomyosis is increasingly understood in the fertility space, and more clinics are personalizing treatment protocols to account for its impact. 

In partnership with The Prelude Network® – the largest and fastest-growing network of fertility clinics in the US and Canada – we spoke with Dr. Robert Straub and Dr. Andrew Toledo, leading fertility specialists at Reproductive Biology Associates (RBA) in Atlanta, to unpack how adenomyosis influences IVF, what treatment paths look like, and the questions you should be asking as you plan your journey.

Keen to connect?

Whether it’s RBA in Atlanta or a different team, find your nearest clinic within The Prelude Network® and put your adenomyosis IVF questions straight to the experts.

What is adenomyosis, and how does it affect IVF?

Adenomyosis occurs when the endometrial tissue that typically lines the uterus instead grows into its muscular wall (the myometrium). This condition often causes heavy, painful periods and pelvic discomfort, and crucially for the question of IVF with adenomyosis, it can also impact embryo implantation.

“Adenomyosis is believed to potentially have a negative impact on IVF success rates,” explains Dr. Straub. “This is due to a combination of factors, including increased uterine contractions, hormonal imbalances, and inflammation.”

While it doesn’t affect egg production or retrieval, adenomyosis can reduce embryo implantation rates and increase miscarriage risk. Some studies report nearly a 40 per cent lower pregnancy rate and double the pregnancy loss rate for IVF patients with adenomyosis compared to those without.

The conversation is happening: read our round-up of celebrities living with adenomyosis.

Can I get pregnant naturally with adenomyosis?

The short answer: yes, but it depends.

“Natural conception is absolutely still possible,” says Dr. Straub. “The severity and spread of adenomyosis – whether it’s focal and isolated to smaller areas of the uterus, or more widespread – plays a big role.”

Dr. Toledo agrees, emphasizing that IVF is not a mandatory first step: “Ultimately, IVF is recommended when other forms of less invasive treatment have failed. Adenomyosis doesn’t always impact fertilization or implantation.”

Does IVF cause or worsen adenomyosis?

This is a really common question. 

IVF itself does not cause adenomyosis. However, both doctors note that the elevated estrogen levels during fertility treatments may exacerbate an existing condition.

“Adenomyosis tends to worsen with prolonged estrogen exposure,” Dr. Straub notes. “That’s why specific, suppressive protocols are used in these cases.”

IVF with adenomyosis: tailoring the protocol

Treatment for adenomyosis often begins months before IVF even starts. Dr. Straub describes how medications such as Lupron, a GnRH agonist, are used to suppress estrogen and reduce inflammation.

“Lupron essentially induces a temporary menopause,” he says. “This helps calm the uterine environment, reduce contractions and inflammation, and improve implantation rates.”

Dr. Toledo adds that in some cases, Orilissa (a GnRH antagonist) may be used instead. While adenomyosis cannot be surgically removed – except with a hysterectomy – these medications offer a critical tool to manage the condition.

Fertility specialists often incorporate Letrozole during stimulation to reduce estrogen’s effects on the uterus. Whatever the pathway, protocol planning needs to be highly individualized, accounting for the inflammation and hormonal dynamics adenomyosis presents.

On your watch list: Learn more about recurrent miscarriage treatment  in our recent chat with Dr. Nischelle Kalakota, Reproductive Endocrinologist at Aspire Houston Fertility Institute – a Prelude Network® clinic.

Does adenomyosis affect IVF implantation?

Yes. Both doctors confirm that adenomyosis can interfere with the endometrial lining’s ability to receive an embryo.

“The inflammatory response within the uterus can reduce endometrial receptivity,” explains Dr. Straub. “Chronic inflammation may lead to scarring, and increased uterine contractions further reduce implantation chances.”

Dr. Toledo adds, “There are tests we can run to assess the impact of adenomyosis and endometriosis on the lining, although the data is still evolving.”

What role does Lupron play in IVF with adenomyosis?

Lupron (leuprolide acetate) plays a pivotal role in managing adenomyosis before a frozen embryo transfer.

“It shuts down estrogen production and induces a temporary medical menopause,” says Dr. Toledo. “Since estrogen is thought to fuel adenomyosis, lowering it can help reset the uterine environment.”

Lupron is often prescribed for 2 to 3 months prior to embryo transfer. This pre-treatment stage is key in improving outcomes for patients with adenomyosis.

Adenomyosis vs. endometriosis: and what if you have both?

Dr. Straub explains, “Adenomyosis occurs when endometrial tissue (the lining of the uterus) grows into the myometrium, the muscular wall of the uterus. In contrast, endometriosis involves endometrial-like cells growing outside the uterus – commonly on the ovaries, fallopian tubes, pelvic lining, bowel, or bladder.” 

While the two conditions are often discussed together and can coexist, they are distinct medical diagnoses. “Both are estrogen-dependent and may contribute to symptoms such as chronic pain and infertility,” notes Dr. Straub. “Treatment options often include hormonal therapies, surgery, and assisted reproductive technologies like IVF. 

Although adenomyosis and endometriosis can reduce IVF success rates, IVF often remains the most effective path to pregnancy with promising outcomes for many.”

Learn more about adenomyosis vs. endometriosis and fertility in our 101 podcast.

Is there a ‘standard’ IVF protocol for adenomyosis?

While there’s no one-size-fits-all IVF protocol for adenomyosis, certain patterns do emerge. Remember, the goal is to reduce estrogen exposure, calm inflammation, and create a receptive uterine lining.

As a pathway starting point, Dr. Straub recommends discussing the following with your team:

• Suppression with Lupron or similar agents for several weeks or months
• A frozen embryo transfer (FET) over a fresh transfer
• Letrozole-modified stimulation protocols
• Comprehensive uterine evaluation before transfer
  

Dr. Toledo emphasizes that in terms of at-home prep, patients can focus on “building consistent, healthy lifestyle habits, avoiding excess estrogen in the diet, and getting any abnormal bleeding or pain thoroughly checked out by a specialist, before beginning treatment.”

What are the success rates for IVF with adenomyosis?

Success rates vary widely and depend on individual factors including the severity of adenomyosis, co-existing conditions, age, and overall reproductive health. 

Dr. Toledo cautions that precise data on success rates is difficult to pin down due to inconsistent diagnostic criteria and the complexity of adenomyosis. However, both experts stress that pregnancy is absolutely achievable.

“Even with adenomyosis, IVF can lead to healthy, successful pregnancies,” Dr. Straub emphasizes. “The key lies in proactive planning and protocol adaptation.”

Top tips for preparing for IVF with adenomyosis

Both experts stress that preparation is everything when it comes to adenomyosis and IVF. Here are their top recommendations for aspects to chat through, with your practitioner:

• Pre-treatment suppression with Lupron or Orilissa, to reduce inflammation.
• Frozen embryo transfer (FET) rather than fresh, to better control the uterine environment.
• Letrozole during stimulation to blunt the estrogen effect.
• Thorough uterine evaluation to assess receptivity and identify any scarring or abnormalities.
• Dietary and lifestyle changes to minimize estrogen exposure.

Key takeaway

While adenomyosis presents challenges for those undergoing IVF, tailored protocols and early suppression strategies are helping more patients than ever achieve their fertility goals. In the hands of experienced specialists like those at RBA, and across The Prelude Network®, IVF with adenomyosis is now a path forward.

For anyone newly diagnosed, the key takeaway is this: you have options, and support is out there. Partner with a fertility clinic that understands the intricacies of adenomyosis and puts personalization at the heart of your treatment.

Visit The Prelude Network® to begin – or pivot – your journey.