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Assisted Conception
Assessment of the impact adenomyosis on endometrial receptivity and reproductive outcome of IVF/ICSI We have just completed a prospective observational screening study in which we used established transvaginal ultrasound criteria for screening for adenomyosis in women presenting with infertility who were due to start IVF/ICSI and assessed the impact of adenomyosis on the outcome of IVF/ICSI. The results of this study show for the first time that adenomyosis has a direct negative impact on the outcome of IVF/ICSI. The presence of abnormal vascularity and heterotopic glands in the myometrium may potentially be a source of cytokines and immunological factors that may have a negative impact on endometrial receptivity and placentation. The endometrial-myometrial interface is a highly specialised tissue that has its own population of immunocompetent cells which when disrupted, as occurs in adenomyosis, may potentially have an impact of endometrial function. There is accumulating evidence that shows the effect of adenomyosis on endometrial cell antigen expression, cytokine production and production of free oxygen radicals, all of which a suggestive of disruption of endometrial receptivity Although, much work has been done into investigating the effects of endometrial factors in infertility, there remains little consensus regarding the significance of each factor. The uterine model of adenomyosis provides an opportunity to target research towards investigating endometrial receptivity in women with adenomyosis. In the light of the evidence obtained from this first study we intend to investigate the uterine endometrial receptivity in patients with adenomyosis undergoing assisted conception
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