الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Adenomyosis has been found to have a negative impact on fertility and IVF outcome. Different mechanisms have been suggested such as uterine dysperistalsis and altered endometrial function. The majority of the available studies in the literature were evaluating the prevalence of adenomyosis in a population of symptomatic women who underwent hysterectomy rather than the infertile population. In addition, histological diagnosis of adenomyosis following hysterectomy in infertile women is not a reasonable option. Currently 2D-TVS and MRI allow an accurate non-invasive diagnosis of adenomyosis. Objectives: This study aimed to assess the prevalence of adenomyosis among infertile women by using 2D-TVS and confirmed by MRI. Patients and methods: This was an observational cross-sectional study of 320 infertile women attending the outpatient clinic of the gynecology department, Mansoura University hospitals between October 2013 to June 2017. Diagnosis of adenomyosis was made in the presence of one or more of its sonographic markers including asymmetrical myometrial thickening, myometrial anechoic cysts, hyperechoic myometrial islands, hyperechoic subendometrial linear striation, heterogenous myometrial texture and irregular or interrupted JZ. Adenomyoma was defined as a heterogenous nodular mass with ill-defined borders. Subsequently, the diagnosis was confirmed by pelvic MRI examination according to the following diagnostic criteria: thickened JZ (JZ max) ≥12 mm, the ratio of the JZ max to the corresponding overall myometrial thickness > 40% and/or high signal intensity myometrial spots. Results: The mean age of the studied group is 29.21±4.74 years old. Prevalence of adenomyosis among them is 7.5% by 2D-TVS and confirmed to be 6.6% by MRI. The majority of cases was diffuse type of adenomyosis (85.7%). A significant higher prevalence was found in women 40 years old (40%) compared to women < 40 years (4.9%). Women with adenomyosis had significantly increased mean age, BMI and more dysmenorrhoea than those without adenomyosis. Associated ovarian endometrioma and fibroid were found in 19% and 23.8% of cases with adenomyosis respectively. Conclusions: In a group of young infertile women, the prevalence of adenomyosis confirmed by diagnostic MRI criteria is 6.6%. Recommendations: Our reported 6.6% prevalence for adenomyosis in a group of young infertile women without being previously detected should alert the awareness of ultrasonographers and gynecologists to look for features of adenomyosis during 2D-TVS examination of young infertile women. In case of positive findings, MRI is important to confirm the diagnosis. More large population studies are needed to find the exact prevalence of adenomyosis in these women.