Yes, adenomyosis may affect fertility, but it does not mean you cannot get pregnant. The condition occurs when tissue from the uterine lining grows into the muscle wall. Research links adenomyosis with lower pregnancy and live-birth rates during IVF and a higher risk of miscarriage, although evidence about natural conception is less clear. Your age, other fertility factors, symptoms, and scan findings all matter when planning next steps.
How can adenomyosis affect fertility?
Adenomyosis develops when tissue similar to the lining of the uterus grows into its muscular wall. This tissue responds to the menstrual cycle and may cause the uterus to become enlarged, along with symptoms such as heavy periods and painful cramps. According to Johns Hopkins Medicine, the condition can affect reproductive health, although research into its effects on fertility is still developing.
Getting pregnant involves several steps, including the release of an egg, fertilization by sperm, and the implantation of an embryo into the uterine lining. Researchers are studying whether adenomyosis affects the uterine environment or activity in ways that make implantation or the continuation of an early pregnancy more difficult. However, the exact processes involved are not fully understood, and the effect of the condition may differ from one person to another.
The important distinction is that adenomyosis is associated with fertility difficulties, but it does not automatically cause infertility. Some people with the condition conceive without fertility treatment, while others may experience difficulties getting pregnant or maintaining a pregnancy. A diagnosis alone cannot predict whether pregnancy will occur or how long conception might take.
Can you get pregnant naturally with adenomyosis?
Yes, natural pregnancy is possible with adenomyosis. Evidence about whether the condition directly reduces the chance of conceiving without medical assistance remains limited. The University College London Hospitals NHS Foundation Trust (UCLH) explains that there is no evidence establishing that adenomyosis prevents natural conception, although some evidence suggests it may affect the success of fertility treatment.
This uncertainty means that adenomyosis should not be treated as proof that you will need in vitro fertilization (IVF). The likelihood of natural conception also depends on factors such as age, ovulation, sperm health, fallopian tube function, and other reproductive conditions. Endometriosis and uterine fibroids, for example, may occur alongside adenomyosis and can also be relevant when assessing fertility.
If you have been diagnosed with adenomyosis and are planning a pregnancy, discuss your reproductive goals with a gynecologist. The appropriate next step will depend on your medical history, symptoms, age, previous pregnancies, and how long you have been trying to conceive.
What does adenomyosis mean for IVF success?
Evidence linking adenomyosis to fertility problems is more consistent in studies of people undergoing assisted reproduction, particularly IVF. A systematic review and meta-analysis available through the U.S. National Library of Medicine's PubMed Central found that ultrasound-diagnosed adenomyosis was associated with lower clinical pregnancy and live-birth rates and higher miscarriage rates among people undergoing IVF, compared with those without the condition.
These findings describe associations across groups of patients, not a prediction for any one person. The researchers rated the certainty of evidence for the overall comparisons as very low, reflecting important limits in the available studies. The results also differed according to the features of adenomyosis and how it was diagnosed. Some people with the condition still achieve pregnancy and live birth through fertility treatment.
For someone considering IVF, adenomyosis is therefore a factor worth discussing during treatment planning. A fertility specialist may consider the ultrasound or MRI findings, symptoms, reproductive history, and any other conditions that could influence outcomes. The presence of adenomyosis does not, by itself, determine whether IVF will succeed or which treatment approach is most appropriate.
Does adenomyosis increase the risk of miscarriage?
Research suggests that adenomyosis may be associated with an increased risk of miscarriage. However, not everyone with the condition experiences pregnancy loss, and the diagnosis cannot establish what will happen in a future pregnancy. Fertility research also needs to distinguish between the likelihood of conceiving, the chance of a pregnancy continuing, and the likelihood of a live birth. These are related but different outcomes.
Adenomyosis may also be linked with certain pregnancy complications. According to Mayo Clinic, reported complications include miscarriage, preterm birth, and babies being small for their gestational age. The evidence does not mean these outcomes are inevitable. If you become pregnant and have a known diagnosis, let your maternity care team know so they can consider your medical history when planning care during pregnancy.
How is adenomyosis assessed when you want to conceive?
A fertility assessment generally starts with a review of your menstrual cycle, symptoms, reproductive history, and previous investigations. A clinician may ask about heavy or prolonged periods, severe menstrual cramps, persistent pelvic pain, or pain during sex. These symptoms can occur with adenomyosis, but they may also have other causes, and some people with adenomyosis have no noticeable symptoms.
A pelvic examination and imaging may help assess the uterus. Transvaginal ultrasound is commonly used to look for features of adenomyosis and other uterine conditions. Magnetic resonance imaging (MRI) may be considered when more detailed information is needed. No single symptom or scan finding can determine your individual fertility prospects on its own.
If conception has been difficult, the evaluation may also include checking whether ovulation is occurring, assessing the fallopian tubes, and evaluating sperm health when relevant. This broader approach matters because difficulties conceiving may have more than one contributing factor. Focusing only on adenomyosis could overlook another issue that needs attention or treatment.
What treatment options may help when pregnancy is the goal?
Treatment decisions depend on whether the main priority is relieving symptoms, improving the chances of pregnancy, or addressing both concerns. There is no single approach that is proven to restore fertility in every person with adenomyosis. A gynecologist or fertility specialist can explain the potential benefits, limitations, and risks of the options available for your circumstances.
Managing symptoms while planning pregnancy
Hormonal treatments, including certain contraceptive medicines and hormonal intrauterine devices, are often used to manage heavy bleeding or pain associated with adenomyosis. However, these methods generally prevent pregnancy while in use. If you are trying to conceive now or soon, tell your clinician before starting or changing treatment so that symptom control can be coordinated with your reproductive plans.
Considering fertility treatment
If natural conception has not occurred or other fertility factors are present, a specialist may discuss options such as IVF. The decision depends on the complete fertility assessment rather than an adenomyosis diagnosis alone. During IVF planning, the specialist may also consider whether treating symptoms or using medication before a treatment cycle is appropriate for you.
Evidence comparing different IVF approaches for adenomyosis remains limited. A 2024 systematic review and meta-analysis published in BMJ Open examined different IVF and intracytoplasmic sperm injection protocols and found that the available evidence did not establish one approach as best for everyone with adenomyosis. A treatment plan should therefore reflect your clinical findings and be reviewed with a fertility specialist rather than relying on a single protocol as a guaranteed solution.
Understanding the role of surgery
Surgery may be considered in selected cases, but procedures involving the uterus require careful discussion when future pregnancy is important. Some operations aim to remove affected tissue while preserving the uterus, yet their suitability and reproductive outcomes depend on the individual case, and supporting evidence is limited. A hysterectomy removes the uterus and makes carrying a pregnancy impossible, so it is not compatible with a future pregnancy. Before agreeing to surgery, discuss its impact on fertility and whether alternatives are available.
When should you seek fertility advice?
Consider speaking with a gynecologist if you have been diagnosed with adenomyosis and want to become pregnant, particularly if you have persistent pelvic pain, very heavy periods, or a history of pregnancy loss. You do not necessarily need to wait until you have tried to conceive for a long time before asking for advice. The American Society for Reproductive Medicine recommends starting a fertility evaluation without delay when a known or suspected condition may affect reproductive function.
For people without a known fertility concern, a typical guideline is to seek an evaluation after 12 months of trying if younger than 35, or after 6 months if aged 35 or older. People over 40 may benefit from more immediate assessment. These timeframes should not be used to delay evaluation when a medical condition or concerning symptoms already warrant a discussion with a healthcare professional.
Seek medical assessment sooner if menstrual bleeding is unusually heavy, pain is worsening, or symptoms interfere with daily activities. The goal is to understand what is contributing to your symptoms and fertility circumstances, then choose a plan that reflects your needs and priorities.
What is the overall outlook for fertility with adenomyosis?
Adenomyosis may affect fertility, and studies suggest that it can be associated with less favorable IVF outcomes and a greater risk of miscarriage. However, the evidence is not strong enough to predict an individual's outcome from the diagnosis alone, and natural conception remains possible. An early conversation with a gynecologist or fertility specialist can help clarify which factors matter most in your situation and whether any further evaluation or treatment is appropriate.