Clinical challenges and therapeutic strategies in women with endometriosis, deep infiltrating endometriosis, and/or adenomyosis undergoing assisted reproductive technologies: a narrative review - PubM

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This review examines fertility treatment strategies and outcomes for women with endometriosis, deep infiltrating endometriosis (DIE), and/or adenomyosis undergoing assisted reproductive technologies (ART).
A literature search up to September 2025 identified 91 relevant studies, highlighting that endometriosis and adenomyosis are significant causes of infertility and often coexist.
Endometriosis is associated with reduced oocyte yield and embryo quality, but live birth rates (LBR) are generally comparable to other infertility causes.
Adenomyosis, especially diffuse forms affecting the junctional zone, often has an adverse effect on IVF/ICSI outcomes, including lower LBR and higher miscarriage rates.
Evidence on GnRH analogue treatment and fresh vs. frozen embryo transfer (FET) cycles is mixed; FET may benefit endometriosis but shows similar results to fresh cycles in adenomyosis alone.
When both conditions are present, adenomyosis tends to have a greater negative impact on miscarriage and LBR than endometriosis alone.
Pre-ART screening with ultrasonography and MRI is recommended due to increased pregnancy complications, highlighting the importance of cumulative LBR as a measure of ART success.

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