Main conclusion
In a retrospective analysis, extensive surgery for diffuse adenomyosis was associated with fewer miscarriages, but no significant improvement in live birth. Three uterine ruptures among 34 women who delivered after surgery show why potential benefit must be weighed against serious harm.
What was studied
The study compared 221 women with severe diffuse adenomyosis: 125 underwent cold-knife excision with multilayer uterine reconstruction and staged assessment, while 96 received GnRH-agonist treatment alone. After AIPW adjustment, surgery was associated with lower miscarriage risk, RR 0.18, but not with a significant live-birth improvement. One rupture required hysterectomy.
Key limitations
The study was not randomized, and treatment selection may have created baseline differences. Only a subset completed monitoring and embryo transfer. Three events cannot provide a precise risk estimate, but they are too serious to dismiss.
What this means in practice
This is not a routine step before IVF. Selection requires a specialist center, discussion of alternatives, high-risk pregnancy planning, and explicit acknowledgment that live-birth benefit remains unproven.
Source
Journal of Minimally Invasive Gynecology, 2026. DOI: https://doi.org/10.1016/j.jmig.2026.08.024 PubMed: https://pubmed.ncbi.nlm.nih.gov/42697509/
Educational material; it does not replace individual medical advice.