225 MATERIALS AND METHODS Study design and setting This single-centre retrospective cohort study was set at the Catharina Hospital in Eindhoven, The Netherlands, a regional referral centre between the years of 2008 and 2020. Participants Patients were women aged 18 to 42 years undergoing their first, fresh embryo transfer during IVF/ICSI. After meeting the local IVF/ICSI treatment eligibility requirements (see Appendix 10B), women in our centre received the same standard treatment. Pituitary downregulation was initiated with a recombinant GnRH agonist (Decapeptyl, Ferring Pharmaceuticals, Hoofddorp, the Netherlands), followed by ovarian stimulation using either recombinant follicle stimulating hormone (Gonal-F, Merck KGaA, Darmstadt, Germany) or human menopausal gonadotrophin (Menopur, Ferring Pharmaceuticals, Hoofddorp, the Netherlands; Fostimon, Goodlife Pharma, Lelystad, the Netherlands) at a standard starting dose of 150 IE/mL. Oocytes were fertilised on the same day as oocyte retrieval, either by IVF or ICSI (see Appendix 10B). Embryo transfer (single or double) took place three days after oocyte retrieval, after administration of human chorionic gonadotrophin (HCG, Pregnyl, Merck KGaA, Darmstadt, Germany) boost. Selection of the best quality (cleavage-stage) embryos was carried out according to local and alpha scoring criteria (see Appendix 10C). Luteal support was initiated with intravaginal progesterone (Utrogestan, Besins Healthcare, Utrecht, the Netherlands). See Appendix 10A for full details of local IVF/ICSI treatment protocol. Study group The study group included IVF/ICSI patients diagnosed with adenomyosis, endometriosis or both in the period of 2008 to 2020 on MRI. MRI consisted of T2-weighted images in axial, coronal and sagittal planes as well as axial T1weighted images. Slight variations in protocol existed, however without significant implications for diagnostic quality. MRI criteria for the presence of adenomyosis were: focal or diffuse JZ thickening >12 mm, JZ/myometrium ratio >40%, and/or presence of high signal intensity myometrial foci on T1/T2 corresponding to an adenomyotic cyst (>2mm in diameter). MRI criteria for
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