3 01 uterine contractility compared to healthy controls (albeit using different measurement methods). It remains to be researched how the uterine contractions associated with these different uterine abnormalities compare to those affected by adenomyosis versus healthy controls. We thus open up an avenue into the quantification of uterine contractility as an added marker of (ab)normal uterine function in the domain of gynaecological research and, perhaps one day, in gynaecological standard examinations. - Objectives Three and Four: Adenomyosis and its effect on fertility and obstetric outcomes Having established that adenomyosis can be diagnosed reliably and noninvasively, and that adenomyosis seems to affect a core element of uterine function by way of its effect on the uterine myometrial activity, we then assessed if this is indeed reflected in terms of reproductive outcomes. When looking at adenomyosis-specific imaging markers, only the presence of myometrial cysts was significantly associated with worse IVF/ICSI outcomes in Chapter 10. A specific adenomyosis subtype as such could not be significantly associated with worse IVF/ICSI outcomes in our study. A variety of recent studies have suggested certain subtypes of adenomyosis to be associated with worse outcomes, but these studies are conflicting, with some suggesting an association with focal and others with diffuse adenomyosis. However, answering this query is not easy as there is still no uniform consensus on adenomyosis subtypes in general, and MRI diagnostic criteria in particular. This makes comparing and summarising the available literature difficult, as available studies often use different diagnostic criteria and categorisations. More attention is being given to the probable importance of adenomyosis and fertility outcomes. The hope is that, in time, a consensus will be reached as to not only which MRI diagnostic markers are most leading, but also what their clinical consequences could be. A consensus meeting with Delphi procedure of relevant experts is something which could aid and streamline this process. This has in fact already been done for adenomyosis ultrasound criteria (197), and for outcome reporting in uterus-sparing adenomyosis treatments (299), and paves the way for further strides in the field regarding adenomyosis on MRI and fertility outcome reporting.
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