32 The junctional zone and infertility As junctional zone dysfunction and changes are thought be associated with infertility, several studies have specifically investigated if changes in the JZ can be correlated with IVF outcomes. While these studies are heterogenous in design and study population, they all seem to show a potential link between thickened JZ and infertility. For instance, Meylaerts et al. (95) reported that infertile women have a thicker mean JZ on MRI than healthy nulliparous women. Similarly, El Gaber et al.(96) showed that women with recurrent implantation failure had a thicker JZ (on TVUS) than women with unexplained infertility. Kunz et al.(97) also linked a thickened JZ to reduced oocyte quality amongst IVF or intracytoplasmic sperm injection (ICSI) patients. Maubon et al. (98) and Piver et al. (99) suggested more specifically that a JZ of over 7mm can be used to predict IVF failure with 97% accuracy. Several of these studies included women with endometriosis, and suggested that a thicker junctional zone (and thereby potential adenomyosis) could also be independently related to IVF failure in the context of endometriosis (97,98,100). Adenomyosis on MRI and infertility Despite promising results separately suggesting a link between MRI characterisation of the JZ and infertility, and adenomyosis on MRI and infertility, few studies have investigated these two aspects in conjunction with each other. Some evidence does exist suggesting a link between adenomyosis severity and fertility, for instance that women with diffuse adenomyosis do seem to have worse fertility outcomes than those with focal adenomyosis (101). More detailed studies characterising adenomyosis on MRI in the context of infertility are needed. We thus propose to carry out a detailed exploration into the characterisation of adenomyosis and MRI in the context of infertility, and to attempt to correlate this concretely to IVF outcomes. Effect of adenomyosis on pregnancy outcomes In the foregoing section, we established that it is now becoming accepted that presence of adenomyosis affects a woman’s chances of becoming pregnant, and increases her chance of miscarriage. More and more current literature also denotes however, that the risk of complications continue into later pregnancy as well.
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