36 Thesis Outline: In this thesis, we assess the effect of adenomyosis on the whole spectrum of uterine contractile and reproductive function, starting with an exploration into non-invasive diagnosis by way of MRI, and ending with its influence on obstetric outcomes. The thesis is divided into dedicated parts assessing each of the thesis objectives as described above. Part II: Chapter Two of this thesis focusses on the existing MRI-based diagnostic criteria for adenomyosis and their reported diagnostic accuracy from available literature. Based on the resultant described criteria, we then developed a multivariate diagnostic tool for adenomyosis diagnosis based on MRI and clinical parameters in Chapter Three. In Chapter Four we externally validate this prediction model using a separate patient cohort. Part III: In Chapter Five we develop a new 2D TVUS method employing speckle tracking and explore its use for assessing uterine contractile function and its potential for predicting IVF success. In Chapter Six, using this new method, we suggest a set of reference values for normal uterine contractile function in a prospective cohort of healthy women with normal uteri. In Chapter Seven, we then investigate existing literature for the effect that uterine abnormalities (including adenomyosis, leiomyomas and congenital uterine anomalies) have on uterine contractile function. We then used the same cohort of normal women to compare uterine contractility features to women with adenomyosis in Chapter Eight to assess how and if uterine contractility is affected. Part IV: Chapter Nine explores the IVF/ICSI outcomes of patients with adenomyosis, endometriosis or both compared to match male infertility controls. Subsequently, in Chapter Ten individual MRI characteristics of adenomyosis in IVF/ICSI patients are associated with IVF/ICSI outcomes. Part V: After assessing the effect of adenomyosis on fertility in the previous chapters, Chapter Eleven focusses on the association of adverse obstetric outcomes in histologically diagnosed adenomyosis patients at the Dutch population-level.
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