Hormonal health

Adenomyosis and Fertility: What Research Shows

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Adenomyosis may reduce fertility and is linked to a somewhat higher miscarriage risk, but studies are small and mixed, and many people conceive. It often coexists with endometriosis, which lowers fertility on its own. There is no single test for it. A specialist weighs age, imaging, and history to plan care.

Last updated: July 2026

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Does adenomyosis make it harder to get pregnant?

Adenomyosis can reduce fertility for some people, though the size of the effect is uncertain and many conceive without help. Because the tissue grows into the muscle of the uterus, it may change how the lining prepares for an embryo and how the muscle contracts. Adenomyosis also frequently occurs alongside endometriosis, which the ESHRE guideline links to lower fertility 1.

Endometriosis affects roughly 1 in 10 women of reproductive age, so untangling the two matters 2. Studies of adenomyosis and conception are small and use different definitions, which is why researchers call the fertility link probable but not precisely measured. To compare, see endometriosis and pregnancy chances.

Can you still have a healthy pregnancy with adenomyosis?

Many people with adenomyosis carry healthy pregnancies, though the condition is linked to a somewhat higher risk of certain complications. Observational research has tied adenomyosis to increased odds of miscarriage and preterm birth, but studies are small and results conflict, so a precise personal risk is hard to quote.

For context, about 1 in 10 recognized pregnancies end in miscarriage even without adenomyosis, according to obstetric guidance 5. Extra monitoring during pregnancy is common when adenomyosis is known. Anyone who has had repeated losses may benefit from a workup, as described in recurrent miscarriage testing.

How is fertility evaluated when you have adenomyosis?

A fertility evaluation for adenomyosis starts with the same steps used for anyone trying to conceive. Clinicians generally suggest an assessment after 12 months of trying, or after 6 months if you are 35 or older, according to reproductive-medicine guidance 34. Testing may include ovulation checks, ovarian-reserve blood tests, a look at the fallopian tubes, and a semen analysis for a partner.

Pelvic ultrasound or MRI can gauge how extensive the adenomyosis is. Because findings guide very different plans, imaging is read alongside your age and history. For the broader picture, read female infertility causes and when to see a fertility specialist.

Do fertility treatments work with adenomyosis?

Fertility treatments can succeed with adenomyosis, and specialists sometimes adjust the plan to improve the odds. For people using IVF, some clinics use a course of hormone-suppressing medication before embryo transfer to calm the uterus, an approach borrowed from endometriosis care 1. Success still depends heavily on age, with IVF outcomes declining after 35 regardless of adenomyosis 4.

Timing matters because adenomyosis tends to progress over years and symptoms usually improve only after menopause, when fertility has ended. In adolescence adenomyosis is rare, so teens with heavy painful periods are more likely to have other causes. See IVF success rates by age to understand the age effect.

When a fertility specialist helps

A reproductive endocrinologist can tell you how much your adenomyosis is likely to matter and what, if anything, to do before trying. Because adenomyosis, endometriosis, and age often act together, a specialist can test for each and build a plan that fits your timeline 14.

If you are early in the journey, a preconception visit can flag issues before they cost time. Gale can help you organize your history and questions for that appointment. Many people with adenomyosis do conceive, and knowing your specific picture beats guessing from worst-case stories.

Common questions

Yes, many people with adenomyosis conceive naturally. Adenomyosis may lower the odds somewhat, especially when it coexists with endometriosis, but it is not a guarantee of infertility. If you have been trying for 12 months, or 6 months when you are 35 or older, an evaluation is reasonable.

Some studies link adenomyosis to a higher miscarriage risk, but the research is limited and inconsistent, so no exact number applies to everyone. For context, about 1 in 10 recognized pregnancies end in miscarriage even without adenomyosis. Repeated losses are worth investigating with a clinician.

It can, though the evidence is still developing. Before IVF, some specialists use hormone-suppressing medication to quiet the uterus, an approach adapted from endometriosis care. Surgery to remove focal disease is sometimes considered, but it carries its own risks and is decided case by case.

It depends on your age, ovarian reserve, and plans, not on adenomyosis alone. Because fertility declines with age and adenomyosis can progress, some people discuss preserving eggs earlier. A fertility specialist can review your ovarian-reserve tests and timeline to help you decide.

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When to seek care with adenomyosis and pregnancy

  • —Trying to conceive for 12 months without success, or 6 months when you are 35 or older, is a reason to arrange a fertility evaluation.
  • —Two or more miscarriages is a reason to ask a clinician about recurrent-loss testing.
  • —Severe pelvic pain or very heavy bleeding while trying to conceive is a reason to seek prompt clinician review.
  • —A positive pregnancy test with sharp one-sided pain or shoulder-tip pain is a reason to seek urgent care to rule out an ectopic pregnancy.

If you have a positive pregnancy test with severe one-sided pelvic pain, shoulder-tip pain, fainting, or heavy bleeding, treat it as an emergency and call 911 or go to the nearest emergency room.

This article is general health education, not medical advice. How adenomyosis affects your fertility depends on your age, imaging, and health history, and should be assessed with a gynecologist or fertility specialist.

References

  1. 1.Becker CM, et al. (ESHRE) (2022). ESHRE guideline: endometriosis. Human Reproduction Open. doi:10.1093/hropen/hoac009 ✓ESHRE endometriosis guideline describing the link between endometriosis and reduced fertility and the use of hormone-suppressing pre-treatment before assisted reproduction, relevant because adenomyosis frequently coexists with endometriosis.
  2. 2.World Health Organization (2025). Endometriosis (fact sheet). World Health Organization (WHO). link ✓WHO fact sheet stating endometriosis affects roughly 1 in 10 (about 10%) women of reproductive age, a condition that commonly coexists with adenomyosis.
  3. 3.World Health Organization (2025). Infertility (fact sheet). World Health Organization (WHO). link ✓WHO fact sheet defining infertility as failure to conceive after 12 months of regular unprotected intercourse.
  4. 4.Practice Committee of the American Society for Reproductive Medicine (2021). Fertility evaluation of infertile women: a committee opinion. Fertility and Sterility. doi:10.1016/j.fertnstert.2021.08.038 ✓ASRM committee opinion on when and how to evaluate female infertility, including earlier assessment at 6 months for people 35 and older, and the influence of age on outcomes.
  5. 5.American College of Obstetricians and Gynecologists (2018). ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002899 ✓ACOG practice bulletin noting early pregnancy loss occurs in about 10% (roughly 1 in 10) of clinically recognized pregnancies, providing baseline context for miscarriage risk.

5 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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