Adenomyosis and Fertility: What the Evidence Shows

What is adenomyosis, and how does it affect fertility?

Adenomyosis is a condition in which endometrial-like tissue grows inside the muscular wall of the uterus, called the myometrium. The uterus can become enlarged, boggy, and tender, and periods are often heavy and painful.

How it lowers fertility is not fully settled, but researchers point to distorted uterine architecture, altered muscle contractions, and inflammation that may make embryo implantation harder. According to the World Health Organization, endometriosis affects about 10% of reproductive-age women, roughly 190 million people, and adenomyosis frequently coexists with it 1Ref 1World Health Organization (2025).Endometriosis (fact sheet).WHO fact sheet states endometriosis affects roughly 10% (about 190 million) of reproductive-age women; used to frame the frequent coexistence of adenomyosis and endometriosis.. Because the two overlap, separating their individual effects on conception is difficult, and estimates vary widely between studies. Symptoms can include heavy bleeding, intense cramps, and a feeling of pelvic pressure, though some people notice nothing unusual.

Can you get pregnant naturally with adenomyosis?

Natural conception is possible, and many people with adenomyosis conceive without any treatment. Whether the condition meaningfully reduces your chances depends on how extensive it is, your age, and whether other factors are present.

Infertility is common in the general population regardless of adenomyosis: the World Health Organization estimates that about 1 in 6 people of reproductive age experience it at some point 2Ref 2World Health Organization (2025).Infertility (fact sheet).WHO fact sheet states about 1 in 6 people of reproductive age experience infertility, framing adenomyosis as one of many possible contributors.. Age matters too. According to a committee opinion from the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, fertility declines gradually through the early 30s and more steeply after age 37 3Ref 3American College of Obstetricians and Gynecologists / American Society for Reproductive Medicine (2014).Female age-related fertility decline. Committee Opinion No. 589.Joint ACOG/ASRM committee opinion on age-related fertility decline: fertility declines gradually in the early 30s and more steeply after age 37.. Understanding how age affects fertility helps put an adenomyosis diagnosis in context. Even so, many with mild adenomyosis conceive within a year, and the diagnosis alone does not predict an individual outcome.

How is adenomyosis diagnosed before fertility treatment?

Imaging is the main way clinicians identify adenomyosis today, since a definitive diagnosis once required examining the uterus after a hysterectomy. Transvaginal ultrasound and MRI can now suggest the diagnosis with reasonable confidence.

During a fertility workup, imaging of the uterus is standard. The American Society for Reproductive Medicine notes that evaluating the uterine cavity and structure is a routine part of assessing female infertility 4Ref 4Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity and structure, and timing of evaluation after 12 months (or 6 months if age 35+), are standard in the female fertility workup.. Clinicians also look for coexisting conditions, because heavy periods can point to fibroids or endometriosis alongside adenomyosis. Mapping the full picture guides whether treatment before trying to conceive makes sense. A pelvic exam that finds an enlarged, tender uterus is often what prompts the imaging in the first place.

What treatments can improve the odds of conceiving?

Treatment aims to calm the uterus and reduce the affected tissue before conception, though fertility-sparing options are limited. Hormonal therapies that suppress periods can ease symptoms but are paused when someone wants to conceive, since they also prevent pregnancy.

For people using assisted reproduction, some specialists use a course of medication to quiet the uterus before an embryo transfer, an approach that remains under study. Surgery to remove adenomyosis is technically difficult and can affect the uterine wall, so it is reserved for selected cases. Because the evidence is still evolving, guideline groups stress individualized decisions rather than a single recommended path. Weighing frozen embryo transfer timing is one such decision.

When adenomyosis needs a fertility specialist

A reproductive endocrinologist or gynecologist with fertility expertise can turn a confusing diagnosis into a concrete plan. If you have been trying to conceive for 12 months, or 6 months if you are over 35, have heavy or worsening periods, or have had a pregnancy loss, a specialist can evaluate the uterus and coexisting conditions 4Ref 4Practice Committee of the American Society for Reproductive Medicine (2021).Fertility evaluation of infertile women: a committee opinion.ASRM committee opinion establishing that evaluation of the uterine cavity and structure, and timing of evaluation after 12 months (or 6 months if age 35+), are standard in the female fertility workup.. Adenomyosis is more often recognized in the later reproductive years and around the perimenopausal transition, so age and timing are part of the conversation. Care is individualized, and no two plans look alike. Gale can help you prepare for that conversation.