I’m just writing this mail because of my adenomyosis : an adenomyoma of 9 cm in the myometrium, found in april 2009 after a laparotomia. Everybody told me Adenomyosis is impossible to surgery. So I did therapy whit Enantone 3,75 for 6 months, but the adenomyoma not reduced its size. I’m looking for a pregnancy, so I’m going to do a Isteroscopy in november, the 6, before the end of the enantone effect, and then, if the situation of the uterus is not dramatic, we’ll try a FIVET.
If the isteroscopy result will says that uterus is compromised, and the mass occupying the uterine cavity, making it impossible to complete the pregnancy, do you think it is possible to surgery and remove an adenomyoma? is there any case where this was possible?
Thanks for the kindness and willingness. I await the response that you will send me.

Response

Concerning your (focal) adenomyosis consider the following
1. It is difficult to distinguish between a myoma and a nodular adenomyosis both by ultrasound and by MRI. It is close to impossible to make the diagnosis during laparotomy. Therefore the diagnosis might be wrong.
2. For an adenomyosis (and for a myoma), treatment with enanthone is a waist of time : it never cures and at best will give a reduction in volume by 30% (ie of some 10% in diameter). When given as a preparation for surgery, it might reduce blood loss during surgery ; surgery itself however, often is more difficult since the planes of cleavage are less clear.
3. An adenomyoma is (always) intramural ie in the wall of the uterus : therefore an adenomyoma (as does an an intramural myoma,) will almost always distort severely the uterine cavity. An hysteroscopy therefore is not adding anything to the diagnosis. Moreover hysteroscopic surgery for a 9 cm is not possible.
4. This means that (laparoscopic) surgery is the only option
- a myoma of 9 cm clearly can be removed by laparoscopy with subsequently a ‘normal’ fertility and pregnancy.
- an focal adenomyoma cannot be removed completely since the planes of cleavage are not clear. Therefore a debulking - reducing the mass- should be done ( by laparoscopy). with afterwards an almost normal uterus. The results for fertility are not that clear : when I reviewed the literature, a few years ago I found 4 cases reports of which 3 had a spontaneous pregnancy. I personally have done 3 debulkings for big adenomyoma’s and 2 became pregnant spontaneously.

In conclusion, for a focal adenomyotic nodule of 9 cm a laparoscopic debulking is the only option today (focused ultrasound is not realistic for a volume of 9 cm diameter). If no other fertility reducing factors exist I would try for at least 6 months to get pregnant spontaneously. After that period IVF should be considered

Prof P.R. Koninckx and Drssa A. Ussia