Does Adenomyosis Cause Infertility? Let's Break It Down

If you're dreaming about starting or growing your family, getting hit with a confusing medical diagnosis can feel like a punch to the gut. Maybe you’ve just heard the word adenomyosis for the first time, or maybe you’ve been dealing with painful periods for years and are only now connecting the dots. Either way, if you’re wondering whether adenomyosis can make it harder to get pregnant, you’re not alone. It’s a common but often misunderstood condition that can affect fertility. The good news? It’s manageable, and pregnancy is still possible.

Here’s what you need to know about adenomyosis, its potential impact on fertility, and what you can do next.

What is adenomyosis?

“Adenomyosis is a condition where tissue that normally lines the uterus grows into the muscle wall of the uterus. It can lead to heavy or painful periods, pelvic pain, pain with sex, and gastrointestinal or urinary symptoms like bloating, constipation, or urgency,” says Dr. Stacey Scheib, MD, a Minimally Invasive Gynecological Surgeon at The Fertility Institute of New Orleans.

If any of this sounds familiar, you’re not imagining things — and you deserve solutions.

Can adenomyosis affect fertility?

The short answer is yes, it can — but it doesn’t mean you can’t get pregnant. “Adenomyosis may lower clinical pregnancy rates, reduce live birth rates, and increase the risk of miscarriage, especially during assisted reproductive technology (ART) like IVF,” explains Dr. Amy Dhesi, MD, a Reproductive Endocrinologist & Infertility Specialist at Fertility & Surgical Associates of California.

There are several reasons why: it can create a proinflammatory environment in the uterus, it may disrupt implantation by affecting the endometrial lining, and it can cause abnormal uterine contractions or distort the uterine cavity. Each of these can interfere with the embryo’s ability to implant or develop.

Still, there’s plenty of hope. “It’s important to note that a diagnosis of adenomyosis doesn’t mean pregnancy is out of reach. Many people conceive naturally or with fertility support,” says Dr. Dhesi. “In some cases, treating adenomyosis before embryo transfer during IVF may improve outcomes. With the right care plan, many patients find a path forward.”

How is adenomyosis diagnosed?

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One of the biggest frustrations with adenomyosis is that it’s often overlooked. It shares symptoms with other conditions like endometriosis or fibroids, and doesn’t always show up on standard ultrasounds.

“Adenomyosis and endometriosis overlap in symptoms — heavy periods, pelvic pain, painful sex — which can make them hard to tell apart,” says Dr. Randy Fink, MD, a Fertility Gynecologist at NewLIFE Fertility. “They also often occur together and are harder to diagnose. The good news is, with greater awareness and evolving diagnostic tools and treatments, adenomyosis can be more accurately identified and effectively managed. ”

Here’s how fertility specialists typically diagnose adenomyosis today:

• Pelvic exam (to check for an enlarged, tender uterus)
• Transvaginal ultrasound (may show signs like thickening of the uterine wall or cysts)
• MRI (a more advanced tool that offers a clearer view of uterine tissue)
• Clinical history and symptom tracking play a huge role

If you’ve been experiencing severe cramps, heavy bleeding, or unexplained fertility issues, it’s worth asking your provider if adenomyosis could be involved.

Treatment options (that consider your fertility goals)

While there’s no one-size-fits-all treatment for adenomyosis, and there’s no “cure” short of hysterectomy (which obviously isn’t ideal if you’re trying to conceive), there are several ways to manage symptoms and improve your chances of conceiving:

• Medications: Hormonal therapies, such as birth control pills or GnRH agonists, can help regulate menstrual cycles and reduce symptoms.
• Minimally invasive procedures: Options like uterine embolization or focused ultrasound surgery can target and reduce adenomyosis tissue.
• Surgical options: In severe cases, surgical removal of adenomyosis tissue or a hysterectomy may be considered, especially if other treatments haven't been effective.

Dr. Scheib, who regularly performs adenomyosis-related surgery as a Minimally Invasive Gynecological Surgeon (MIGS), furthers:

“Historically, adenomyosis could only be diagnosed after a hysterectomy, but now imaging tools like ultrasound and MRI can help identify it. However, in the U.S., radiologists don’t always apply the diagnostic criteria consistently. Because of that, adenomyosis is often underdiagnosed or diagnosed late. It’s important for your gynecologist to review the imaging themselves if adenomyosis is suspected.”

“Treatment options include medications like NSAIDs, hormone therapies (birth control pills, IUDs, Depo Provera), and procedures such as high-intensity focused ultrasound or uterine embolization. Some of these are not recommended if you're hoping to preserve fertility. In more severe cases, surgery — including hysterectomy — may be considered.”

That’s why it’s essential to work with a provider who understands both your symptoms and your family-building goals. A personalized plan that takes into account your age, symptoms, and reproductive timeline is key.

What women or couples should know

For many women or couples, adenomyosis becomes an issue in their 30s, right when fertility naturally starts to decline and when many are finally ready to start or add to their families. If you're navigating this diagnosis alongside work, financial stress, and family planning, it’s a lot.

Here’s the takeaway: you didn’t cause this. Adenomyosis isn’t your fault. You’re not too late. Even with this condition, pregnancy is possible. You deserve answers. Your pain and your fertility concerns are valid. You have options. From medication to fertility treatments to supportive care, you can build a plan that works for you.

Finding support on the journey

Adenomyosis is real, and so are the emotions that come with it — confusion, grief, frustration, and sometimes fear. But you don’t have to face this alone. Support from fertility specialists, mental health professionals, or support groups can be empowering. Connecting with experienced providers, like those at First Fertility’s network of clinics, can help you feel seen, heard, and supported every step of the way. There is hope. And there’s a community ready to walk beside you.

Dahlia Rimmon is a freelance writer, editor, and registered dietitian. She writes for various publications and family-focused brands, covering everything from food and supplements to overall health and wellness. Her experience spans private practice, consulting, and working in the baby food industry. She lives in St. Louis with her family.