Adenomyosis and subfertility: evidence of association and causation.

Due to the confounding or unknown presence of endometriosis in both cases and controls, it is difficult to test the hypothesis that adenomyosis causes infertility. Based on the limited available evidence, there is evidence to support a causal association between adenomyosis and subfertility: Adenomyosis is associated with lifelong infertility in baboons, is associated with impaired reproductive outcome after assistive reproductive technique, and a dose-effect relationship between the degree of adenomyosis and the degree of abnormal uterotubal contractility has been demonstrated. More and better designed studies are needed to assess the impact of adenomyosis on infertility in women with the laparoscopic-proven presence or absence of endometriosis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.