Adenomosis, what is the “sister” pathology of the endometriosis and how the new protocol that doubles the possibilities of pregnancy works

Adenomosis is one of the main causes of the bankruptcy of the plant and spontaneous abortion in medically assisted procreation techniques. “Sister” pathology of the endometriosis, in Italy it affects up to 1 out of 5 women in fertile age. It is a Benign gynecological pathology, characterized by the presence of endometrial tissue (what normally covers the uterus) Inside the Miometrium, the muscle layer of the uterus. A phenomenon that causes thoroughness of the uterine wall, causing abundant menstruation, pelvic pains and, in many cases, difficulty conceivingprecisely.

A new study carried out by Ivi – one of the main international groups specialized in medically assisted reproduction – and presented at the 41st Congress of the European Society of Human Reproduction and Embryology (EShre) of Paris, has shown the effectiveness of A new protocol that doubles the possibilities of pregnancy.

What is the new hormonal protocol for women with adenomyosis

The new hormonal protocol shows how a combination of GNRH competitive and aromatase inhibitor, administered before the embryonic transfer, doubles the pregnancy rate compared to standard treatments. The data come from a clinical study led by Dr. Mauro CozzolinoSpecialist in reproduction medicine, Director of Center of Bolognaconducted at Rome on women between 30 and 49 years of age with a form of adenomosis called adenomiomaanalyzing transfers of frozen embryos. Patients who followed a specific hormonal treatment – consisting of two months of therapy to block ovarian hormones, followed by three weeks of a second drug – they obtained almost double the pregnancies Compared to those who received the standard treatment: 47% against 26%. Even the number of pregnancy confirmed ultrasound was clearly higher: 66% in the treated group, compared to 33% in the control group.

“They were very significant, and mark an important step forward in the treatment of an often underestimated condition,” Cozzolino highlighted. “Adenomosis is characterized by an excess of estrogen and a chronic inflammatory state that compromise the receptivity of the endometrium. With this protocol we manage to turn off the hormonal fire that feeds the disease and significantly improve the results in assisted fertilization treatments ».

At the base of the pathology: causes, diagnosis, drugs

The hormonal protocol adopted by Ivi acts on the mechanism behind the disease. The first drug blocks the production of estrogen by the ovaries, while the second reduces the effect of estrogen present in the tissues of the uterus. This lowers inflammation, reduces the contractions of the uterus and improves the conditions to welcome the embryo.
And there is more: this treatment seems to increase the presence of some molecules, calls integrinewhich help the embryo to “attack” better to the endometrium (the internal wall of the uterus). Even taking into account factors such as the patient age, the weight, the quality of the embryos and the state of the endometrium, the treatment has continued to demonstrate its effectiveness.

“This combination works because it acts on the biological roots of the disease,” specifies the specialist. “Adenomosis and endometriosis are” sisters “diseases, they share a common genetic and inflammatory base: everything starts from a mutation of the blueder K-Ras, which alters the endometrium making it resistant to progesterone. Our approach allows you to reduce the risk of abortions and increase the number of children born, “he adds. «For us, this protocol is already the standard in cases of adenomyosis. We do not make a transfer without this pretreatment ».

PMA, the “modified natural cycle” arrives, more manageable and with less risk of abortion. Mauro Cozzolino: «It means less pain, less frustration, less awaited. Has a huge psychological weight “

A new Italian-Spanish study, presented at the Congress of the European Human Reproduction Society of Embriology in Paris, demonstrates the effectiveness of the “modified natural cycle”, a new PMA path that works as it is the artificial one, reduces the risk of abortion and is easier to face from an emotional point of view. Also for women who are over 40

Today we know that 1 in 5 women, in Italy, suffers from adenomyosis. Dr. Cozzolino, what has changed on the diagnosis front?
«The diagnosis of adenomyosis has always been difficult because it was based only on histological confirmations after hysterectomy. Today, thanks to the expert ultrasound, We can diagnose the pathology in a non -invasive way, but specific skills are needed: a woman with persistent menstrual pain or anomalous bleeding, must be evaluated by a gynecologist expert in ultrasound, because many cases are still ignored or underestimated. In general, we have however become more capable of diagnosing this pathology also because the machines we have available are not the same as 20 years ago ».

Which women are more “affected”?
“It is a pathology that tends to highlight itself more frequently with advanced age, also due to the delay in the diagnosis. Fortunately, however, we live an important social change: in the past, all the problems related to the female sphere were underestimated, there was no right location and we did not go to the gynecologist in a systematic way. Although this still happens in certain realities, today there is however a greater awareness of one’s health and the importance of approaching a path, it is understood that there are problems that are not normal within what a woman’s life can be. This is the reason why the diagnoses of adenomyosis in teenage women have also increased ».

So it’s not just a problem of adult women …
«The disease has a latency time but can also appear in younger women and in most cases with the symptom of dysmenorrhea: abundant bleeding are a bell, however in most cases they are resolved with the intake of the pill and liquidated without giving a specific diagnostic location. Instead, a well -made ultrasound is needed, by a professional who knows how to recognize this condition. Early diagnosis can change everything».

Do you know what this pathology could cause?
«Studies of this type, at the moment, we do not. It certainly was an association between adenomyosis and insulin -resistance has been identifiedtherefore with metabolic disorders. But it is still to be understood if it is the insulin -resistance that causes adenomyosis or adenomyosis that causes insulinance. Over time we will have to clarify what is the causing link of what, because considering that there are drugs for insulinance, the use could also be evaluated for the control of the development of a pathology such as adenomyosis “.

Are there specific treatments for adenomyosis? Is pharmaceutical research moving in this sense?
«Yes, of course there is a continuous interest from pharmaceuticals in trying to produce more effective and more tolerated drugs, with a lower impact regarding side effects. In our case, for a treatment aimed at PMA, we use a combination of two drugs that are already on the market but that nobody had thought of associating. Considering, then, that a new drug for adenomosis is about to be introduced on the market, we will surely evaluate it within our setting ».

What suggestion do you feel like giving women with adenomyosis who have a desire for motherhood?
“Adenomosis is not a condemnation. With the right treatments it is possible to obtain pregnancyeven if it could serve more than an attempt or the transfer of multiple embryos. The point is not to surrender ».