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IVF With Adenomyosis: Success Rates, Treatment Options and When to Consider Surrogacy

IVF with adenomyosis can lead to pregnancy and a healthy birth, but adenomyosis may lower implantation and live birth rates and raise miscarriage risk.

How much the condition affects your chances depends on factors such as:

If you’ve already had unsuccessful transfers, the next decision is whether treatment or a different IVF strategy could improve your chances enough to justify another attempt.

If those options have been evaluated or tried, it may also be reasonable to ask whether carrying the pregnancy has become the main barrier and whether gestational surrogacy deserves consideration.

How Does Adenomyosis Affect IVF Success?

Adenomyosis can reduce IVF success by changing the uterine conditions involved in implantation and early pregnancy. It can affect IVF even when fertilization and embryo development are going well.

Adenomyosis occurs when endometrial-type tissue is present within the muscular wall of the uterus. It has been associated with:

An embryo may therefore develop normally but still have more difficulty implanting or continuing as a pregnancy.

Research also suggests that symptomatic or diffuse adenomyosis may affect IVF outcomes more than mild or asymptomatic disease.

After failed transfers, your reproductive endocrinologist can review embryo quality alongside disease extent, uterine size, symptoms, previous pregnancies or miscarriages and any coexisting endometriosis.

That gives you a clearer basis for deciding whether another transfer should follow the same plan.

IVF Success Rates With Adenomyosis

IVF can succeed with adenomyosis, but studies generally find lower pregnancy or live birth rates than among patients without the condition.

There isn’t one success percentage that accurately predicts an individual IVF with adenomyosis outcome.

A 2025 prospective cohort published in Human Reproduction followed patients through up to three consecutive IVF or ICSI treatments.

The 2025 IVF outcome study found that women diagnosed by ultrasound with endometriosis and/or adenomyosis had a 15% lower adjusted chance of cumulative live birth than women without either condition.

On an intention-to-treat basis, cumulative live birth was 53.2% in the endometriosis/adenomyosis group compared with 68.7% in the comparison group.

Live birth rates in the affected group were 30.7% after the first treatment, 28.6% after the second and 26.2% after the third, although the third-treatment difference was not statistically significant.

Endometriosis and adenomyosis can occur together, but they aren’t interchangeable diagnoses. That’s particularly important when interpreting this study because its outcome figures combine patients with endometriosis, adenomyosis or both, so the percentages shouldn’t be treated as adenomyosis-only IVF success rates.

Your age, embryo quality, previous implantation history and severity of adenomyosis may provide more useful guidance about what another attempt could mean for you.

What Is the Best IVF Protocol for Adenomyosis?

There is no single best IVF protocol for adenomyosis.

Treatment is usually individualized according to ovarian reserve, disease severity, previous IVF response and whether the immediate goal is embryo creation or embryo transfer.

A 2024 case series, The Administration of Long In-Vitro Fertilization Protocol in Adenomyosis, reported successful pregnancies in two patients treated with long IVF protocols.

The long IVF protocol report discusses how GnRH agonist treatment may reduce inflammatory and estrogen-dependent disease activity while also noting that no preferred protocol has been established.

For some patients, treatment works better as two separate stages.

Embryos can be created and frozen first, particularly when age or ovarian reserve makes delaying retrieval undesirable.

Adenomyosis can then be treated before transfer. That doesn’t mean every patient needs prolonged suppression; the value depends on what your fertility specialist believes is limiting success and whether changing the protocol addresses that problem.

Long GnRH Agonist Protocols

Long GnRH agonist protocols may help some patients by temporarily suppressing ovarian hormone production and reducing estrogen stimulation of adenomyotic tissue.

They appear to be more relevant for certain disease patterns than for adenomyosis as a whole.

Treatment may last roughly two to six months in selected patients. The appropriate length depends on:

  • Disease severity
  • Treatment history
  • Whether the potential benefit of additional suppression justifies delaying embryo transfer

A 2021 retrospective cohort compared 371 fresh IVF/ICSI cycles using ultra-long and standard long GnRH agonist protocols.

The ultra-long protocol study found no statistically significant live birth difference across the full adenomyosis population, although early miscarriage was lower with the ultra-long protocol at 12.0% compared with 26.5%.

Among patients with diffuse adenomyosis, the results were stronger.

Clinical pregnancy rates were 55.3% with the ultra-long protocol versus 37.9% with the long protocol, while live birth rates were 43.4% and 25.9%, respectively.

The study did not find the same advantage among patients with focal adenomyosis.

If prolonged suppression is recommended, ask what feature of your diagnosis makes your fertility specialist expect a meaningful benefit.

Several extra months of treatment are easier to evaluate when you know what the delay is intended to change.

Frozen Embryo Transfer After Suppression

Frozen embryo transfer after suppression may give your fertility team more control over when an embryo is transferred. It separates ovarian stimulation and retrieval from treatment of the uterus.

A frozen transfer gives your fertility clinic something a fresh transfer doesn’t: time between ovarian stimulation and embryo transfer to treat adenomyosis.

That can matter when your doctor believes suppressing disease activity before transfer may improve the conditions for implantation.

A review of hormonal suppression published in 2026 found that prolonged GnRH agonist pretreatment, particularly within freeze-all strategies followed by frozen embryo transfer, may improve implantation or reduce miscarriage for some patients.

The studies used different regimens and patient populations, so one preferred suppression duration has not been established.

Fresh transfer isn’t automatically inappropriate when adenomyosis is present.

The potential advantage of frozen transfer is the additional treatment window when your doctor believes the uterus would benefit from suppression before an embryo is transferred.

If you already have frozen embryos, ask what suppression is expected to change before the next transfer.

That tells you more about whether delaying transfer is worthwhile than choosing a frozen transfer solely because adenomyosis appears on imaging.

Additional Medications

Additional medications may help selected patients with adenomyosis, but no medication should be considered a routine IVF add-on simply because the condition is present.

Progestins, aromatase inhibitors and other approaches are being studied for specific treatment goals.

A prospective study published in late 2024 examined 94 women with adenomyosis and recurrent implantation failure who underwent frozen embryo transfer.

In the progestin treatment IVF study, patients treated for two months with dienogest and low-dose aspirin had successful implantation and clinical pregnancy rates of 25%, compared with 7.4% among untreated patients.

Because dienogest and aspirin were given together, the study can’t determine how much of the observed benefit came from either medication individually. Its relatively small size also limits how broadly the findings should be applied.

A 2025 Human Reproduction conference study examined GnRH agonist suppression plus an aromatase inhibitor before frozen embryo transfer.

The aromatase inhibitor treatment study reported ongoing pregnancy in 47.06% of the pretreatment group compared with 25.96% of patients without pretreatment.

That study was retrospective, conducted at one center and included 42 transfers in the pretreatment group. These findings support further study rather than establishing a standard protocol.

If your clinic recommends additional medication, ask what the drug is intended to change in your case.

The answer should connect the treatment to your adenomyosis, transfer history or another identified clinical issue.

Should Adenomyosis Be Treated Before IVF?

Adenomyosis should be evaluated before IVF, but not every patient needs treatment before egg retrieval or embryo transfer. Treatment is more commonly considered when there is a reason to believe adenomyosis could interfere with implantation or pregnancy.

Your fertility specialist may put more weight on treatment when you have:

  • Symptomatic, diffuse or more extensive adenomyosis
  • An enlarged uterus or imaging findings that suggest more significant disease
  • Previous implantation failures or pregnancy losses
  • A treatment history that increasingly points to the uterus rather than embryo creation as the concern

Treatment before embryo transfer is more likely to make sense when reducing adenomyosis activity could improve the conditions for implantation.

Hormonal suppression may be used before transfer, while embryo creation can sometimes happen first when age or ovarian reserve makes delaying retrieval a concern.

Treatment may also reduce heavy bleeding or pelvic pain. Symptom improvement can be valuable, although feeling better does not necessarily mean implantation chances have improved by the same degree.

A 2021 adenomyosis IVF review found that adenomyosis was associated with lower clinical pregnancy and live birth rates and greater pregnancy loss after IVF.

The authors also described treatment decisions as dependent on factors including age, symptoms, uterine volume and the depth and extent of disease.

Your fertility specialist may monitor symptoms and ultrasound findings and, in selected situations, use MRI to assess the uterus.

Changes in uterine size or other imaging features may help evaluate treatment response, but they cannot predict the outcome of the next embryo transfer.

Treatment may provide less fertility benefit when adenomyosis is mild, asymptomatic and there is no history suggesting implantation problems. The decision is stronger when your doctor can explain what treatment is expected to improve before the next transfer.

Is Surgery Necessary Before IVF?

No. Surgery is not routinely necessary before IVF for adenomyosis.

Whether it makes sense depends on the location and extent of disease, symptoms, uterine anatomy, ovarian reserve and previous treatment.

Focal adenomyosis may sometimes be treated surgically because the affected tissue is more localized.

Diffuse adenomyosis can be harder to remove because adenomyotic tissue may extend throughout the uterine muscle without a clear border.

A fertility and surgery comparison discusses the tradeoff between treating adenomyosis surgically and moving ahead with fertility preservation or IVF.

When ovarian reserve is declining, creating eggs or embryos before surgery may sometimes protect against losing reproductive time.

Surgery can also leave uterine scarring and affect management of a later pregnancy. That makes the order of treatment part of the decision, not just whether surgery is technically possible.

For some patients, embryo creation and freezing may come first. For others with significant focal disease that distorts the uterus, surgery may deserve more consideration before transfer.

If surgery is seriously being considered, compare recommendations from your reproductive endocrinologist and a surgeon experienced in fertility-preserving adenomyosis treatment.

 Ask what surgery is expected to improve, what pregnancy risks it may introduce and whether embryos should be created before the procedure.

How Many IVF Cycles Should You Try Before Considering Surrogacy?

There is no universal number of IVF cycles you must complete before considering surrogacy.

The better decision point is whether another embryo transfer would meaningfully address the reason previous attempts haven’t worked.

One unsuccessful transfer usually isn’t enough to establish that adenomyosis is the cause. A discussion about changing strategies becomes more useful when you have:

Euploid embryos can make this discussion more specific because PGT-A has screened them for the chromosome-number abnormalities the test is designed to detect.

Repeated failure of euploid embryos doesn’t prove adenomyosis caused the failures, but it can give your fertility team more reason to investigate whether the uterus is limiting success.

This adenomyosis surrogacy decision guide provides additional context on when persistent uterine problems may make gestational surrogacy worth discussing after fertility treatment.

Your remaining embryos affect the decision as well.

If only one or two embryos remain after several unsuccessful transfers, another attempt has a different consequence than it did when several embryos were available.

Cost also deserves a direct comparison. Another transfer may require medication, monitoring and clinic fees, while additional suppression can add months to treatment.

Gestational surrogacy has a much larger and different cost structure, but it also changes the part of the process being addressed.

At this point, your reproductive endocrinologist can explain what another transfer could realistically change. A surrogacy professional can separately explain screening, matching, program costs and what transferring an existing embryo to a gestational surrogate would involve.

Why Surrogacy Can Improve Success After IVF Failure Caused by Adenomyosis

Gestational surrogacy may improve the chance of success when adenomyosis-related uterine factors are the main reason an embryo is not implanting or a pregnancy cannot be maintained.

It addresses the gestational barrier rather than improving egg or embryo quality.

In gestational surrogacy, an embryo created through IVF is transferred to a medically screened gestational surrogate. This adenomyosis and surrogacy overview explains why the option can become medically relevant when adenomyosis continues to interfere with carrying a pregnancy.

Surrogacy doesn’t correct chromosome abnormalities in embryos or improve egg quality.

If embryo quality is the primary reason IVF isn’t succeeding, changing who carries the pregnancy does not remove that problem.

Its value is different when viable embryos exist but the uterus remains the main barrier despite treatment. In that situation, gestational surrogacy changes the part of reproduction that adenomyosis is affecting.

Surrogacy therefore becomes more relevant after failed transfers despite appropriate treatment, recurrent losses associated with uterine factors or a medical recommendation against carrying a pregnancy.

The reason to consider it is not simply that IVF has been difficult, but that it may address the specific problem another transfer to the intended parent’s uterus would leave unchanged.

When to Connect With a Surrogacy Professional About Adenomyosis

It may be useful to speak with a surrogacy professional when adenomyosis remains a significant barrier after treatment, you’ve experienced repeated unsuccessful transfers or your medical team no longer recommends carrying a pregnancy yourself.

You don’t need to decide on surrogacy before having that conversation.

We help intended parents understand when surrogacy becomes medically appropriate after unsuccessful IVF with adenomyosis and connect them with experienced surrogacy professionals who can discuss individualized options.

When comparing surrogacy programs, look beyond the advertised program price. Differences that can affect your experience and financial exposure include:

You can learn about surrogacy and potential next steps with an experienced surrogacy professional before deciding whether to move forward. That conversation can help you understand how these differences apply to your embryos, budget and previous IVF experience.

Another IVF attempt may still make medical sense. If it doesn’t, you’ll already have the information needed to compare gestational surrogacy with continuing a treatment strategy that may no longer address the main barrier.

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