Laparoscopic bilateral uterine artery ligation in the treatment of patients with adenomyosis uteri undergoing ICSI

Background: Adenomyosis is frequently detected in women of reproductive age. Although uterine artery ligation has minimal efficacy on its own, it can give appropriate therapeutic control when combined with other methods.
Patients and methods: This prospective pilot study in- volved 20 patients who had uterine adenomyosis confirmed by ultrasonography or MRI, complained of infertility, and were scheduled for ICSI. Laparoscopic ligation of both uterine arteries using hemoclips and bilateral electrocoagulation of uterine ovarian vessels was done. Intracytoplasmic sperm injection (ICSI) done six months postoperatively and recording the outcome. Moreover, recording the uterine size, the menstrual symptoms and the adenomyosis volume prior to ICSI.
Results: Generally, the all symptoms of the patients un- der the study were improved significantly postoperatively during follow up period after 3 months and 6 months respectively (p <0.05). The uterine volume at preoperative period ranged from 160-240 cm3 with mean value (205.6±38.5) and in postoperative period ranged from 120-182 cm3 with mean value (142.6±21.3). There was a significant statistical decrease between preoperative and postoperative uterine volumes (P<0.05). There was no statistically significant difference between preoperative and postoperative sonographic scoring of the patients. There was no significant difference between preoperative and postoperative MRI degree of adenomyosis but there was an improve in the grade of external adenomyosis.
The outcome of ICSI 6 months postoperatively was recorded in the patients under the study, as regards the primary infertility cases it was found that 6 cases from 14 cases (42.8%) were succeded and became pregnant, while in the secondary infertility group 3 cases from 6 cases (50.0%) were succeded and became pregnant.
Conclusion: Bilateral uterine arteries ligation significantly cause reduction in the uterine volume and improve the adenomyosis symptoms and the reproductive outcome. These parameters showed in PCOS patients on the level of TAC; all parameters have no significant effect except for age.