{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T06:41:12Z","timestamp":1772692872039,"version":"3.50.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify factors associated with clinical pregnancy and live birth in frozen embryo transfer (FET) cycles among women with adenomyosis and to develop internally validated prediction models using readily available clinical, laboratory, and imaging indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 673 FET cycles in women with imaging-confirmed adenomyosis treated at the Reproductive Center of Women and Children\u2019s Hospital of Ningbo University between June 2018 and December 2024. Cycles ending in transfer failure or biochemical pregnancy were classified as non-clinical pregnancy, whereas cycles resulting in miscarriage or live birth were classified as clinical pregnancy. Among cycles achieving clinical pregnancy, outcomes were further categorized as miscarriage or live birth. Candidate predictors comprised demographic and infertility characteristics, anti-M\u00fcllerian hormone (AMH), pictorial blood loss assessment chart (PBAC) score, hemoglobin, carbohydrate antigen 125 (CA125), uterine volume, dysmenorrhea severity, adenomyosis type, endometrial-myometrial junctional zone involvement, and pretreatment modality. Separate multivariable logistic regression models were developed to predict clinical pregnancy and live birth. Model discrimination, calibration, and clinical usefulness were evaluated using the area under the receiver operating characteristic curve (AUC), bootstrap calibration, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 673 cycles, 216 achieved clinical pregnancy (32.10%); 160 resulted in live birth (23.77%) and 56 in miscarriage. Independent predictors of clinical pregnancy included CA125, uterine volume, dysmenorrhea severity, adenomyosis type, JZ involvement, and pretreatment modality. Live birth was primarily predicted by CA125, uterine volume, JZ involvement, and pretreatment modality. Higher CA125, larger uterine volume, and JZ involvement were associated with miscarriage risk, whereas medical therapy was associated with improved live birth. These predictors were identified for risk prediction, the observed relationships should not be interpreted as causal treatment effects. The models showed good performance (AUC 0.830 for clinical pregnancy, 0.921 for live birth), with acceptable bootstrap calibration and net clinical benefit across a broad range of thresholds. Observed event rates increased across low, intermediate, and high predicted-probability strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In adenomyosis patients undergoing FET, uterine volume, adenomyosis type, JZ involvement, dysmenorrhea severity, CA125, and pretreatment modality are key predictors of clinical pregnancy and live birth. The proposed models may support individualized risk stratification and clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1770158","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T05:26:07Z","timestamp":1772688367000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of adenomyosis on pregnancy outcomes following frozen embryo transfer: development and validation of a single-center clinical predictive model"],"prefix":"10.3389","volume":"17","author":[{"given":"Huan","family":"Chen","sequence":"first","affiliation":[{"name":"Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Department of Gynecology, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Central Laboratory, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linghui","family":"Weng","sequence":"additional","affiliation":[{"name":"Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Department of Gynecology, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Central Laboratory, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yichen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Central Laboratory, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jue","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Central Laboratory, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]},{"name":"Central Laboratory, Women and Children\u2019s Hospital of Ningbo University","place":["Ningbo, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.26436","article-title":"Diagnosis, evaluation, and treatment of adenomyosis","volume":"326","author":"Kho","year":"2021","journal-title":"Jama"},{"key":"B2","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1038\/s41392-025-02339-z","article-title":"Single-cell RNA sequencing identifies the prolactin receptor as a therapeutic target in adenomyosis","volume":"10","author":"Wang","year":"2025","journal-title":"Signal Transduct Target Ther"},{"key":"B3","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.fertnstert.2018.01.006","article-title":"Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis","volume":"109","author":"Gordts","year":"2018","journal-title":"Fertil Steril"},{"key":"B4","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1002\/uog.26159","article-title":"Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis","volume":"62","author":"Mishra","year":"2023","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12958-016-0185-6","article-title":"Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease","volume":"14","author":"Puente","year":"2016","journal-title":"Reprod Biol Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1246819","article-title":"The role of the junctional zone in the management of adenomyosis with infertility","volume":"14","author":"Wang","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmab017","article-title":"Adenomyosis pathogenesis: insights from next-generation sequencing","volume":"27","author":"Bulun","year":"2021","journal-title":"Hum Reprod Update"},{"key":"B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.xfnr.2022.11.004","article-title":"How does adenomyosis impact endometrial receptivity? An updated systematic review of clinical and molecular insights","volume":"4","author":"Hiraoka","year":"2023","journal-title":"F&S Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s00281-025-01040-1","article-title":"Perturbations of the endometrial immune microenvironment in endometriosis and adenomyosis: their impact on reproduction and pregnancy","volume":"47","author":"Shi","year":"2025","journal-title":"Semin Immunopathol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13247501","article-title":"Controversial roles of autophagy in adenomyosis and its implications for fertility outcomes-A systematic review","volume":"13","author":"Vervier","year":"2024","journal-title":"J Clin Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.865358","article-title":"Reproductive outcomes of in vitro fertilization and fresh embryo transfer in infertile women with adenomyosis: A retrospective cohort study","volume":"13","author":"Liang","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s43032-021-00818-6","article-title":"The effect of uterine adenomyosis on IVF outcomes: a systematic review and meta-analysis","volume":"29","author":"Cozzolino","year":"2022","journal-title":"Reprod Sci"},{"key":"B13","doi-asserted-by":"publisher","first-page":"109175","DOI":"10.5498\/wjp.v15.i9.109175","article-title":"Anxiety and depression in recurrent implantation failure after frozen-thawed embryo transfer and efficacy of endometrial receptivity testing","volume":"15","author":"Guo","year":"2025","journal-title":"World J Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24786","article-title":"Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure","volume":"60","author":"Harmsen","year":"2022","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1093\/humupd\/dmz012","article-title":"Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis","volume":"25","author":"Horton","year":"2019","journal-title":"Hum Reprod Update"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.127305","article-title":"The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature","volume":"187","author":"Brosens","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dep474","article-title":"The enigmatic uterine junctional zone: the missing link between reproductive disorders and major obstetrical disorders","volume":"25","author":"Brosens","year":"2010","journal-title":"Hum Reprod"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2023.03.018","article-title":"Association of endometriosis and adenomyosis with pregnancy and infertility","volume":"119","author":"Vercellini","year":"2023","journal-title":"Fertil Steril"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.575197","article-title":"Maternal immunological adaptation during normal pregnancy","volume":"11","author":"Abu-Raya","year":"2020","journal-title":"Front Immunol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"14910","DOI":"10.3389\/bjbs.2025.14910","article-title":"The placenta as an immunological environment","volume":"82","author":"Menzies","year":"2025","journal-title":"Br J BioMed Sci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"42317","DOI":"10.1038\/s41598-025-26412-3","article-title":"Combined magnetic resonance imaging with serum CA125 for dysmenorrhea in adenomyosis","volume":"15","author":"Su","year":"2025","journal-title":"Sci Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/s12905-025-03681-8","article-title":"Sequential therapy of dienogest following relugolix for adenomyosis and impact on symptoms and serum CA125 levels: a case series","volume":"25","author":"Nishida","year":"2025","journal-title":"BMC Womens Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"3000605211005878","DOI":"10.1177\/03000605211005878","article-title":"Serum levels of cancer antigen 125 before hormone replacement therapy are not associated with clinical outcome of frozen embryo transfer in women with adenomyosis","volume":"49","author":"Huang","year":"2021","journal-title":"J Int Med Res"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13164926","article-title":"From diagnosis to fertility: optimizing treatment of adenomyosis for reproductive health","volume":"13","author":"Kim","year":"2024","journal-title":"J Clin Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1111\/jog.70149","article-title":"Pregnancy outcomes with and without adenomyomectomy in infertile patients with adenomyosis: A single-center retrospective study","volume":"51","author":"Hamaguchi","year":"2025","journal-title":"J Obstet Gynaecol Res"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1770158\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T05:26:08Z","timestamp":1772688368000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1770158\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":25,"alternative-id":["10.3389\/fendo.2026.1770158"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1770158","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]},"article-number":"1770158"}}