Adenomyosis is the presence of endometrial glands and mesenchyme in the myometrium, forming limited or diffuse lesions. In a few cases, the growth is confined to form nodules or masses that resemble interstitial fibroids and are called adenomyomas. Does adenomyosis affect fertility? Not necessarily. Adenomyosis is more common in menstruating women over 40 years of age, and past fertility is recognized. Adenomyosis is associated with chronic inflammation, abnormal endometrial peristaltic waves, and abnormal sperm transportation in the uterine tubes, which can have a detrimental effect on fertility. Scholars have examined whether adenomyosis affects pregnancy outcomes in IVF, and conclusions are mixed, with some saying it does not, and others saying it decreases pregnancy rates and increases miscarriage rates. The gonadotropin-releasing hormone agonist GnRH-a is widely used for improving pregnancy outcomes in infertile patients with adenomyosis. Patients with adenomyomas pretreated with a long course of GnRH-a have a significant tumor shrinkage effect. In some patients with small lesions, the effect on pregnancy can be largely eliminated by the drug. For patients with severe adenomyosis, especially women under the age of 40, good pregnancy outcomes can also be achieved with personalized surgical treatment combined with medication, and natural pregnancies can be achieved in women with no other infertility factors. Fertility-minded patients with adenomyosis are advised to go to a regular hospital for reasonable investigations, to rule out comorbidities, and to evaluate and intervene in a timely manner, so as not to miss out on their condition.