Background: Adenomyosis is a most common benign gynecological disease that is identified by intrusion of endometrium in to myometrium and is associated with presenting symptoms of pelvic pain, dysmenorrhea and menorrhagia. It causes diffuse enlargement of uterus and mostly affects the women in late reproductive age. Adenomyosis has an unclear etiology and remains asymptomatic in some patients so diagnosis and treatment remains and immense challenge.Furthermore most of the time adenomyosis co-exist with other relevant gynaecological pathologies including endometriosis and uterine leiomyomas so sensitivity and specificity of transvaginal ultrasound and MRI remain uncertain.Adenomyosis affects the women of reproductive age and has great impact on quality of life and female fertility .The most effective and non-invasive tool in routine gynaecological examination and diagnosis of adenomyosis is transvaginal ultrasound. Objective: The main objective of this study was to evaluate the diagnosis of adenomyosis with Sonography and to describe its impact on fertility and women reproduction. Method: An electronic based search is made on Google scholar using key words “Adenomyosis” , “Sonography” and “fertility”.The relevant articles from different journals including( Pubrsna, Science Direct, Bio Med, ncbi,tandfonline ) and others included.The articles were selected from 2002 to 2020 and consist of retrospective study, cross sectional study and systematic review.The selected articles were assessed for study plan and further discussion and systematic review is made. Results: Most of the studies concluded that adenomyosis can be diagnosed by a combination of clinical history and Transvaginal Ultrasonography, which is the primary imaging equipment for the diagnosis of adenomyosis. Adenomyosis plays a crucial role in fertile women and is a widespread pathology that has a negative impact on female reproduction and fertility. Conclusion: With increased number of advances and upgradation of imaging modalities adenomyosis diagnosis is not dependent on surgical methods as it was done before by hysterectomy .Transvaginal sonography (2D & 3D) is one of the most accurate, non invasive and important criteria for the evaluation of adenomyosis and its widespread use in recent era allowed us to improve our pattern towards the diagnosis and management of the disease. Adenomyosis is one of the most challenging pathology as its etiology and true incidence is still unknown and prevalence varies widely depending on diagnostic criteria. Adenomyosis has a negative impact on female fertility and is highly associated with increased risk of infertility , primary infertility in case of focal adenomyosis. Predominantly detected in female of late reproductive age( fourth and fifth decade of life) .Adenomyosis is also associated with miscarriages, preterm delivery, reduced implantation and rate of fertility in patients with IVF treatment. Keywords: Ultrasonography, Adenomyosis, Fertility