High-Intensity Focused Ultrasound Ablation of Uterine Fibroids – Potential Impact on Fertility and Pregnancy Outcome

 

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Abstract

Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk.

Zusammenfassung

Als Therapiestandard für Frauen mit Kinderwunsch und symptomatischen Myomen wird die möglichst wenig invasive operative Myomenukleation angesehen. Die Myombehandlung mit hochintensiviertem fokussiertem Ultraschall (HIFU/MRgFUS) wird als minimalinvasive Therapiemöglichkeit ebenfalls diskutiert. Diese Übersichtsarbeit wertet die vorhandene Literatur zum Thema „Einfluss von HIFU/MRgFUS auf Fertilität und Schwangerschaft“ aus, wobei sowohl mögliche direkte Nebenwirkungen der Intervention an sich auf Ovarien, Tuben und Uterus als auch mögliche spätere Auswirkungen auf Schwangerschaft und Geburt auf der Basis der vorliegenden Literatur ausführlich diskutiert werden. Die bisher publizierten knapp 100 Schwangerschaften nach HIFU/MRgFUS wurden ausgewertet. Die vorliegenden Fallserien legen nahe, dass eine HIFU/MRgFUS-Behandlung keinen Einfluss auf Abortrate sowie weitere geburtshilfliche Outcome-Parameter ausübt. Dennoch kann eine solche Therapie bis dato nur denjenigen Frauen mit vermuteten myomassoziierten Fertilitätsproblemen empfohlen werden, die chirurgische Maßnahmen ablehnen oder ein inakzeptabel hohes chirurgisches Risiko aufweisen, da keine prospektiven Studien vorliegen, die eine Aussage über den Einfluss der HIFU/MRgFUS-Therapie auf Fertilitätsrate und Schwangerschaftsausgang bei Frauen mit symptomatischen Myomen zulassen.

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