Focused Ultrasound Surgery for Uterine Fibroids: Potential Impact on Fertility and Pregnancy Outcome - A Review

Abstract

Uterine fibroids are a common gynecological disorder affecting a large number of infertile women. Their pregnancy outcomes may also be poor because of complications such as miscarriage, preterm labor, obstructed labor, or postpartum bleeding. Myomectomy was traditionally used to enhance women’s reproductive ability or reduce the above complications. However, operative myomectomy, either laparoscopic or open approach, may cause operative morbidity and raise hysterectomy risks. After myomectomy, women would also require a Caesarean section because of uterine ruptures’ risks. High Intensity Focused Ultrasound ablation (Focused Ultrasound Surgery - FUS) is currently increasingly used as a new technology to treat fibroids. Therefore, the impact of HIFU ablation on patients’ fertility and pregnancy outcomes has become a topic of interest. This paper reviewed the currently existing but limited evidence of this issue in the literature. It showed that USgHIFU/MRgFUS treatment for fibroids could be a safe alternative to myomectomy or UAE for women who wish to have babies. It also appears that FUS treatment can shorten the treatment to pregnancy interval after FUS ablation. Given the large number of women developing fibroids before childbearing, addressing this important issue in a large clinical trial is critical.