Kimberley J Anneveldt1, Heleen J van 't Oever2, Ingrid M Nijholt3, Jeroen R Dijkstra4, Wouter J Hehenkamp5, Sebastiaan Veersema6, Judith A F Huirne5, Joke M Schutte4, Martijn F Boomsma3. 1. Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands; Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands. Electronic address: k.j.anneveldt@isala.nl. 2. Department of Emergency Medicine, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands. 3. Department of Radiology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands. 4. Department of Gynecology, Isala hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands. 5. Department of Gynecology, Amsterdam University Medical Centre, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands. 6. Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Abstract
PURPOSE: Myomectomy is currently the gold standard for the treatment of uterine fibroids in women who desire pregnancy. However, this surgical fibroid removal has a long convalescence. Promising alternatives may be non-invasive High Intensity Focused Ultrasound (HIFU) under either MRI (MR-HIFU) or ultrasound guidance (USgHIFU). In this systematic review, an overview is provided of reproductive outcomes after these two relatively new ablation techniques. METHOD: A systematic literature search was performed to identify studies reporting reproductive outcomes after HIFU treatment of fibroids. Only peer reviewed, full papers were included. Outcomes included pregnancy-, live-birth- miscarriage and caesarian section rate, time to conceive, reported complications, and possible prognostic factors. RESULTS: In total 21 studies were included. Fourteen studies reported 124 pregnancies after MR-HIFU. Two placenta previas and no uterus ruptures were reported. Pregnancy rates were only retrospectively collected and ranged between 7% and 36%. Miscarriage rate in the oldest and largest prospective registry was 39%. After USgHIFU 366 pregnancies were reported with one fetal intrauterine death, six placenta previas and no uterus ruptures. The only prospective study reported a pregnancy rate of 47% and a miscarriage rate of 11%. Possible prognostic factors like age were not available in most studies. CONCLUSIONS: Based on the heterogeneous data currently available, reproductive outcomes after HIFU appear non-inferior to outcomes after the current standard of care. However, a (randomized) controlled trial comparing reproductive outcomes after HIFU and standard care is necessary to provide sufficient evidence on the preferred fibroid treatment for women with a pregnancy wish.
PURPOSE: Myomectomy is currently the gold standard for the treatment of uterine fibroids in women who desire pregnancy. However, this surgical fibroid removal has a long convalescence. Promising alternatives may be non-invasive High Intensity Focused Ultrasound (HIFU) under either MRI (MR-HIFU) or ultrasound guidance (USgHIFU). In this systematic review, an overview is provided of reproductive outcomes after these two relatively new ablation techniques. METHOD: A systematic literature search was performed to identify studies reporting reproductive outcomes after HIFU treatment of fibroids. Only peer reviewed, full papers were included. Outcomes included pregnancy-, live-birth- miscarriage and caesarian section rate, time to conceive, reported complications, and possible prognostic factors. RESULTS: In total 21 studies were included. Fourteen studies reported 124 pregnancies after MR-HIFU. Two placenta previas and no uterus ruptures were reported. Pregnancy rates were only retrospectively collected and ranged between 7% and 36%. Miscarriage rate in the oldest and largest prospective registry was 39%. After USgHIFU 366 pregnancies were reported with one fetal intrauterine death, six placenta previas and no uterus ruptures. The only prospective study reported a pregnancy rate of 47% and a miscarriage rate of 11%. Possible prognostic factors like age were not available in most studies. CONCLUSIONS: Based on the heterogeneous data currently available, reproductive outcomes after HIFU appear non-inferior to outcomes after the current standard of care. However, a (randomized) controlled trial comparing reproductive outcomes after HIFU and standard care is necessary to provide sufficient evidence on the preferred fibroid treatment for women with a pregnancy wish.
Authors: K J Anneveldt; I M Verpalen; I M Nijholt; J R Dijkstra; R D van den Hoed; M Van't Veer-Ten Kate; E de Boer; J A C van Osch; E Heijman; H R Naber; E Ista; A Franx; S Veersema; J A F Huirne; J M Schutte; M F Boomsma Journal: Insights Imaging Date: 2021-12-18
Authors: Luz Angela Torres-de la Roche; Sarah Rafiq; Rajesh Devassy; Hugo Christian Verhoeven; Sven Becker; Rudy Leon De Wilde Journal: J Clin Med Date: 2022-02-05 Impact factor: 4.241
Authors: Kimberley J Anneveldt; Ingrid M Nijholt; Joke M Schutte; Jeroen R Dijkstra; Geert W J Frederix; Erwin Ista; Inez M Verpalen; Sebastiaan Veersema; Judith A F Huirne; Wouter J K Hehenkamp; Martijn F Boomsma Journal: JMIR Res Protoc Date: 2021-11-24