Systematic review and meta-analysis of reproductive outcomes after high-intensity focused ultrasound (HIFU) treatment of adenomyosis

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 92; p. 102433
• Main Authors: Chen, Yishan, Lin, Shunhe, Xie, Xi, Yi, Jingsong, Liu, Xishi, Guo, Sun-Wei
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-02-2024
• Subjects: Adenomyosis; High-intensity focused ultrasound; Live birth rate; Meta-analysis; Pregnancy rate; Systematic review; Pregnancy rate; Live birth rate; Systematic review; Adenomyosis; High-intensity focused ultrasound; Meta-analysis
• ISSN: 1521-6934; 1532-1932; 1532-1932
• DOI: 10.1016/j.bpobgyn.2023.102433

High-intensity focused ultrasound (HIFU) has emerged as a promising uterus-sparing and possibly fertility-sparing treatment modality for women with adenomyosis, especially those who desire to conceive. We conducted this systematic review and performed a meta-analysis on clinical studies aimed to improve reproduction in women with adenomyosis. After extensive search of PubMed and CNKI, we identified 10 studies published in English and Chinese involving a total of 557 patients with adenomyosis who desired to conceive after HIFU treatment. We found a pooled estimate of pregnancy rate of 53.4% and of the live birth rate of 35.2%, and there was a substantial heterogeneity among these studies. While there is a potential for HIFU treatment to improve fertility for patients with adenomyosis who desired to conceive, such evidence is very weak as of now. Comparative studies with much higher methodological rigor, preferably randomized clinical trials, are badly needed to further illuminate this issue.
•High-intensity focused ultrasound (HIFU) is an uterus-sparing ablation method.•HIFU may have the potential to improve fertility in patients with adenomyosis.•Currently there is no solid evidence for the efficacy of HIFU in improving fertility.•Certain patients may be more suitable than others for HIFU treatment.•Yet there is a lack of standardized protocol and patient stratification.