Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Abstract

Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods—UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.

Update on Endovascular Therapy for Fibroids and Adenomyosis

“…64 Nonetheless, this study identified maternal age as a confounding variable that could have contributed to the odds of fetal and maternal complications. 64 Another systematic review was conducted on a cohort of 2,000 women, out of which 1,575 underwent myomectomies, while 424 underwent UAE, as reported by Zanolli et al 65 The study revealed that the birth rate outcome was 60.6% for both UAE and myomectomies, compared to 75.6% for the latter. There was a higher rate of spontaneous abortion of 27.4% for the UAE, as opposed to 19.0% for myomectomies.…”

“…63 However, one study found that miscarriage rates were highest in the UAE group compared to other minimally invasive techniques like HIFU and transcervical radiofrequency ablation. 64 Nonetheless, this study identified maternal age as a confounding variable that could have contributed to the odds of fetal and maternal complications. 64 Another systematic review was conducted on a cohort of 2,000 women, out of which 1,575 underwent myomectomies, while 424 underwent UAE, as reported by Zanolli et al 65 The study revealed that the birth rate outcome was 60.6% for both UAE and myomectomies, compared to 75.6% for the latter.…”

Management of Uterine Fibroids and Sarcomas: The Palermo Position Paper

“…Reproduction after the HIFU, UAE, and RF fibroid ablation has been evaluated in a systematic review [56]. The pooled estimate of pregnancies was 17.31-44.52% after UAE, 18.69-78.53% after HIFU, and 2.09-7.63% after RF ablation.…”

The impact of ultrasound-guided high-intensity focused ultrasound for uterine fibroid on ovarian reserve and quality of life: A prospective cohort study

“…Ultrasound-guided HIFU is a safe and reliable noninvasive treatment for uterine fibroids. 18,19,20 It has been shown to be effective in reducing the size and symptoms of uterine fibroids, such as heavy menstrual bleeding, pelvic pain, and urinary symptoms. Previous research had reported that the uterine fibroid volume reduction rates at 3-, 6-, and 12-month after treatment were 58.08%,66.18%, and 77.59%, respectively, compared to initial volume.…”