Comparison of pregnancy outcomes in infertile patients with different types of adenomyosis treated with high-intensity focused ultrasound

Abstract

Objective

This study assessed the improvement of symptoms and pregnancy outcomes in infertile patients with various types of adenomyosis who were treated with high-intensity focused ultrasound (HIFU).

Materials and methods

Between October 2017 and January 2022, 129 infertile patients with adenomyosis who wished to conceive were treated with HIFU. Based on the relationship between the adenomyotic lesion, the endometrium, and the subserosa of the uterus on magnetic resonance imaging, the adenomyotic lesions were divided into internal, external, intramural, and full-thickness types. Menstruation pain score, menstruation blood volume score, anti-Müllerian hormone (AMH) levels, reproductive results, pregnancy and delivery complications, and other clinical variables were compared among these four groups.

Results

Patients with external adenomyosis had the greatest menstrual distress, whereas patients with internal adenomyosis had the greatest menstrual blood volume. Dysmenorrhea and heavy menstruation were significantly improved after HIFU treatment in all groups. AMH levels were not significantly different before and six months after HIFU. Of the 129 patients, 50 (38.7%) became pregnant after HIFU, and patients with internal adenomyosis had the highest pregnancy rate. Patients with adenomyotic lesions located in the posterior wall of the uterus had a higher pregnancy rate than those with lesions located in the fundus of the uterus.

Conclusions

The classification of adenomyosis is closely related to distinctions in clinical symptoms and pregnancy outcomes. Infertile patients with different types of adenomyosis could be effectively treated with HIFU. HIFU can be considered as an option for infertile patients with adenomyosis who want to maintain their fertility.

Keywords:

• Adenomyosis
• infertility
• high-intensity focused ultrasound
• pregnancy outcomes

Disclosure statement

No potential conflict of interest was reported by the author(s).

Geolocation information

No. 50, Boyuan Avenue, Yufeng District, Liuzhou City, Guangxi Zhuang Autonomous Region, China

Additional information

Funding

This work was supported by the Guangxi Science and Technology Plan Project under Grant from the Guangxi Clinical Research Center for Obstetrics and Gynecology, GuiKe AD22035223; Key Research and Development Program of Guangxi under Grant No. Guike AB18126056; and State Key Laboratory of Ultrasound Medical Engineering Open subject under Grant No.2020KFA3012.