Comment on “Analysis of Pregnancy Outcomes and Influencing Factors in Patients With Uterine Fibroids after High-Intensity Focused Ultrasound Ablation”

The most common benign tumors of the reproductive system in women of childbearing age are uterine fibroids, with an estimated prevalence ranging from 5.4% to 77%. Symptoms of fibroids vary, and can include abnormal menstruation and pressure, as well as others. Fibroids can also lead to infertility through structural changes to the uterus, with up to 10% of patients with infertility also being diagnosed with uterine fibroids. Typical treatment for uterine fibroids in patients who want to have children is myomectomy. Both laparoscopic and hysteroscopic approaches are associated with various benefits and risks, and often, there are significant time restrictions postprocedure before conception is safe. Effective treatment of fibroids, shortening the time to conception after their removal, and improving reproductive capacity and pregnancy outcomes are important pursuits. A noninvasive treatment used for uterine fibroids is high-intensity focused ultrasound (HIFU) ablation, and previous studies have shown this method to effectively shorten the time to conception. This study is designed to expand on previous studies through a larger sample, as well as to evaluate the effects of HIFU on fertility.

This was a retrospective study using data from the Haifu Hospital in Chongqing between April 2011 and May 2024. Inclusion criteria were patients with uterine fibroids and fertility claims based on clinical history and confirmed through imaging, having completed HIFU treatment, and having agreed to undergo preoperative and postoperative plain magnetic resonance imaging (MRI) and extended scan. Exclusion criteria were women who were unmarried, divorced, or lacking fertility indicators during study follow-up, and not presenting for follow-up within 10 months of HIFU treatment.

Final analysis included 748 patients who met the inclusion criteria. Of these, 405 had multiple fibroids, and 343 had only one. A total of 77 patients had subserosal fibroids, 448 had intramural fibroids, 142 had submucosal fibroids, and 81 had mixed types of fibroids. Symptoms documented included increased menstrual volume, prolonged menstrual period, and anemia, as well as adverse outcomes during pregnancy and childbirth or infertility. All patients completed treatment in a single session. Median uterine volume decreased after treatment, as did fibroid volume at 2, 6, and 12 months after treatment. At 12 months, median uterine volume showed a 77.4% reduction from baseline and fibroid volume showed an 80.4% reduction from baseline. These findings confirm that HIFU is effective at reducing uterine and fibroid volume. Many patients also reported symptom relief to varying degrees.

Over the follow-up period for this study, 302 patients experienced a total of 310 pregnancies between 1 and 24 months after HIFU treatment. The natural conception rate in these patients was 88.1%, with a miscarriage rate of 6.0%. Of 273 patients who gave birth over the follow-up period, 31.1% delivered vaginally and 68.9% delivered via cesarean section; of 188 cesarean deliveries, 93 were for obstetric factors, and the remaining cases were due to refusal of trial of labor and/or clinician recommendation for a cesarean due to the procedure. There were no cases of uterine rupture or hysterectomy, and there were 14 cases of intrapartum bleeding >500 mL.

Multiple logistic regression showed that independent factors influencing pregnancy after HIFU treatment included age, number of fibroids, and location of fibroids, with multiple fibroids resulting in a decreased likelihood of conception ( P <0.05), while submucosal fibroids exhibited the most reduced likelihood of pregnancy ( P <0.05).

These findings indicate that HIFU treatment is both efficacious and well-tolerated, and it significantly shortens the time to conception compared with myomectomy. HIFU can be used effectively and safely in patients who wish to conceive in the near future. HIFU can also increase pregnancy rates and improve pregnancy outcomes for patients with uterine fibroids. Future research should evaluate long-term outcomes of HIFU and pregnancy after treatment, particularly the recurrence of fibroids. In addition, future studies should assess the cost and accessibility of HIFU treatment that may limit widespread adoption of the treatment and seek to develop interventions to allow for its more widespread use.

(Summarized from Briones DAB, Ma R, Zhou W, et al. Analysis of pregnancy outcomes and influencing factors in patients with uterine fibroids after high-intensity focused ultrasound ablation. Gynecol Minim Invasive Ther . 2026;15(1):44-51. Published 2026 Feb 6. doi:10.4103/gmit.GMIT-D-24-00059).