Effect of High Intensity Focused Ultrasound on Female Fertility in the Treatment of Uterine Fibroids

doi:10.12280/gjszjk.20250100

Abstract

Abstract:

High intensity focused ultrasound (HIFU), as a kind of non-invasive treatment, can project the ultrasound wave to the target tissues of the body, causing coagulative necrosis of the target tissues. HIFU has good clinical efficacy for patients with uterine fibroids who have fertility requirements. HIFU can improve the physiological function, relieve pain, and shorten the hospitalisation time and reduce medical costs. It can also reduce the likelihood of bleeding and infection. HIFU treatment for fibroids has less impact on ovarian function, improves endometrial tolerance, and reduces the incidence of pelvic adhesions, suggesting therapeutic advantages for protecting women's fertility. HIFU treatment for fibroids can shorten the interval between pregnancies after the treatment. The quality and reliability of studies on the effect of HIFU on pregnancy need to be further improved. In this paper, we review the effects of HIFU treatment of fibroids on ovarian function, the female reproductive tract, pregnancy, and fertility reservation.

Key words: High-intensity focused ultrasound ablation, Leiomyoma, Fertility, Therapy, Pregnancy

WAN Zi-hua, WANG Jia-li, ZHANG Shi-xia, LIU Chang. Effect of High Intensity Focused Ultrasound on Female Fertility in the Treatment of Uterine Fibroids[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(4): 348-352.

References 36

[1]	Izadifar Z, Izadifar Z, Chapman D, et al. An Introduction to High Intensity Focused Ultrasound: Systematic Review on Principles, Devices, and Clinical Applications[J]. J Clin Med, 2020, 9(2):460. doi: 10.3390/jcm9020460.
[2]	林卫, 朱博雅. 女性生育力保护的“三级预防”[J]. 西南医科大学学报, 2024, 47(3):188-192. doi: 10.3969/j.issn.2096-3351.2024.03.002.
[3]	Li H, Hu Z, Fan Y, et al. The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis[J]. BMC Pregnancy Childbirth, 2024, 24(1):345. doi: 10.1186/s12884-024-06545-5.
[4]	Kim YR, Na ED, Jung JE, et al. Clinical features at the time of non-hysteroscopic myomectomy before pregnancy, which affect adverse pregnancy outcomes: a retrospective cohort study[J]. BMC Pregnancy Childbirth, 2022, 22(1):896. doi: 10.1186/s12884-022-05240-7.
[5]	Mahalingam M, Hu M, Schointuch M, et al. Uterine myomas: effect of prior myomectomy on pregnancy outcomes[J]. J Matern Fetal Neonatal Med, 2022, 35(25):8492-8497. doi: 10.1080/14767058.2021.1984424.
[6]	Ji J, Liu J, Chen Y, et al. Analysis of high intensity focused ultrasound in treatment of uterine fibroids on ovarian function and pregnancy outcome[J]. J Clin Ultrasound, 2022, 50(2):202-208. doi: 10.1002/jcu.23116.
[7]	Liu L, Wang T, Lei B. High-intensity focused ultrasound (HIFU) ablation versus surgical interventions for the treatment of symptomatic uterine fibroids: a meta-analysis[J]. Eur Radiol, 2022, 32(2):1195-1204. doi: 10.1007/s00330-021-08156-6.
[8]	Jeng CJ, Ou KY, Long CY, et al. 500 Cases of High-intensity Focused Ultrasound (HIFU) Ablated Uterine Fibroids and Adenomyosis[J]. Taiwan J Obstet Gynecol, 2020, 59(6):865-871. doi: 10.1016/j.tjog.2020.09.013.
[9]	Chen J, Li Y, Wang Z, et al. Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: an IDEAL prospective exploration study[J]. BJOG, 2018, 125(3):354-364. doi: 10.1111/1471-0528.14689.
[10]	马旺娃. HIFU消融子宫肌瘤后症状复发或肌瘤再生长的再次手术对比研究[D]. 重庆: 重庆医科大学, 2024.
[11]	Otgontuya A, Jeng CJ, Wu TN, et al. Comparison of the treatment efficacies of HIFU, HIFU combined with GnRH-a, and HIFU combined with GnRH-a and LNG-IUS for adenomyosis: A systematic review and meta-analysis[J]. Taiwan J Obstet Gynecol, 2023, 62(2):226-238. doi: 10.1016/j.tjog.2022.11.009. pmid: 36965889
[12]	Jiang L, Yu JW, Yang MJ, et al. Ultrasound-guided HIFU for uterine fibroids of hyperintense on T2-weighted MR imaging with or without GnRH-analogue-pretreated: A propensity score matched cohort study[J]. Front Surg, 2022,9:975839. doi: 10.3389/fsurg.2022.975839.
[13]	Moolhuijsen L, Visser JA. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function[J]. J Clin Endocrinol Metab, 2020, 105(11):3361-3373. doi: 10.1210/clinem/dgaa513.
[14]	Zhou Y, Chen P, Ji X, et al. Long-term Efficacy of Fibroid Devascularization with Ultrasound-Guided High-Intensity Focused Ultrasound[J]. Acad Radiol, 2024, 31(5):1931-1939. doi: 10.1016/j.acra.2023.10.045.
[15]	Gu W, Yuan J, Zhou Y, et al. Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study[J]. BMC Womens Health, 2024, 24(1):470. doi: 10. 1186/s12905-024-03315-5. pmid: 39182055
[16]	Qu K, Mao S, Li J, et al. The impact of ultrasound-guided high-intensity focused ultrasound for uterine fibroids on ovarian reserve[J]. Int J Hyperthermia, 2020, 37(1):399-403. doi: 10.1080/02656736.2020.1754473.
[17]	Hao Y, Yang R, Li J, et al. Age-specific random day serum antimüllerian hormone reference values for women of reproductive age in the general population: a large Chinese nationwide population-based survey[J]. Am J Obstet Gynecol, 2022, 227(6):883.e1-883.e18. doi: 10.1016/j.ajog.2022.07.029.
[18]	Otonkoski S, Sainio T, Mattila S, et al. Magnetic resonance guided high intensity focused ultrasound for uterine fibroids and adenomyosis has no effect on ovarian reserve[J]. Int J Hyperthermia, 2023, 40(1):2154575. doi: 10.1080/02656736.2022.2154575.
[19]	Laughlin-Tommaso S, Barnard EP, AbdElmagied AM, et al. FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery[J]. Am J Obstet Gynecol, 2019, 220(2):174.e1-174.e13. doi: 10.1016/j.ajog.2018.10.032.
[20]	Cui Y, Dong Y, Guo B, et al. Effect of HIFU on endometrial receptivity and sex hormone level in uterine fibroid patients and analysis of influencing factors for its treatment rate[J]. Exp Ther Med, 2019, 17(3):2291-2297. doi: 10.3892/etm.2019.7194. pmid: 30867713
[21]	樊梓怡, 刘芬婷, 李蓉. 生殖道菌群对女性生育力的影响[J]. 中华生殖与避孕杂志, 2020, 40(6):515-520. doi: 10.3760/cma.j.cn101441-20190617-00261
[22]	唐丽萍, 刘晓芳, 黄国华, 等. 基于16S rRNA测序分析高强度聚焦超声治疗子宫肌瘤前后患者阴道微生态的变化[J]. 川北医学院学报, 2024, 39(12):1591-1597. doi: 10.3969/j.issn.1005-3697.2024.12.002.
[23]	Zhang PP, He XP, Tang W, et al. Alterations in vaginal microbiota in uterine fibroids patients with ultrasound-guided high-intensity focused ultrasound ablation[J]. Front Microbiol, 2023,14:1138962. doi: 10.3389/fmicb.2023.1138962.
[24]	郭薇, 李蓉. 女性生育力的评估[J]. 中国实用妇科与产科杂志, 2022, 38(6):585-588. doi: 10.19538/j.fk2022060103.
[25]	Melkozerova O, Shchedrina I, Gryshkina A, et al. How noninvasive treatment of uterine fibroids affects endometrial receptivity: a prospective cohort study[J]. Gynecol Endocrinol, 2020, 36(sup1):28-32. doi: 10.1080/09513590.2020.1816725. pmid: 33305668
[26]	金男, 杨洪艳, 裴会, 等. 有生育要求的子宫肌瘤患者经高强度聚焦超声消融治疗前后子宫内膜容受性、性激素的变化及其妊娠结局的影响因素分析[J]. 现代生物医学进展, 2022, 22(18):3454-3458. doi: 10.13241/j.cnki.pmb.2022.18.009.
[27]	邓婉璐, 王霞, 潘淑敏. 高强度聚焦超声消融术对子宫肌瘤患者围术期指标、子宫恢复情况、性激素、MMPs、TIMPs水平的影响[J]. 航空航天医学杂志, 2025, 36(2):149-152. doi: 10.3969/j.issn.2095-1434.2025.02.008.
[28]	张晓波, 李小娟, 邓晓红. 高强度聚焦超声消融治疗对子宫肌瘤患者子宫血流动力学指标、卵巢功能的影响[J]. 临床医学研究与实践, 2023, 8(19):60-63. doi: 10.19347/j.cnki.2096-1413.202319015.
[29]	Liu X, Dong X, Mu Y, et al. High-intensity focused ultrasound (HIFU) for the treatment of uterine fibroids: does HIFU significantly increase the risk of pelvic adhesions?[J]. Int J Hyperthermia, 2020, 37(1):1027-1032. doi: 10.1080/02656736.2020.1811903.
[30]	陈林, 刘晓芳, 牟燕, 等. 聚焦超声消融与肌瘤挖除术后子宫肌瘤患者盆腔粘连情况及影响因素的对比分析[J]. 重庆医学, 2022, 51(4):612-617. doi: 10.3969/j.issn.1671-8348.2022.04.014.
[31]	Anneveldt KJ, van 't Oever HJ, Nijholt IM, et al. Systematic review of reproductive outcomes after High Intensity Focused Ultrasound treatment of uterine fibroids[J]. Eur J Radiol, 2021,141:109801. doi: 10.1016/j.ejrad.2021.109801.
[32]	Chen Y, Yi J, Lin S, et al. Reproductive outcomes of high-intensity focused ultrasound ablation and myomectomy for uterine fibroids: a systematic review and meta-analysis[J]. Reprod Biomed Online, 2025, 50(1):104436. doi: 10.1016/j.rbmo.2024.104436.
[33]	Li F, Chen J, Yin L, et al. HIFU as an alternative modality for patients with uterine fibroids who require fertility-sparing treatment[J]. Int J Hyperthermia, 2023, 40(1):2155077. doi: 10.1080/02656736.2022.2155077.
[34]	Wu G, Li R, He M, et al. A comparison of the pregnancy outcomes between ultrasound-guided high-intensity focused ultrasound ablation and laparoscopic myomectomy for uterine fibroids: a comparative study[J]. Int J Hyperthermia, 2020, 37(1):617-623. doi: 10.1080/02656736.2020.1774081.
[35]	Liu X, Xue L, Wang Y, et al. Vaginal delivery outcomes of pregnancies following ultrasound-guided high-intensity focused ultrasound ablation treatment for uterine fibroids[J]. Int J Hyperthermia, 2018, 35(1):510-517. doi: 10.1080/02656736.2018.1510548.
[36]	Lai T, Seto M, Cheung V. Intrapartum uterine rupture following ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroid and adenomyosis[J]. Ultrasound Obstet Gynecol, 2022, 60(6):816-817. doi: 10.1002/uog.24983.