We describe an in vitro fertilization (IVF) pregnancy and delivery after magnetic resonance-guided focused ultrasound (MRgFUS) for a symptomatic uterine fibroid. A 45-year-old para 0 + 1, with four previous failed IVF treatments underwent MRgFUS for a single anterior wall fibroid causing intra-cavitary distortion and conceived after the first IVF cycle 10 months following the procedure. The patient received shared antenatal care. She was admitted in spontaneous labor at term but delivered by emergency cesarean section a healthy male infant. We describe the first IVF pregnancy following MRgFUS for a symptomatic fibroid.
"Pretreatment with GnRH the patient conceived 4 months after the treatment Park et al, 2012 37 X (1) Study focused on peduncolated subserosal fibroids rectal filling with gel in the case of bowel interposition Zaher et al, 2011 24 Y 1 The patient become pregnant by IVF 10 months after the treatment Trumm et al, 2013 34 D (2) Yoon et al, 2010 39 Gorny et al, 2011 40 S (11), P (1) "
[Show abstract][Hide abstract] ABSTRACT: We performed a systematic review about studies reporting data of myomectomy performed by magnetic resonance-guided focused ultrasound (MRgFUS) technique in order to define its safety, feasibility, indications, complications, and impact on uterine fibroid symptom and health-related quality of life (UFS-QOL) and fertility. Outcomes were considered according to fibroids shrinkage, nonperfused volume (NPV), NPV ratio, and uterine fibroid symptoms assessed with UFS-QOL questionnaire (baseline 3, 4, 6, and 12 months). We analyzed 38 eligible studies reporting outcomes about 2500 patients (mean age 43.67 years). The MRgFUS results a safe, efficient, and cost-effective minimal invasive technique for treatment of uterine fibroids. Increasing experience, device improvements, and availability for a larger number of patients are enhancing the outcomes, while the obstetrical ones should be more extensively explored. The MRgFUS could be considered as a minimal invasive alternative to traditional surgical or radiological procedures for the treatment of symptomatic uterine myomas improving both QOL and subsequent fertility.
"Unlike the earlier methods of myoma coagulation that involved multiple ablations of fibroids without imaging guidance, today's volumetric, image-guided ablation permits the operator to ablate a fibroid with a single ablation in most cases, and often in a fashion that confines the ablation to the myoma and spares the surrounding myometrium and endometrium. For additional support, there have been more than 50 reported cases of pregnancy after MRI-guided focused ultrasound, another form of hyperthermic ablation, with generally good outcomes and no reports of uterine rupture [52–55]. "
[Show abstract][Hide abstract] ABSTRACT: The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue), which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA), one modality of hyperthermic fibroid ablation.
Obstetrics and Gynecology International 01/2012; 2012:194839. DOI:10.1155/2012/194839
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