Comparison of Pregnancy Outcomes in Uterine Fibroids following High Intensity Focused Ultrasound Ablation versus Laparoscopic Myomectomy: a propensity score-matched observational study

Nenghuan Tang^1,2Jie Yu²Wei Ran¹Chun ling Fang³Luo Can²LI HU³Yuhua Zeng^1*Fan Xu^4*

• ¹Department of obstetrics and gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, China
• ²Department of Clinical Medical College, North Sichuan Medical college, Nanchong City, China
• ³Department of Obstetrics and Gynecology, the Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong City, China
• ⁴Shanghai First Maternity and Infant Hospital, Shanghai, China

Purpose: To compare the pregnancy outcomes of patients with uterine fibroids (UFs) who underwent high-intensity focused ultrasound ablation (HIFU) versus laparoscopic myomectomy (LM). Materials and methods: Patients with UFs and fertility undergoing HIFU or LM from January 2020 to June 2023 were included into this retrospective study. The primary outcomes were pregnancy outcomes including the natural pregnancy rate and the median time to pregnancy. Propensity score matching (PSM) was implemented to evaluate the primary outcomes. The secondary outcomes were the risk factors for natural pregnancy among patients with UFs receiving HIFU or LM. Results: In total, 171 patients were recruited in the HIFU group, while 122 in the LM group. Of them, 60 cases (60/293; 20.5%) achieved pregnancy, including 43 receiving HIFU whereas 17 undergoing LM. After PSM, 75 pairs were acquired. Difference in natural pregnancy rates was not statistically significant between the two groups (HIFU vs. LM: 13.3% vs. 14.7%; p = 0.841). Meanwhile, the interval period of pregnancy was of significant difference between the two groups (HIFU vs. LM: 13.0 (9.5-14.75) months vs. 17.0 (15.0-25.0) months, p = 0.002). Moreover, as revealed by multivariate logistics regression analysis, age (odds ratio (OR) = 0.899, 95% confidence interval (CI): 0.835-0.969, p = 0.005) and classification of the main fibroids (intramural or submucous vs. subserous: OR = 0.379, 95%CI: 0.158-0.910, p = 0.030) were the independent factors affecting the natural pregnancy among women with UFs who underwent HIFU or LM. Conclusions: HIFU demonstrated comparable postoperative pregnancy rates to LM and was associated with a shorter median time to pregnancy, suggesting that HIFU may be a potential fertility-sparing treatment for women with UFs. Additionally, age and the classification of main fibroids were identified as the independent factors influencing postoperative pregnancy rates in patients undergoing treatment.