Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Ayazhan Akhatova; Gulzhanat Aimagambetova; Gauri Bapayeva; Antonio Simone Laganà; Vito Chiantera; Peter Oppelt; Antonio Sarria-Santamera; Milan Terzic

doi:10.3390/ijerph20054480

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2023 Mar 2;20(5):4480. doi: 10.3390/ijerph20054480.

Authors

Ayazhan Akhatova¹, Gulzhanat Aimagambetova², Gauri Bapayeva³, Antonio Simone Laganà⁴, Vito Chiantera⁴, Peter Oppelt⁵, Antonio Sarria-Santamera⁶, Milan Terzic^{2

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Affiliations

¹ School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan.
² Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan.
³ Clinical Academic Department of Women's Health, CF "University Medical Center", Turan Ave. 32, Astana 010000, Kazakhstan.
⁴ Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy.
⁵ Department of Gynecology, Obstetrics and Gynecologic Endocrinology, Kepler University Hospital, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria.
⁶ Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan.
⁷ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA.

Abstract

Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.

Keywords: MRgHIFU; UAE; USgHIFU; leiomyoma; pregnancy; transcervical radiofrequency ablation; uterine fibroids.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Leiomyoma*
Placenta
Pregnancy
Treatment Outcome
Uterine Artery Embolization* / methods
Uterine Neoplasms*

Grants and funding

This research received no external funding.