Fertility and Sterility
Volume 93, Issue 1 , Pages 199-209 , 1 January 2010

Pregnancy outcome after magnetic resonance–guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids

Presented in part at the 64th Annual Meeting of the American Society for Reproductive Medicine, which was held in San Francisco on November 8–12, 2008.

  • Jaron Rabinovici, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
    • ,
  • Matthias David, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Charite Hospital, Berlin, Germany
    • ,
  • Hidenobu Fukunishi, M.D.

      Affiliations

    • Department of Gynecology, Shinsuma General Hospital, Kobe, Japan
    • ,
  • Yutaka Morita, M.D., Ph.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Itabashi Chuo Hospital, Tokyo, Japan
    • ,
  • Bobbie S. Gostout, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Mayo Clinic and Mayo College of Medicine, Rochester, Minnesota
    • ,
  • Elizabeth A. Stewart, M.D.

      Affiliations

    • Department of Obstetrics and Gynecology, Mayo Clinic and Mayo College of Medicine, Rochester, Minnesota
    • Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
    • Corresponding Author InformationReprint requests: Elizabeth A. Stewart, M.D., Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905 (FAX: 507-284-1774).
    • ,
  • MRgFUS Study Group

Received 27 October 2007 ,Revised 28 September 2008 ,Accepted 3 October 2008.

References 

  1. Walker CL, Stewart EA. Uterine fibroids: the elephant in the room. Science. 2005;308:1589–1592
  2. Qidwai GI, Caughey AB, Jacoby AF. Obstetric outcomes in women with sonographically identified uterine leiomyomata. Obstet Gynecol. 2006;107:376–382
  3. Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol. 1989;160:1212–1216
  4. Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilization treatment. Hum Reprod. 1995;10:2576–2578
  5. Eldar-Geva T, Meagher S, Healy DL, MacLachlan V, Breheny S, Wood C. Effect of intramural, subserosal, and submucosal uterine fibroids on the outcome of assisted reproductive technology treatment. Fertil Steril. 1998;70:687–691
  6. Coronado GD, Marshall LM, Schwartz SM. Complications in pregnancy, labor, and delivery with uterine leiomyomas: a population-based study. Obstet Gynecol. 2000;95:764–769
  7. Pritts EA. Fibroids and infertility: a systematic review of the evidence. Obstet Gynecol Surv. 2001;56:483–491
  8. Klatsky PC, Lane DE, Ryan IP, Fujimoto VY. The effect of fibroids without cavity involvement on ART outcomes independent of ovarian age. Hum Reprod. 2007;22:521–526
  9. Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol. 2008;198:357–366
  10. ACOG Practice Bulletin No. 96: Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008;112:387–400
  11. Ecker JL, Foster JT, Friedman AJ. Abdominal hysterectomy or abdominal myomectomy for symptomatic leiomyoma: a comparison of preoperative demography and postoperative morbidity. J Gynecol Surg. 1995;11:11–18
  12. Iverson RE, Chelmow D, Strohbehn K, Waldman L, Evantash EG. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol. 1996;88:415–419
  13. Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril. 1992;58:1–15
  14. Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995;346:671–672
  15. Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol. 2005;106:933–939
  16. Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S, et al. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstet Gynecol. 2008;111:22–33
  17. Ravina JH, Vigneron NC, Aymard A, Le Dref O, Merland JJ. Pregnancy after embolization of uterine myoma: report of 12 cases. Fertil Steril. 2000;73:1241–1243
  18. McLucas B, Goodwin S, Adler L, Rappaport A, Reed R, Perrella R. Pregnancy following uterine fibroid embolization. Int J Gynaecol Obstet. 2001;74:1–7
  19. Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K. The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril. 2003;79:120–127
  20. Pron G, Mocarski E, Bennett J, Vilos G, Common A, Vanderburgh L. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Obstet Gynecol. 2005;105:67–76
  21. Walker WJ, McDowell SJ. Pregnancy after uterine artery embolization for leiomyomata: a series of 56 completed pregnancies. Am J Obstet Gynecol. 2006;195:1266–1271
  22. Stewart EA, Gedroyc WM, Tempany CM, Quade BJ, Inbar Y, Ehrenstein T, et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol. 2003;189:48–54
  23. Hindley J, Gedroyc WM, Regan L, Stewart E, Tempany C, Hynnen K, et al. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. Am J Roentgenol. 2004;183:1713–1719
  24. Fennessy FM, Tempany CM. MRI-guided focused ultrasound surgery of uterine leiomyomas. Acad Radiol. 2005;12:1158–1166
  25. Stewart EA, Rabinovici J, Tempany CM, Inbar Y, Regan L, Gastout B, et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril. 2006;85:22–29
  26. Rabinovici J, Inbar Y, Revel A, Zalel Y, Gomori JM, Itzchak Y, et al. Clinical improvement and shrinkage of uterine fibroids after thermal ablation by magnetic resonance-guided focused ultrasound surgery. Ultrasound Obstet Gynecol. 2007;30:771–777
  27. Stewart EA, Gostout B, Rabinovici J, Kim HS, Regan L, Tempany CM. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol. 2007;110:279–287
  28. Rabinovici J, Inbar Y, Eylon SC, Schiff E, Hananel A, Freundlich D. Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report. Hum Reprod. 2006;21:1255–1259
  29. Gavrilova-Jordan LP, Rose CH, Traynor KD, Brost BC, Gostout BS. Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma. J Perinatol. 2007;27:59–61
  30. Morita Y, Ito N, Ohashi H. Pregnancy following MR-guided focused ultrasound surgery for a uterine fibroid. Int J Gynaecol Obstet. 2007;99:56–57
  31. Hanstede MM, Tempany CM, Stewart EA. Focused ultrasound surgery of intramural leiomyomas may facilitate fertility: a case report. Fertil Steril. 2007;88:497;e5–7
  32. Smart OC, Hindley JT, Regan L, Gedroyc WM. Magnetic resonance guided focused ultrasound surgery of uterine fibroids—the tissue effects of GnRH agonist pre-treatment. Eur J Radiol. 2006;59:163–167
  33. Davis JL, Ray-Mazumder S, Hobel CJ, Baley K, Sassoon D. Uterine leiomyomas in pregnancy: a prospective study. Obstet Gynecol. 1990;75:41–44
  34. Vergani P, Ghidini A, Strobelt N, Roncaglia N, Locatelli A, Lapinski RH, et al. Do uterine leiomyomas influence pregnancy outcome?. Am J Perinatol. 1994;11:356–358
  35. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2003;13:175–190
  36. Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol. 1997;177:1071–1078
  37. Stewart EA. Uterine Fibroids: The Complete Guide. Baltimore: Johns Hopkins University Press; 2007;
  38. Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008;31:73–85
  39. Viswanathan M, Hartmann K, McKoy N, Stuart G, Rankins N, Thieda P, et al. Management of uterine fibroids: an update of the evidence. Evidence report/technology assessment. Evid Rep Technol Assess. 2007;1–122
  40. Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. N Engl J Med. 1999;340:177–183

 J.R. serves as a clinical trial investigator for Insightec. M.D. has nothing to disclose. H.F. has nothing to disclose. Y.M. has nothing to disclose. B.S.G. has nothing to disclose. E.A.S. serves as a clinical trial investigator for Insightec.

 Funding for this study was provided by InSightec (Haifa, Israel).

PII: S0015-0282(08)04132-0

doi: 10.1016/j.fertnstert.2008.10.001

Fertility and Sterility
Volume 93, Issue 1 , Pages 199-209 , 1 January 2010

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