Pregnancy Outcomes of Adenomyosis after Treatment with High-intensity Focused Ultrasound: a Systematic Review and Meta Analysis.

This systematic review and meta analysis was conducted to investigate the reproductive outcomes in the patients with adenomyosis after HIFU treatment, aimed to recommend HIFU treatment for those women with adenomyosis who have reproductive demand. Extensive search was performed through PubMed, EMBASE and Web of Science databases. All available studies that evaluated the reproductive outcomes after HIFU for adenomyosis. Systematic review was performed following PRISMA guidelines. A meta-analysis was performed on data from 15 studies involving 3730 patients with adenomyosis. Pooled results showed that the pregnancy rate (PR) in women who desired to conceive was 54.6%, the live-birth rate (LBR) based on pregnancy was 75.8%, and the possible prognostic factors were non-perfused volume (NPV%) and type of adenomyosis. This review suggests that HIFU was easier to operate, with less adverse events and noninferior to adenomyomectomy. Patients with higher non-perfused volume (NPV%) and focal or internal adenomyosis had more improvement in reproductive outcomes after HIFU treatment. However, the well-designed, prospective, randomized controlled trials (RCT) are needed to compare the reproductive outcomes in those adenomyosis patients after HIFU in the near future.