Effect of pelvic adhesions on reproductive outcomes following high-intensity focused ultrasound in patients with adenomyosis.

OBJECTIVE

To investigate the effect of pelvic adhesions on reproductive outcomes following high-intensity focused ultrasound (HIFU) ablation in patients with adenomyosis.

METHODS

A total of 396 patients with adenomyosis underwent HIFU, including 148 patients with fertility requirements. Magnetic resonance imaging (MRI) was employed to evaluate pelvic adhesions. Reproductive outcomes were evaluated subsequent to the HIFU procedure for adenomyosis, with an assessment of the effect of pelvic adhesions on reproductive outcomes.

RESULTS

A total of 118 patients (79.83%), with an average age of 35.34 ± 4.66 years, were followed up for a median period of 92 months (48-122 months). Successful pregnancy was achieved in 35 individuals (29.66%), including 28 cases of natural conception and 7 cases of in vitro fertilization and embryo transfer. MRI indicated signs of pelvic adhesions in 71 patients (60.17%). Pregnant women had lower numeric rating scale (6 vs. 7, P = 0.008), uterine volume (160.74 vs. 207.57 cm3, P = 0.013), and a lower proportion of pelvic adhesions (40.00% vs. 68.67%, P = 0.004) compared with non-pregnant women. The successful pregnancy rates were 16.28%, 25.00%, and 44.68% in the severe adhesive group, mild adhesive group, and non-adhesive group, respectively. Severe pelvic adhesion was identified as an independent risk factor for achieving pregnancy following HIFU (odds ratio 0.28, 95% confidence interval 0.10-0.76, P = 0.013).

CONCLUSIONS

Severe pelvic adhesion is a hindrance to achieving pregnancy following HIFU in patients with adenomyosis. Assessing pelvic adhesions is crucial for the fertility of women as it provides valuable guidance for clinical decision making.