Reproductive impact of MRI-guided focused ultrasound surgery for fibroids: a systematic review of the evidence

Abstract

Purpose of review: Magnetic-resonance-guided focused ultrasound surgery (MRgFUS) is a minimally invasive technique for the treatment of uterine fibroids. The purpose of this review is to highlight the impact of MRgFUS on fertility and reproductive outcomes.

Recent findings: The role of MRgFUS in the treatment of fibroids has been evolving since its introduction in 2004. Several new devices and techniques including location-specific treatment, volumetric therapy, and vessel-targeted therapy have been introduced over the last few years. Several case series report uncomplicated pregnancy following MRgFUS; however, results of the ongoing studies will further elucidate the utility of MRgFUS in patients planning future fertility. A systematic review of the literature was completed and studies that reported quality of life at baseline and after 6 months were included in a meta-analysis.

Summary: MRgFUS represents a minimally invasive treatment for uterine fibroids that is able to improve the quality of life and fibroid size with durability. It is possible that MRgFUS could be the treatment of choice for patients desiring future fertility; however, further investigation is needed.

FIGURE 1

Schematic diagram of results of literature search. A total of 39 studies were included in the qualitative analysis and 10 studies provided sufficient detail to be included in the quantitative analysis.

FIGURE 2

Patient-reported Symptom Severity Score (y-axis) at 3, 4, 6, and 12 months (x-axis) after MRgFUS treatment. Mean and median patient-reported Symptom Severity Score from 15 studies on MRgFUS from 2004 to 2013 are depicted. MRgFUS, magnetic-resonance-guided focused ultrasound surgery.

FIGURE 3

Quantitative analysis of 10 studies that reported mean Symptom Severity Score (SSS) after 6 months. A random-effects model was used to estimate the overall mean SSS observed in these studies to account for potential heterogeneity among studies in addition to sampling error. The overall mean SSS at baseline was 56.3 and after 6 months SSS was estimated to be 31.0 (95% confidence interval 23.9–38.2). Bars above represent calculated 95% confidence intervals assuming normal distribution.