Patients are increasingly seeking uterus-preserving, minimally invasive treatments for symptomatic uterine fibroids. This has led to a greater use of nonresective treatments such as uterine artery embolization (UAE), focused ultrasound (FUS) and more recently, radiofrequency ablation (RFA) of fibroids. This systematic review, following PRISMA guidelines, examines the change in uterine and fibroid volumes associated with UAE, FUS, and RFA. Pubmed and MedlinePlus databases were searched from 1956 to 2016. The keywords used were 'radiofrequency ablation,' 'magnetic resonance guided focused ultrasound,' 'ultrasound guided focused ultrasound', 'uterine artery embolization,' 'uterine fibroid embolization,' and 'leiomyoma' or 'fibroid'. Publications with at least 20 patients were included. Data were collected and analyzed using Microsoft Excel V R (Microsoft Corporation, Redmond, WA) software. Eighty-one relevant papers were identified: 52 related to UAE, 11 to RFA, 17 to FUS, 1 compared UAE and FUS. We report the published uterine volume and fibroid volume changes seen in these studies at 1 to 36 months. The pooled fibroid volume reductions at six months seen with RFA were 70%, UAE 54% and FUS 32%. All three types of nonresective treatment result in fibroid volume reduction. However, fibroid volume reduction is most marked with RFA, with UAE resulting in the next most volume reduction. Additional larger cohort studies, including those that are randomized and/or comparative, would enable definitive conclusions. This is the first systematic review comparing uterine and fibroid volume reduction after RFA, UAE and MRgFUS. ARTICLE HISTORY

Subsequent retrievals prior to live birth were needed in 30% and 24% cycles, respectively. The groups were similar for BMI, smoking, FSH dose and number of oocytes retrieved in all retrieval cycles. ICSI cycles had lower risk of TFF (AOR 0.47, 95% CI 0.39-0.58) despite lower fertilization rates (66% vs. 68%, p<0.001), and were more likely to have blastocyst transfers (AOR 1.60, 95% CI 1.47-1.74) compared to conventional insemination. In subsequent cycles, 24% of patients had new diagnoses, most commonly DOR (8.1%) and male factor (6.1%). ICSI utilization remained consistent over all cycles with minimal cross-over. There was no difference in the number of retrievals to achieve live birth (median 2 retrievals, AHR 0.97, 95% CI 0.97-1.00), and no difference in live birth rate over multiple fresh cycles by insemination method (AOR 0.95, 95% CI 0.90-1.00).CONCLUSIONS: For patients with unexplained infertility, ICSI results in a lower chance of TFF and a higher likelihood of embryo transfer over time. Insemination method is not associated with number of retrievals to, or incidence of, live birth. Further studies are needed to account for the impact of pre-implantation genetic testing and other indications for frozen embryo transfers in both cumulative live birth rates and time to pregnancy in couples with unexplained infertility.

No abstract

No abstract

No abstract