Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids

Khaw, Shen Chuen; Anderson, Richard A.; Lui, Man-Wa

doi:10.1016/j.rbmo.2020.01.003

Cited by 47 publications

(79 citation statements)

References 118 publications

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“…In conclusion, myomectomy appears to be the gold standard treatment for women wishing conservative management of broids looking for a subsequent pregnancy [11]. More series are essential for establishing the safety of UPA as a treatment of symptomatic broids prior to pregnancy.…”

Section: Discussionmentioning

confidence: 94%

“…Spontaneous rst trimester abortion ocurred in the other two [7]. Khaw et al [11], in a recent systematic review compared pregnancy outcomes after fertility-preserving treatment of uterine broids. They analyzed live birth and miscarriage rates after four treatment modalities: UPA therapy, myomectomy surgery and radiological approach with uterine artery embolization (UAE) or thermal ablation.…”

Section: Discussionmentioning

confidence: 99%

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Management of Fibroids Prior to in Vitro Fertilization. Case Reports

Gastañaga-Holguera

González

Urrutia

et al. 2021

Preprint

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BACKGROUND. Uterine fibroids are common benign uterine neoplasms in women in reproductive age and pregnancy desire. Several surgical approaches for symptomatic fibroids are available, such as surgical or pharmacologic treatments. We report three cases of fibroids treatment in women with primary sterility. CASE PRESENTATION. The first case of a successful in vitro fertilization (IVF) after ulipristal acetate (UPA) as an alternative treatment to reduce the fibroids size in a patient with two previous abdominal myomectomies, resulting in an evolutive pregnancy. The second patient underwent several myomectomies (both abdominal and hysteroscopic) in a long period of time. And the third one of a successful IVF after UPA in a patient with a submucous fibroid which induced myoma migration leading to its prolapse.CONCLUSIONS. Myomectomy appears to be the gold standard treatment for fibroids in women with reproductive desires. Nevertheless, more series are essential for establishing the safety of UPA as a treatment of symptomatic fibroids prior to pregnancy.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Management of Fibroids Prior to in Vitro Fertilization. Case Reports

Gastañaga-Holguera

González

Urrutia

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…It was recommended by the guideline that MYO might be considered to optimize pregnancy outcomes in women with asymptomatic cavity-distorting myomas (39). In a systematic review (40), MYO has higher successful pregnancy rates (75.6%) in comparison with UAE (60.6%), which might be explained by a high risk of disruption of blood supply to the ovary and intima after the UAE treatment. Liu et al (41) reported that a successful vaginal delivery rate after the HIFU ablation had reached 80.8%.…”

Section: Discussionmentioning

confidence: 96%

Comparative Effectiveness and Safety of High-Intensity Focused Ultrasound for Uterine Fibroids: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Uterine fibroids are common benign tumors among premenopausal women. High- intensity focused ultrasound (HIFU) is an emerging non-invasive intervention which uses the high-intensity ultrasound waves from ultrasound probes to focus on the targeted fibroids. However, the efficacy of HIFU in comparison with that of other common treatment types in clinical procedure remains unclear.Objective: To investigate the comparative effectiveness and safety of HIFU with other techniques which have been widely used in clinical settings.Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cumulative Index to Nursing & Allied Health Literature, Web of Science, ProQuest Nursing & Allied Health Database, and three Chinese academic databases, including randomized controlled trials (RCTs), non-RCTs, and cohort studies. The primary outcome was the rate of re-intervention, and the GRADE approach was used to interpret the findings.Results: About 18 studies met the inclusion criteria. HIFU was associated with an increased risk of re-intervention rate in comparison with myomectomy (MYO) [pooled odds ratio (OR): 4.05, 95% confidence interval (CI): 1.82–8.9]. The results favored HIFU in comparison with hysterectomy (HYS) on the change of follicle-stimulating hormone [pooled mean difference (MD): −7.95, 95% CI: −8.92–6.98), luteinizing hormone (MD: −4.38, 95% CI: −5.17−3.59), and estradiol (pooled MD: 43.82, 95% CI: 36.92–50.72)]. HIFU had a shorter duration of hospital stay in comparison with MYO (pooled MD: −4.70, 95% CI: −7.46−1.94, p < 0.01). It had a lower incidence of fever (pooled OR: 0.15, 95% CI: 0.06–0.39, p < 0.01) and a lower incidence of major adverse events (pooled OR: 0.04, 95% CI: 0.00–0.30, p < 0.01) in comparison with HYS.Conclusions: High-intensity focused ultrasound may help maintain feminity and shorten the duration of hospital stay. High-quality clinical studies with a large sample size, a long-term follow-up, and the newest HIFU treatment protocol for evaluating the re-intervention rate are suggested to be carried out. Clinical decision should be based on the specific situation of the patients and individual values.

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“…The development of fertility‐sparing surgery in this cohort of women has resulted in a significant impact on reproductive outcomes, as highlighted by a systematic review reporting high rates of clinical pregnancy following surgical myomectomy (76%) and fibroid ablation (71%) [8]. However, uterine artery embolisation was associated with the lowest live birth (60.6%) and highest miscarriage rates (27%) [18].…”

Section: Fertility‐sparing Surgical Techniquesmentioning

confidence: 99%

Anaesthetic considerations for fertility‐sparing surgery and uterine transplantation

et al. 2021

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Summary A number of benign and malignant gynaecological conditions can cause infertility. Advancements in assisted reproductive technologies have facilitated the rapidly evolving subspecialty of fertility preservation. Regardless of clinical indication, women now have the reproductive autonomy to make fully informed decisions regarding their future fertility. In particular, there has been an increasing interest and demand among patients and healthcare professionals for fertility‐sparing surgery. Gynaecologists find themselves continually adapting surgical techniques and introducing novel procedures to facilitate this rapidly emerging field and anaesthetists need to manage the consequent physiological demands intra‐operatively. Not only is it important to understand the surgical procedures now undertaken, but also the intra‐operative management in an ever evolving field. This article reviews the methods of fertility‐sparing surgery and also describes important anaesthetic challenges including peri‐operative care for women undergoing complex fertility‐sparing surgeries such as uterus transplantation.

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Systematic review of pregnancy outcomes after fertility-preserving treatment of uterine fibroids

Cited by 47 publications

References 118 publications

Management of Fibroids Prior to in Vitro Fertilization. Case Reports

Management of Fibroids Prior to in Vitro Fertilization. Case Reports

Comparative Effectiveness and Safety of High-Intensity Focused Ultrasound for Uterine Fibroids: A Systematic Review and Meta-Analysis

Anaesthetic considerations for fertility‐sparing surgery and uterine transplantation

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