Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology

Pschadka, Gregor; Engelhardt, Matthias; Niehoff, Caroline; Toub, David

doi:10.1089/gyn.2019.0001

“…In recent years, minimally invasive techniques have been widely used in the treatment of gynecological diseases. Traditional open myomectomy has gradually been replaced by laparoscopic surgery [ 12 ]. Laparoscopic surgery has the advantages of small wound, light pain and rapid postoperative recovery, but there are also complications such as pelvic adhesions and cervical stump bleeding.…”

Section: Discussionmentioning

confidence: 99%

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Liu¹,

Gao²,

Li³

et al. 2022

Computational and Mathematical Methods in Medicine

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Background. Uterine fibroids are most common in women aged 30-50 and are the most common benign gynecological tumors. Relevant data suggest that about 25% of patients with uterine fibroids are at childbearing age. Uterine fibroids not only cause the discomfort symptoms, and affect the pregnancy, but also have certain malignant transformation risk, thus needed to be treated positively and promptly. Aim. This study is aimed at exploring the effect of laparoscopic myomectomy and comprehensive rehabilitation nursing on patients with uterine fibroids. Methods. The clinical data of 110 cases of uterine fibroids admitted to our hospital from August 2019 to December 2021 were analyzed retrospectively, and they were divided into two groups according to postoperative rehabilitation strategies. Both groups were treated with laparoscopic myomectomy. The A group was treated with routine rehabilitation strategy, while the B group was treated with comprehensive rehabilitation nursing strategy. The differences in operation-related indicators, stress factors, inflammatory factors, nutritional indicators, knowledge mastery, occurrence of adverse symptoms and pain scores, negative emotion scores, nursing satisfaction, and simplified comfort status scale (GCQ) scores between the two groups under nursing strategies were compared. Results. The postoperative exhaust time ( 13.14 ± 2.03 ) h, bed time ( 9.86 ± 1.94 ) h, postoperative hospital stay ( 4.37 ± 1.31 ) d, and total hospital stay ( 6.78 ± 1.69 ) d in the B group were shorter than those in the A group, and the hospitalization expenses ( 0.74 ± 0.25 ) million were less than those in the A group ( P < 0.05 ). Before operation, stress factors, inflammatory factors, and nutritional indexes were compared between the two groups ( P > 0.05 ). On the 3rd day after operation, tumor necrosis factor-α (TNF-α), cortisol (Cor), norepinephrine (NE), and interleukin-1β (IL-1β) in the two groups showed a significantly upward trend compared with those before operation, and albumin and transferrin were significantly fell compared with those before operation. However, the values of stress factor and inflammatory factor in the B group were significantly lower than those in the A group, and the values after the decrease of nutritional index were significantly higher than those in the A group ( P < 0.05 ). The pain scores at 24 h, 48 h, and 72 h after operation in the B group were significantly lower than those in the A group ( P < 0.05 ). Negative emotions, nursing satisfaction, and GCQ scores were compared between the two groups before intervention ( P > 0.05 ). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the two groups were significantly lower than those before the intervention, and the scores of nursing satisfaction and GCQ were higher than those before the intervention. The values of negative emotions in the B group after the decline were significantly lower than those in the A group, while the values of nursing satisfaction and GCQ after the increase were higher than those in the A group ( P < 0.05 ). The excellent and good rate of knowledge acquisition in the B group was 94.55% (52/55), which was significantly higher than 78.18% (43/55) in the A group ( P < 0.05 ). The incidence of adverse symptoms in the B group was 9.09% (5/55), which was lower than 21.82% (12/55) in the A group, while the difference was not statistically significant ( P > 0.05 ). Conclusion. Laparoscopic myomectomy combined with comprehensive rehabilitation nursing can reduce the postoperative stress state of patients with uterine fibroids, improve patient satisfaction, reduce adverse emotions, and promote rehabilitation.

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“…In one of the cases, the pregnancy occurred after the treatment in a clinical trial in which a desire to have children was an exclusion criterion [27]. In another, the patient made a deliberate decision to undergo treatment with transcervical myoma ablation while in the process of undergoing assisted reproduction for male factor infertility [29]. No complications occurred during the pregnancies or deliveries in the 3 case reports.…”

Section: Pregnancy Outcomesmentioning

confidence: 99%

A Systematic Review of the Treatment of Uterine Myomas Using Transcervical Ultrasound-Guided Radiofrequency Ablation with the Sonata System

Arnreiter

¹

,

Oppelt

²

2021

Journal of Minimally Invasive Gynecology

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To evaluate the treatment success, possible side effects, and safety of radiofrequency ablation with the Sonata System. Data Sources: An electronic literature search in the PubMed and Medline databases was carried out from inception to August 2020. Methods of Study Selection: The review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Keywords such as "Sonata," "transcervical ablation," and "uterine myoma" were used to identify all relevant articles independently by both authors. Full-text articles in English that reported at least 1 of the following outcomes were included in the study: reduction in perfused/total myoma volume, effect of treatment on bleeding intensity and myoma-related symptoms, number of surgical reinterventions, adverse events, return to activities of daily life, effects on surrounding tissue, and safety during pregnancy. Tabulation, Integration, and Results: 10 studies matching the inclusion criteria were identified and used for further analysis. A reduction in total and perfused myoma volume of 63.2% and 64.5% was achieved. One of the studies showed a 53.8 § 50.5% (n = 48) reduction in Menstrual Pictogram Score, and another study showed a 51.1 § 40.9% (n = 142) reduction in Pictorial Blood Loss Assessment Chart at 12 months. 87.2% (n = 190) of the patients reported a clinically meaningful reduction in menstrual blood loss after 12 months. While Symptom Severity Scores dropped by 28.8 § 19.3, 23.3 § 23.7, and 23.7 § 19.4 points at 3, 6, and 12 months, respectively, Health-Related Quality of Life Scores increased to 77.5 § 22.0, 82.8 § 19.0, and 83.3 § 20.5 points.One study had an 8% reintervention rate after 12 months, and another study showed a 0.7% and 5.2% rate after 12 and 24 months. After an average of 64 months after ablation, the reintervention rate was 11.8%. Time to return to activities of daily life was 2.9 § 2.5 days. No related complications during pregnancy and delivery were reported. Conclusion:Radiofrequency ablation with the Sonata System represents a minimally invasive, organ-preserving treatment option in patients with symptomatic uterine myomas, associated with clinically meaningful improvement of myoma-related symptoms.

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“…For example, the effect on bleeding disorders and dysmenorrhea, quality of life, or adverse events is primarily studied [71]. The relationship between RFA and infertility is rarely the focus [72]. However, individual papers address case reports comparing pregnancy rates after RIF with those after surgical treatment and find similar outcomes concerning pregnancy, live birth, and abortion rates [70,73].…”

Section: Managementmentioning

confidence: 99%

Uterine Fibroids and Infertility

Freytag

¹

,

Maass

²

,

Alkatout

³

2021

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Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2–3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery.

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Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology

Cited by 9 publications

References 21 publications

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

A Systematic Review of the Treatment of Uterine Myomas Using Transcervical Ultrasound-Guided Radiofrequency Ablation with the Sonata System

Uterine Fibroids and Infertility

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