Pregnancy outcomes and influencing factors following high-intensity focused ultrasound treatment for adenomyosis: a single-center retrospective study.

Objectives: To evaluate pregnancy outcomes and influencing factors in adenomyosis patients undergoing high-intensity focused ultrasound (HIFU) treatment with fertility requirements.

Materials and methods: From April 2012 to December 2022, 223 patients with adenomyosis desiring fertility underwent HIFU at the Third Xiangya Hospital. Patients were followed up at 1, 3, 6, and 12 months post-HIFU treatment in the first year, and subsequently every 6 months. Data on pregnancy and pregnancy outcomes were recorded.

Results: All patients completed HIFU treatment in a single session. During the average follow-up period of 39.0 ± 19.3 months (range: 7-91 months), 103 patients achieved a total of 109 pregnancies, resulting in an overall pregnancy rate of 48.9% (109/223). Among these, 82 pregnancies occurred through natural conception and 27 through assisted reproductive technology. Among 45 infertile patients, 23 (51.1%) conceived after HIFU treatment. Among the 57 patients with a history of adverse pregnancy outcomes, 27 achieved successful pregnancies post-treatment, with 15 live births. The incidence of complications during pregnancy and delivery was 23.8% (15/63). Body mass index (BMI) and ablation rate significantly influenced post-HIFU pregnancy outcomes. Higher BMI values and excessive ablation rates were associated with lower pregnancy rates. Advanced age was significantly associated with a higher risk of adverse pregnancy outcomes.

Conclusion: HIFU treatment is associated with improved pregnancy outcomes in patients with adenomyosis complicated by infertility or a history of adverse pregnancy outcomes. Higher BMI values and excessive ablation rates may reduce postoperative pregnancy rates, while advanced age increases the risk of adverse pregnancy outcomes.