Fertility Prognosis in Adenomyosis: The Role of Pelvic Adhesions Post-HIFU

Severe pelvic adhesions significantly reduce pregnancy rates following high-intensity focused ultrasound (HIFU) ablation for adenomyosis, as per findings of a new study published in The International Journal of Gynecology & Obstetrics.1

Researchers undertook this study to investigate the impact of pelvic adhesions on reproductive outcomes in 396 women with adenomyosis who underwent HIFU ablation, of whom 148 had fertility requirements. Pelvic adhesions were assessed with magnetic resonance imaging (MRI), and reproductive outcomes were evaluated post-procedure.

Out of the 148 women, 118 (79.8%), mean age 35.3 years, were followed up for a median duration of 92 months. Thirty-five women (29.7%) achieved successful pregnancy, including 28 spontaneous conceptions and seven via in vitro fertilization (IVF) and embryo transfer. Pelvic adhesions were observed in 60.2% of cases.

Women who became pregnant had lower pain scores (6 vs 7 on numeric rating scale), smaller uterine volumes (160.74 vs 207.57 cm3), and a lower incidence of pelvic adhesions (40.00% vs. 68.67%) compared with those who did not. The pregnancy rates differed according to the severity of pelvic adhesions: 44.7% in women without adhesions, 25.0% in those with mild adhesions, and 16.3% in women with severe adhesions. Severe pelvic adhesions were identified as independent adverse risk factor for achieving pregnancy after HIFU with odds ratio (OR) of 0.28.

This study highlights the negative impact of severe pelvic adhesions on pregnancy rates after HIFU for adenomyosis. Hence, careful pre-treatment assessment of adhesions is essential for the fertility of women as it provides valuable guidance for patient counselling, and clinical decision-making.

Reference

1.   Lin JF, et al. Effect of pelvic adhesions on reproductive outcomes following high-intensity focused ultrasound in patients with adenomyosis. Int J Gynaecol Obstet. 2025 Oct;171(1):438-445. doi: 10.1002/ijgo.70194.