Back to all available

High-Intensity Focused Ultrasound and Laparoscopic Surgery efficacy in preserving fertility in adenomyosis: a meta-analysis

gynecology-and-obstetrics
womens-health

Abstract

Objective: We conducted a meta-analysis to evaluate the efficacy of current non- or minimally invasive treatment modalities for fertility preservation in adenomyosis.

Data Sources: A comprehensive literature search was performed across PubMed, Science Direct, and Cochrane Library for studies published between January 1, 2000, and January 1, 2025.

Methods: Studies reporting reproductive outcomes after either high-intensity focused ultrasound (HIFU) or laparoscopic surgery for adenomyosis were included. Comprised mostly of single-arm retrospective cohorts, they were screened and evaluated by two independent reviewers. Pregnancy rate, live birth rate, and miscarriage rate were the primary outcomes, assessed through a random-effects model. Heterogeneity was assessed using I 2 statistic.

Results: Eight studies (4 HIFU, 5 laparoscopic; 1 assessed both), comprising 932 women, were included. The pooled pregnancy rates were 42% (95% CI 35-50%) and 44% (95% CI 19-70%) after HIFU and laparoscopy, respectively. The pooled live birth rates were 65% (95% CI 55-75%) in the HIFU group and 85% (95% CI 66-97%) in the laparoscopy group. The pooled miscarriage rates were 26% (95% CI 16-37%) for HIFU and 14% (95% CI 5-27%) for laparoscopy. Heterogeneity was found to be lower in HIFU studies than in laparoscopic surgery studies.

Conclusion: Both HIFU and laparoscopic surgery are equally attractive and feasible fertility-preservation methods in adenomyosis. Whilst laparoscopic surgery appears to achieve slightly better outcomes than HIFU, it is associated with greater variability in techniques and surgeons’ expertise. The better outcomes with surgery may be attributable to more complete excision of adenomyotic tissue and uterine repair, whereas HIFU provides a non-invasive, standardized approach that could appeal to women seeking fertility preservation. Larger studies directly comparing HIFU and laparoscopic surgery are needed. This meta-analysis is limited by the predominance of single-arm observational studies, potential selection bias, variability in surgical techniques and patient demographics, and incomplete reporting of confounders such as disease severity and uterine volume.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].