Magnetic resonance-guided focused ultrasound surgery for leiomyoma-associated infertility

Esther V A Bouwsma, Krzysztof R Gorny, Gina K Hesley, Jani R Jensen, Lisa G Peterson, Elizabeth A Stewart, Esther V A Bouwsma, Krzysztof R Gorny, Gina K Hesley, Jani R Jensen, Lisa G Peterson, Elizabeth A Stewart

Abstract

Objective: To describe magnetic resonance-guided focused ultrasound surgery (FUS) as a treatment for a case of leiomyoma-associated infertility.

Design: Case report from a randomized clinical trial.

Setting: Academic medical center.

Patient(s): A 37-year-old woman with known leiomyomas and a history of 18 months of home-inseminations from a known donor.

Intervention(s): Magnetic resonance-guided FUS treatment of uterine fibroids, where the dominant fibroid distorted the uterine cavity.

Main outcome measure(s): Pregnancy.

Result(s): A viable intrauterine pregnancy, with a full-term vaginal delivery, was conceived after a single clomiphene citrate and intrauterine insemination cycle.

Conclusion(s): The role of FUS for enhancement of fertility in women with nonhysteroscopically resectable uterine fibroids distorting the uterine cavity should be investigated further.

Trial registration: ClinicalTrials.gov NCT00730886.

Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
(A–B) Two fibroids (F1 and F2) on sagittal T2-weighted magnetic resonance imaging (MRI) before treatment. F1 is the dominant intramural fibroid in the right lateral myometrial wall abutting the endometrium. F2 is the smaller fundal fibroid. (C–D) Posttreatment sagittal T1-weighted images demonstrating a large area of nonenhancement in both fibroids after the administration of gadolinium. The nonenhanced areas correspond to nonperfused tissues resulting from focused ultrasound surgery (FUS) ablation. These images show the largest dimensions of the fibroids and do not illustrate the cavitary distortion.
Figure 2
Figure 2
Transabdominal ultrasound image at 12 weeks' gestation showing the implantation of the placenta on the anterior wall. The treated dominant fibroid is located in the lateral myometrial wall and abuts the endometrial cavity.

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