A comparison of reproductive outcomes of patients with adenomyosis and infertility treated with High-Intensity focused ultrasound and laparoscopic excision

Figures & data

Table 1. Patients’ baseline characteristics.

Variables	HIFU group (n = 50)	LE group (n = 43)	p-value
Age (years)	36.0 (32.0, 38.0)	35.0 (31.0, 38.0)	0.562
BMI (kg/m^2)	21.4 (19.7, 23.5)	22.7 (21.4, 23.4)	0.535
Dysmenorrhea pain score	5.0 (4.0, 6.0)	5.0 (4, 7)	0.330
Menorrhagia severity score	3.0 (3.0, 4.0)	3.0 (2.0, 3.0)	0.148
Hemoglobin level (g/L)	111.5 (87.0, 124.0)	118.0 (109.0, 127.0)	0.088
Uterine volume (cm^3)	179.9 (114.3, 240.7)	148.3 (73.5, 202.1）	0.073
Length of infertility (years)	5 .0 (3.0, 10.0)	4.0 (2.0, 8.0)	0.283

Data are presented as medians and interquartile ranges.

BMI: body mass index; HIFU: high-intensity focused ultrasound; LE: laparoscopic excision.

Table 2. Comparison of dysmenorrhea severity pain scores between groups.

Follow-up time	HIFU group (n = 50)	LE group (n = 43)	p-value
Pretreatment	5.0 (4.0, 6.0)	5.0 (4.0, 7.0)	0.330
1 month	2.5 (2.0, 3.0)^##	3.0 (2.0, 4.0)^$$	0.071
6 months	2.0 (1.0, 2.0)^##	2.0 (1.0, 3.0)^$$	0.123
12 months	1.0 (1.0, 2.0)^##	2.0 (1.0, 3.0)^$$	0.383

Data are presented as the medians and interquartile ranges, ^## or ^$$p < 0.01 vs. pretreatment.

HIFU: high-intensity focused ultrasound; LE: laparoscopic excision.

Table 3. Comparison of menorrhagia severity scores between patients treated with HIFU and those who underwent LE.

Follow-up time	HIFU group (n = 50)	LE group (n = 43)	p-value
Pretreatment	3.0 (3.0, 4.0)	3.0 (2.0, 3.0)	0.148
1 month	2.0 (2.0, 3.0)^##	2.0 (1.0, 2.0)^$$	0.148
6 months	1.0 (1.0, 2.0)^##	1.0 (1.0, 1.3)^$$	0.618
12 months	1.0 (1.0, 1.3)^##	1.0 (1.0, 1.3)^$$	0.868

Data are presented as medians and interquartile ranges, ^## or ^$$p < 0.01 vs. pretreatment.

HIFU: high-intensity focused ultrasound; LE: laparoscopic excision.

Table 4. Comparison of pregnancy outcomes between the groups.

Variables	HIFU group (n = 50)	LE group (n = 43)	χ^2 value	p-value
Pregnancy (%)	52 (26/50)	30.2 (13/43)	4.499	0.034*
Pregnancy approach
Natural (%)	40 (20/50)	18.6 (8/43)	5.029	0.025*
Assisted (%)	12 (6/50)	11.6 (5/43)	0.003	0.956
Pregnancy outcome
Delivery rate (%)	36 (18/50)	27.9 (12/43)	0.693	0.405
Miscarriage (%)	6.0 (3/50)	2.3 (1/50)	0.128	0.720
Delivery
Vaginal delivery (%)	33.3 (6/18)	58.3 (7/12)	1.833	0.176
Cesarean section (%)	66.7 (12/18)	41.7 (5/12)	1.833	0.176
Complications (%)	10 (5/50)	7 (3/43)	0.022	0.883

Data were presented as number (%). *p < 0.05.

HIFU: high-intensity focused ultrasound; LE: laparoscopic excision.

Table 5. Comparison of complications during pregnancy and delivery between the groups.

Complications	HIFU group (n = 50)	LE group (n = 43)	p-value
Total cases with complications (%)	10 (5/50)	6.9 (3/43)	0.721
Placenta accrete (%)	4 (2/50)	2.3 (1/43)	1.000
Postpartum hemorrhage (%)	4 (2/50)	0 (0/43)	0.497
Premature rupture of membranes (%)	2 (1/50)	0 (0/43)	1.000
Fetal distress (%)	0 (0/50)	4.6 (2/43)	0.211

Data were presented as number (%).

HIFU: high-intensity focused ultrasound; LE: laparoscopic excision.

Table 6. Univariate logistic regression analysis of factors influencing pregnancy outcomes after HIFU treatment.

Variables	Pregnant group (n = 26)	Non-pregnant group (n = 24)	χ^2 value	p-value
Age (years)			0.002	0.963
<35	11	10
≥35	15	14
Uterine volume^a			1.974	0.160
Smaller than average	16	10
Larger than average	10	14
Numbers of abortion before operation^b			0.033	0.856
Below average	14	10
Above average	11	7
Location of the uterus			2.457	0.293
Front	16	14
Middle	1	4
Back	9	6
Location of adenomyosis			6.425	0.040
Anterior uterine wall	4	9
Posterior uterine wall	19	9
Lateral uterine wall	3	6
Type of adenomyosis			4.327	0.038
Diffuse adenomyosis	12	18
Focal adenomyosis	14	6
Gray-scale change^c			0.480	0.488
Nodular gray change	16	17
Integrate gray change	10	7
Ablation rate^d			0.244	0.621
<80%	19	16
≥80%	7	8
Ultrasound power^e			0.263	0.608
Lower	9	10
Higher	17	14
Ultrasound energy^f			0.321	0.571
Lower	14	11
Higher	12	13

^aPatients with uterine volumes smaller than the average size (189.3 cm³) were designated as smaller than the average. Other patients were counted as larger than the average.

^bThe median number of abortions was 2 times.

^cNodular gray change: local, immediate, and instantaneous obvious grayscale changes; integrate gray change: the gray level increased gradually in the entire lesion.

^dAblation rate = ablated volume/focus volume.

^eThe average ultrasound power was 374 W. Patients treated with an ultrasound power lower than or equal to 374 W were designated as low. Other patients were counted as high.

^fThe average ultrasound energy was 1,31,575 J. Patients treated with an ultrasound energy lower than or equal to 1,31,575 J were designated as low. Other patients were counted as high.

Table 7. Multivariate logistic regression analysis of factors influencing pregnancy outcomes after HIFU treatment.

Variables	Regression coefficient	Std. error	Wald value	df	P-value	OR value
Location of adenomyosis	0.181	0.449	0.162	1	0.687	1.198
Degree of adenomyosis diffusion	−1.248	0.615	4.116	1	0.042	0.287
Constant	0.497	0.993	0.251	1	0.617	1.644

Dependent variable: pregnant = 1, non-pregnant = 0; Covariate: lesion location = X₁ (anterior wall = 1, posterior wall = 2, lateral wall = 3), type of adenomyosis = X₂ (diffuse adenomyosis = 1; focal adenomyosis = 0). LogitP1 = 0.497–1.248 * X₂ (P1: incidence of pregnancy after HIFU).