Comparison of pregnancy outcomes in infertile patients with different types of adenomyosis treated with high-intensity focused ultrasound

Figures & data

Table 1. Comparison of Baseline characteristics of patients between different types of adenomyosis.

Variable	Internal (n = 52)	External (n = 35)	Intramural (n = 17)	Full-thickness (n = 25)	p
Age (years)	36.0 (34.0, 39.8)	36.0 (32.0,40.0)	36.0 (34.0,38.5)	36.0 (32.0,38.0)	0.958
BMI (kg/m^2)	22.7 (20.8, 25.0)	21.6 (19.8,24.6)	21.5 (18.9,25.5)	22.9 (20.8,24.4)	0.457
Infertility					0.160
Primary infertility (%)	15.4 (8/52)	34.3 (12/35)	35.3 (6/17)	24.0 (6/25)
Secondary infertility (%)	84.6 (44/52)	65.7 (23/35)	64.7 (11/17)	76.0 (19/25)
Length of infertility (years)	3.0 (2.0,5.0)	4.0 (3.0,6.0)	5.0 (4.5,6.0)	4.0 (2.0,5.5)	0.072
Location of lesions (A/P/F)	12/23/17	15/11/9	8/2/7	11/8/6	0.151
Volume of adenomyosis (cm^3)	110.4 (74.5, 201.3)	96.5 (64.3,192.8)	184.3 (70.7,266.5)	134.5 (83.2, 31.1)	0.342

Notes: A: anterior wall of the uterus; P: posterior wall of the uterus; F: fundus.

Table 2. Comparison of HIFU treatment outcomes between different types of adenomyosis.

Variable	Internal (n = 52)	External (n = 35)	Intramural (n = 17)	Full-thickness (n = 25)	p
Power(W)	346.0 (332.5, 352.8)	342.0 (336.0,351.0)	345.0 (339.5,356.0)	346.0 (341.5,350.0)	0.619
Treatment time (min)	109.0 (102.3,120.0)	106.0 (99.0,114.0)	106.0 (102.5,120.5)	103.0 (98.0,108.5)	0.088
Sonication time(s)	1012.0 (728.0,1252.0)	866.0 (746.0,960.0)	1116.0 (804.0,1180.0)	952.0 (804.0,1318.0)	0.269
Total energy (KJ)	345.5 (243.5,434.0)	291.0 (257.0,335.0)	378.0 (270.0,410.0)	338.0 (270.5,456.0)	0.243
NPV ratio (%)	56.9 ± 12.8 a	43.1 ± 12.0 c	53.1 ± 15.2	49.6 ± 14.4 b	0.000
EEF(J/mm^3)	3.7 (2.1,6.2)	4.8 (2.7,8.3)	3.0 (1.9,6.6)	3.3 (1.5,8.0)	0.494

Notes: a. Indicates a significant difference between patients with internal adenomyosis and patients with external adenomyosis (p < 0.01).

b. Indicates a significant difference between patients with internal adenomyosis and patients with full-thickness adenomyosis (p < 0.01).

c. Indicates a significant difference between patients with external adenomyosis and patients with intramural adenomyosis (p < 0.01).

Table 3. Comparison of adverse effects between different types of adenomyosis.

Variable	Internal (n = 52)	External (n = 35)	Intramural (n = 17)	Full thickness (n = 25)	p
Leg pain (%)	9.6 (5/52)	8.5 (3/35)	11.7 (2/17)	12.0 (3/25)	0.930
gluteal pain (%)	19.2 (10/52)	28.6 (10/35)	35.3 (6/17)	32.0 (8/25)	0.474
Groin pain (%)	23.1 (12/52)	25.7 (9/35)	29.4 (5/17)	36.0 (9/25)	0.687
Skin burning sensation (%)	30.8 (16/52)	31.4 (11/35)	35.3 (6/17)	36.0 (9/25)	0.965

Table 4. Comparison of dysmenorrhea Severity pain scores between different types of adenomyosis.

Follow-up time	Internal (n = 51)	External (n = 35)	Intramural (n = 16)	Full-thickness (n = 25)	p
Pretreatment	4.0(2.0,6.0)^a	8.0(8.0,9.0)^c	6.0(5.0,7.0)	6.0(6.0,7.0)^b,d	0.000
1 month	3.0(1.0,3.0)^a	3.0(3.0,4.0)	4.0(4.0,5.0)^e	4.0(3.0,4.0)^b	0.000
3 month	2.0(1.0,3.0)	2.0(2.0,3.0)	3.0(2.0,3.0)	3.0(2.0,3.0)	0.069
6 month	2.0(0.0,2.0)^a	2.0(1.0,2.0)	2.0(1.0,2.0)	2.0(1.0,2.0)	0.038
12 month	0.0(0.0,1.0)	1.0(0.0,1.0)	1.0(0.25,1.0)	1.0(0.0,1.0)	0.150
P	0.000	0.000	0.000	0.000

Notes: One patient with internal adenomyosis and one patient with intramural adenomyosis who did not experience menstrual pain before HIFU treatment were excluded from this statistical analysis.

a. Indicates a significant difference between patients with internal adenomyosis and patients with external adenomyosis (p < 0.01).

b. Indicates a significant difference between patients with internal adenomyosis and patients with full-thickness adenomyosis (p < 0.01).

c. Indicates a significant difference between patients with external adenomyosis and patients with intramural adenomyosis (p < 0.01).

d. Indicates a significant difference between patients with external adenomyosis and patients with full-thickness adenomyosis (p < 0.01).

e. Indicates a significant difference between patients with internal adenomyosis and patients with intramural adenomyosis (p < 0.01).

Table 5. Comparison of menorrhagia severity scores between different types of adenomyosis.

Follow-up time	Internal (n = 14)	External (n = 4)	Intramural (n = 5)	Full-thickness (n = 5)	p
Pretreatment	142.5(123.5,146.5) a	102.0(100.5,105.0)	102.0(101.5,104.5) b	103.0(102.5,104.5) c	0.000
1 month	100.0(94.8,104.3) a	73.5(69.0,94.5)	83.0(75.0,93.0)	80.0(77.0,90.0)	0.004
3 month	80.0(75.0,87.0)	75.5(74.0,89.8)	77.0(71.5,88.0)	75.0(69.5,85.5)	0.854
6 month	62.0(57.3,65.3) a	75.5(72.5,83.0)	65.0(61.5,76.5)	80.0(69.5,85.5) c	0.002
12 month	65.0(58.8,66.5)	71.0(62.8,72.5)	71.0(58.5,85.0)	68.0(68.0,73.5)	0.082
P	0.000	0.012	0.000	0.002

Notes: 11 patients with internal adenomyosis, 5 patients with external adenomyosis, 5 patients with intramural adenomyosis, and 7 patients with full-thickness adenomyosis who had heavy menstrual blood volume before HIFU treatment were included in this statistical analysis.

a. Indicates a significant difference between patients with internal adenomyosis and patients with external adenomyosis (p < 0.01).

b. Indicates a significant difference between patients with internal adenomyosis and patients with intramural adenomyosis (p < 0.01).

c. Indicates a significant difference between patients with internal adenomyosis and patients with full-thickness adenomyosis (p < 0.01).

Table 6. Comparison of AMH level between different types of adenomyosis.

Follow-up time	Internal (n = 37)	External (n = 30)	Intramural (n = 15)	Full-thickness (n = 20)	p
Pretreatment	2.9 ± 1.0	3.0 ± 1.2	3.2 ± 1.0	3.1 ± 1.0	0.778
6 month	2.9 ± 1.0	2.9 ± 1.1	3.3 ± 1.0	3.0 ± 1.0	0.617
P	0.553	0.438	0.492	0.557

Notes: All patients without pregnancy 6 months after HIFU were reexamined with AMH.

Table 7. Comparison of pregnancy outcomes between different types of adenomyosis.

Variable	Internal (n = 52)	External (n = 35)	Intramural (n = 17)	Full-thickness (n = 25)	P
Pregnancy (%)	59.6 (31/52) a	22.9 (8/35)	17.6 (3/17) b	32.0 (8/25) c	0.001
Pregnancy interval (m)	6.0 (4.0,8.0)	5.0 (4.0, 7.5)	4.0 (3.5, 5.5)	5.0 (4.3, 7.8)	0.807
Pregnancy approach					0.006
Natural (%)	74.2 (23/31) a	12.5 (1/8)	50 (1/2)	50 (4/8)
Assisted (%)	25.8 (8/31)	87.5 (7/8)	50 (1/2)	50 (4/8)
Pregnancy outcome					0.459
Delivery	14	5	2	5
Miscarriage	14	2	1	1
Delivery					0.819
Vaginal delivery (%)	50 (7/14)	20.0 (1/5)	50 (1/2)	40 (2/5)
Cesarean section (%)	50 (7/14)	80.0 (4/5)	50 (1/2)	60 (3/5)
Delivery complication (%)	28.6 (4/14)	20 (1/5)	50 (1/2)	40 (2/5)	1.000

Notes: a. Indicates a significant difference between patients with internal adenomyosis and patients with external adenomyosis (p < 0.01).

b. Indicates a significant difference between patients with internal adenomyosis and patients with intramural adenomyosis (p < 0.01).

c. Indicates a difference between patients with internal adenomyosis and patients with full-thickness adenomyosis (p < 0.05).

Table 8. Univariate and multivariate logistic regression analysis of factors influencing pregnancy outcomes after HIFU treatment.

	Univariate logistic		Multivariate logistic
Variable	OR (95%CI)	p-value	OR (95%CI)	p-value
Age (years) <35 (vs ≥ 35)	3.242 (1.536,6.845)	0.002	6.578 (1.593,27.168)	0.004
BMI (kg/m2)	0.942 (0.844,1.053)	0.293	–	–
AMH(ng/ml)	2.003 (1.382,2.904)	0.000	2.256 (1.098,4.632)	0.016
NPV ratio (%)	0.994 (0.970,1.018)	0.617	–	–
adverse effects	0.761 (0.278,2.080)	0.594	–	–
Position of uterine (vs Posterior)			–	–
Anterior	0.994 (0.222,4.448)	0.993	–	–
Horizon	1.212 (0.252,5.824)	0.810	–	–
Location of lesions (vs Fundus)
Anterior	0.473 (0.141,1.586)	0.225	–	–
Posterior	20.482 (6.676,62.839)	0.000	13.637 (141.684,1472.073)	0.000
Volume of adenomyosis (cm3)	1.000(1.000,1.000)	0.204	–	–
Type of adenomyosis (vs Full-thickness)
Internal	3.137 (1.417,8.582)	0.026	1.945 (13.295,90.894)	0.011
External	0.630 (0.199,1.994)	0.431	–	–
Intramural	0.455 (0.101,2.048)	0.305	–	–

Figure 1. Receiver operating characteristic curves.