Comparative study on the effects of high-intensity focused ultrasound (HIFU) and laparoscopic myomectomy on ovarian function and endometrial receptivity in patients with uterine fibroids.

内容摘要

To compare the effects of high-intensity focused ultrasound (HIFU) ablation and laparoscopic myomectomy on ovarian function and endometrial receptivity in patients with uterine fibroids. In this prospective, non-randomized cohort study, 60 patients with uterine fibroids were either treated with HIFU (n&#x2009;=&#x2009;30) or laparoscopic myomectomy (n&#x2009;=&#x2009;30) based on patient preference after standardized counseling. Ovarian function and endometrial receptivity were evaluated preoperatively and at 1, 3, and 6&#x2009;months post&#x2011;treatment. Ovarian reserve was assessed using anti&#x2011;M&#xfc;llerian hormone (AMH), sex hormone levels of luteinizing hormone (LH), follicle&#x2011;stimulating hormone (FSH), estradiol (E2), and antral follicle count (AFC). Endometrial receptivity was evaluated using endometrial thickness and vascular indices, including endometrial artery resistance index (RI), pulsatility index (PI), and the systolic/diastolic velocity ratio (S/D). Regarding endometrial receptivity, the HIFU group exhibited significantly greater endometrial thickness at the 1&#x2011;month follow&#x2011;up compared to the laparoscopic group (mean difference: 1.5&#x2009;mm, 95% CI: 0.6 to 2.4&#x2009;mm; Cohen's d&#x2009;=&#x2009;0.72, p&#x2009;<&#x2009;0.05). Both groups showed a reduction in PI after treatment, though the change was not statistically significant. RI and S/D ratios were comparable between the two groups at any time point (p&#x2009;>&#x2009;0.05). Both HIFU and laparoscopic myomectomy preserved ovarian function in patients with uterine fibroids. HIFU was associated with faster short-term endometrial recovery at 1&#x2009;month post-treatment, but no differences in ovarian function or other receptivity markers were observed between the two groups of patients. Randomized trials with pregnancy outcomes are needed before clinical recommendations can be made.