- Prof. Jaron Rabinovici Sheba, Hospital, Israel, spoke about pregnancies after ExAblate at the 3rd Focused Ultrasound Foundation Symposium in Washington DC. See his presentation or download the abstract of his talk.
- Dr. Andrew Dobrotwir, Royal Women’s Hospital, Melbourne, Australia speaks about collaboration with IVF specialists
- Click here to see a case study as reported by Cantero et al.
Pregnancy After Uterine Fibroids Treatment
It is known that uterine fibroids can impair fertility and cause pregnancy complications, depending upon the location of the fibroid and its relation to the uterine cavity. The process of treating fibroids can also lead to morbidity and fertility impairment. Increasingly physicians are reporting on cases of women who have become pregnant and delivered babies after ExAblate treatment.
Post Fibroids Pregnancy Case Reports
Following is a summary of published reports of pregnancies following ExAblate therapy:
Rabinovici et al (2006) reported the first case of pregnancy after ExAblate treatment in a 36 year old woman who had difficulty conceiving because of profuse menometrorrhagia. An 84 cm3 uterine tumor was diagnosed on ultrasonography as leiomyoma, and a conservative myomectomy was planned. Magnetic resonance imaging (MRI) corrected the diagnosis to focal adenomyosis. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) destroyed a significant part of the tumor. Following an uncomplicated MRgFUS treatment, a non-perfused volume of 33 cm3 was measured. At 6 weeks, the patient experienced a significant reduction in menometrorrhagia and a marked decrease in tumor size (about 50%). She conceived spontaneously and, after an uneventful pregnancy, gave birth at term to a healthy infant via normal vaginal delivery.
Hanstede et al. (2007) reported a case in which the treatment of two uterine fibroids by ExAblate resulted in the restoration of normal shape to the endometrial cavity, which possibly facilitated a subsequent pregnancy. In this case, ExAblate was used to treat the patient’s intramural myomas and the authors reported that at 1 year follow-up, a conformational change of the uterine cavity was observed on MRI and after this a pregnancy was successful.
Gavrilova et al. (2007) was the first to address conception after treatment of a solitary large 9 x 10 x 10 cm3 symptomatic uterine myoma. At 39 weeks, the patient delivered a healthy male infant following labor induction and vacuum-assisted vaginal delivery. According to the report, there were no associated antepartum or intrapartum obstetrical complications after pregnancy following ExAblate.
Morita et al. (2007) reported a case of a 29-year-old patient who had never been pregnant and whose history revealed no significant medical or gynecologic problems such as pain, abnormal bleeding or infertility. On clinical examination the size of her uterus was comparable to the size at 14 weeks of pregnancy. After successful ExAblate treatment, the patient conceived and at 39 weeks of pregnancy she had a vaginal delivery of a healthy baby.
Rabinovici et al (2010) reported on 54 pregnancies in 51 women after ExAblate treatment for their symptomatic uterine fibroids. The mean time to pregnancy after the procedure was 8 ± 7 months (range, 0 – 30 months). Of the 54 pregnancies, 22 (41%) resulted in live births and 11 (20%) were ongoing at more than 20 weeks. The spontaneous abortion rate was 27% and the rate of therapeutic abortion was 11%. The mean birth weight was 3.3 kg and 64% of the women had a vaginal delivery.
Zaher et al. (2010) described the first pregnancy and successful delivery in a 39 year old patient who was part of a fertility trial and treated with ExAblate for symptomatic fibroids. Prior to ExAblate, this patient had a premature delivery at 28 weeks. Six months post treatment patinet had almost complete resolution of symptoms, 4 months later she conveived with no ante natal problems. Patient vaginally delivered a healthy 3.6 Kg female.
Yoon et al. (2010) described a patient with two distinct intramural myomas that were treated successfully with two consecutive ExAblate treatments one month apart. According to the case report, four months post treatment the patient spontaneously conceived and continued her pregnancy to term. After 39 weeks of normal pregnancy, a baby girl was born, weighing 3190 grams, through a vaginal delivery. No complications were recorded during the labor or post-partum periods.
Zaher et al. (2011) described a case of successful in vitro fertilization and pregnancy following ExAblate therapy. A 45-year old patient presented with a single symptomatic intramural fibroid measuring 9 x 6.2 x 7.1 cm3 in the anterior wall of the uterus, causing distortion of the uterine cavity. The patient had already undergone four previous IVF cycles, resulting in one pregnancy which ended in miscarriage in the first trimester. ExAblate was subsequently performed, resulting to 90% non-perfused volume. Three months after the therapy, 80% shrinkage of the fibroid was observed, and the distortion of the endometrial cavity resolved. Ten months following therapy, the patient had her fifth IVF cycle, which resulted in a successful pregnancy. Initially the patient was admitted in spontaneous labor at term, although emergency caesarian section was performed due to suboptimal cardiotocograph. Patient delivered healthy 3.05 Kg male with Epgar score 9/10.
Bouwsma et al. (2011) reported a case of a 37-year-old woman with several symptomatic leiomyomas, with the two largest intramural fibroids measuring 4.8 x 4.4 x 5.1 cm3 and 3.5 x 3.2 x 3 cm3. The patient had a history of 18 months of home-inseminations from a known donor, resulting in one miscarriage at 6 weeks. Two months after ExAblate treatment, the patient underwent intrauterine insemination, resulting in pregnancy. Patient delivered a 3.45 Kg female at full-term via vaginal delivery.
Millan Cantero et al. (2011) reported on the first 3 cases of term pregnancy in Spain. Case one was a 39 year old woman, nulligravida. She was treated for 16 cc intramural fibroids and an 8 cc subserosal fibroids. She became pregnant 4 months after ExAblate treatment and delivered a 3.8 Kg baby at 41 weeks. Two and a half years after ExAblate she again became pregnant and delivered a 3.4Kg baby at 39 weeks. Case two was a 36 year old with secondary infertility who had undergone two previous pregnancies: one ending in a spontaneous abortion and the other in vaginal delivery. After ExAblate treatment she gave birth to a 2.7 Kg boy in an urgent C-section at 38 weeks. Case three was a 36 year old, nulligravida with a 270 cc intramural fibroid. Five months after ExAblate treatment she spontaneously conceived resulting in a full-term vaginal delivery of a 2.7 Kg girl.