Indications for and Techniques of Microwave Ablation of Uterine Fibroids in Patients Seeking to Conceive

doi:10.26599/AUDT.2026.250035

Abstract

Abstract:

Objective

To investigate the indications and techniques of microwave ablation for uterine fibroids in fertility-seeking patients, and to evaluate its safety and pregnancy outcomes.

Methods

This prospective study analyzed 1,600 patients who underwent percutaneous microwave ablation, stratified by fertility desire. For the fertility-seeking group, protective interventions including intrauterine and pelvic saline isolation, as well as vaginal fornix support, were implemented. Patients were followed up to assess pregnancy rates, ovarian reserve (AMH), and obstetric outcomes.

Results

Menstrual patterns, sex hormone levels, and AMH values showed no significant changes post-ablation. Among 104 patients intending to conceive, 78 achieved successful pregnancy (75.0%), resulting in 52 healthy live births. Higher pregnancy success rates were observed in patients with FIGO type 0-IV fibroids and those ≤ 8 cm in diameter. Standardized protective measures effectively prevented thermal injury to the endometrium, serosa, and vaginal mucosa. Patients are advised to use contraception for 3-6 months post-procedure and attempt conception once the fibroid shrinks to ≤ 4 cm and uterine cavity morphology improves.

Conclusion

For fertility-seeking patients, FIGO types 0-6 uterine fibroids measuring ≤ 8 cm in diameter represent favorable indications. Adjunctive techniques during ablation, notably intrauterine catheter-mediated hydrodissection and artificial ascites, effectively preserve the structural integrity of the endometrium, uterine serosa, and ovaries.

Key words: Microwave ablation; Uterine fibroids; Fertility; Indications; Pregnancy

Zhang Jing, Zhang Bingsong, Wang Jing, Lin Xiaoliang, Dong Xuejuan, Ou Xianchun, Qi Xiaoguang, Wu Xinyao. Indications for and Techniques of Microwave Ablation of Uterine Fibroids in Patients Seeking to Conceive. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(4): 259-263.

/ Recommend

Figures/Tables 5

Figure 1

Figure 2

Table 1

Table 2

Figure 3

References 15

[1]	Munro MG, Critchley HO, Fraser IS. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011; 95: 2204-8,8.e1-3. doi: 10.1016/j.fertnstert.2011.03.079
[2]	ACOG Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas: Correction. Obstet Gynecol 2021; 138: 683
[3]	Zhang J, Feng L, Zhang B, Ren J, Li Z, Hu D, et al. Ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroid treatment-a clinical study. Int J Hyperthermia 2011; 27: 510-516.
[4]	Liu H, Zhang J, Han ZY, Zhang BS, Zhang W, Qi CS, et al. Effectiveness of ultrasound-guided percutaneous microwave ablation for symptomatic uterine fibroids: a multicentre study in China. Int J Hyperthermia 2016; 32: 876-880. doi: 10.1080/02656736.2016.1212276
[5]	Ahmadzade M, Rouientan H, Golzarian J, Akhlaghpoor S. An Evaluation of Ultrasound-Guided Percutaneous Microwave Ablation for the Treatment of Symptomatic Uterine Fibroids. J Vasc Interv Radiol 2024; 35: 45-50. doi: 10.1016/j.jvir.2023.09.017
[6]	Yang Y, Zhang J, Han ZY, Yu MA, Ma X, Zhou HY, et al. Ultrasound-guided percutaneous microwave ablation for submucosal uterine fibroids. J Minim Invasive Gynecol 2014; 21: 436-441. doi: 10.1016/j.jmig.2013.11.012
[7]	Lei F, Jing Z, Bo W, Dongmei H, Zhencai L, Xue J, et al. Uterine myomas treated with microwave ablation: the agreement between ablation volumes obtained from contrast-enhanced sonography and enhanced MRI. Int J Hyperthermia 2014; 30: 11-8. doi: 10.3109/02656736.2013.853107
[8]	Li QY, Li XL, Deng EY, Yu SY, Sun LP, Zhang HL, et al. Ultrasound-guided percutaneous microwave ablation for uterine fibroids: mid-term local treatment efficiency and associated influencing factors. Br J Radiol 2022; 95: 20220039. doi: 10.1259/bjr.20220039
[9]	Ierardi AM, Petrillo M, Fumarola EM, Coppola A, Angileri SA, Garanzini E, et al. Percutaneous microwave ablation of uterine fibroids: correlation between shrinkage and trend symptoms. Minim Invasive Ther Allied Technol 2021; 30: 33-39. doi: 10.1080/13645706.2019.1668417
[10]	Jonsdottir G, Beermann M, Lanz E, Nikodell A, Cronsioe A, Hasselrot K, et al. Ultrasound guided microwave ablation treatment of uterine fibroids: Clinical response and patient acceptability. Acta Obstet Gynecol Scand 2025; 104: 350-356. doi: 10.1111/aogs.15041
[11]	Xia J, Teng D, Sui G, Luo Q, Lin Y, Wang H. Effectiveness and safety of ultrasound-guided percutaneous microwave ablation for a single uterine fibroid greater than 300 cm(3). J Minim Invasive Gynecol 2023; 30: 290-299. doi: 10.1016/j.jmig.2022.12.013
[12]	Bing-song Z, Jing Z, Zhi-Yu H, Chang-tao X, Rui-fang X, Xiu-mei L, et al. Unplanned pregnancy after ultrasound-guided percutaneous microwave ablation of uterine fibroids: A follow-up study. Sci Rep 2016; 6: 18924. doi: 10.1038/srep18924
[13]	Zia G, Sebek J, Alvarez E, Prakash P. Assessment of thermal damage to myometrium during microwave ablation of uterine fibroids. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020: 5263-5266.
[14]	Xu RF, Zhang J, Han ZY, Zhang BS, Liu H, Li XM, et al. Variables associated with vaginal discharge after ultrasound-guided percutaneous microwave ablation for adenomyosis. Int J Hyperthermia 2016; 32: 504-510. doi: 10.3109/02656736.2016.1150523
[15]	Yang Y, Zhang J, Han ZY, Ma X, Hao YL, Xu CT, et al. Ultrasound-guided percutaneous microwave ablation for adenomyosis: efficacy of treatment and effect on ovarian function. Sci Rep 2015; 5: 10034. doi: 10.1038/srep10034

Grouping	N	Age (Y)	Mean diameter of fibroids cm×⁻±SD	Uterine Amenorrhea	Vaginal Mucosal Burns	Irregular periods after ablation
A group	220	34.6 ± 10.5	5.54 ± 1.89	0	0	0
B group	1380	35.7 ± 10.0	7.54 ± 1.78	4	1	4
P value		P ≥ 0.05	P ≥ 0.05	P ≥ 0.05	P ≥ 0.05	P ≥ 0.05

Classification of Fibroids	Mean diameter of fibroidscm	Number of Successful Pregnancies N	Induced Abortion N	Spontaneous Abortions N	Deliveries N
Submucosal	4.6 2.7-7.3	7	2	2	3
Intramural	5.7 (4.3-12)	63	11	11	36
Subserosal	6.0 (3-12)	10	1	1	15
Single		54	13	11	36
Multiple		26	1	3	18
Total number of cases		80	14	14	54