Individualized strategies and future perspectives of high-intensity focused ultrasound combined with pharmacological treatment for adenomyosis-associated infertility: A narrative review

BACKGROUND: Adenomyosis is a common gynecological condition associated with chronic pelvic pain, menorrhagia, and infertility. High-intensity focused ultrasound (HIFU) has gained attention as a noninvasive treatment modality. However, monotherapy with HIFU or pharmacological agents alone may be inadequate for improving fertility outcomes. OBJECTIVE: This narrative review examines current evidence on individualized strategies combining HIFU with pharmacological therapies for the management of adenomyosis-associated infertility. METHODS: A literature search was conducted using PubMed, Embase, and Web of Science for studies published from 2000 to 2025. Included were clinical trials, observational studies, and expert consensus on HIFU, GnRH analogues,and hormonal therapy related to adenomyosis and infertility. RESULTS: Combining HIFU with medical therapy may enhance lesion ablation, reduce inflammation, and improve uterine receptivity. Individualized regimens based on lesion type, symptom severity, reproductive goals, and comorbidities offer the potential to optimize both symptom control and fertility outcomes. Evidence suggests that HIFU combined with GnRH agonists or LNG-IUS achieves superior outcomes in pain relief, lesion shrinkage, and recurrence prevention compared to monotherapy. However, variability in study design and limited long-term reproductive data remain key limitations. CONCLUSION: HIFU combined with pharmacological therapy represents a promising, fertility-sparing strategy for women with adenomyosis-associated infertility. Further high-quality prospective studies are essential to establish standardized protocols and confirm reproductive benefits.