Ultrasound-guided radiofrequency ablation of an intramural fibroid in a woman desiring fertility with coexisting focal adenomyosis: a case report

OBJECTIVE: To report the reproductive outcome after ultrasound-guided radiofrequency ablation (RFA) in a woman with an intramural uterine fibroid and coexisting focal adenomyosis who experienced infertility and desired pregnancy. DESIGN: Case report. PATIENT: A 40-year-old nulligravid woman with heavy menstrual bleeding, dysmenorrhea, and a history of infertility, defined by failure to conceive after more than 12 months of unprotected intercourse. Transvaginal ultrasound demonstrated a FIGO type 3 intramural fibroid distorting the endometrial cavity and associated focal anterior adenomyosis. INTERVENTION: Ultrasound-guided transvaginal RFA of the intramural fibroid. MAIN OUTCOME MEASURES: Changes in fibroid volume and uterine cavity morphology on ultrasound, improvement of clinical symptoms, and reproductive outcome. RESULTS: The procedure was completed without complications. Follow-up ultrasound showed progressive fibroid volume reduction of 76.9% at 6 months, migration of the lesion away from the endometrial cavity, restoration of normal cavity anatomy, and improvement of sonographic features of focal adenomyosis. Menstrual symptoms improved significantly. Spontaneous conception subsequently occurred, resulting in an uncomplicated term vaginal delivery. CONCLUSION: This case suggests that ultrasound-guided RFA may represent a minimally invasive, uterus-sparing option for selected women with intramural fibroids and coexisting focal adenomyosis associated with infertility.