MR-HIFU: a choice to make for women suffering from uterine fibroids?
Authors:   , Anneveldt Kimberley Jessica 
Published: October 2023

Although the MR-HIFU treatment of uterine fibroids have been available for over 20
years, still most women worldwide, including the Netherlands, have no access to this noninvasive treatment option. In this thesis some of the remaining hurdles were addressed.

PART 1: EFFECTIVITY OF GYNECOLOGICAL AND
REPRODUCTIVE OUTCOMES
In chapter 2 we evaluated the results of uterine fibroid MR-HIFU that were available at
this point. Our work differed from previous work since we only included studies without a
restricted treatment protocol. This means that the studies aimed for a complete treatment
and we showed that this resulted in more decrease of uterine fibroid related symptoms
and less re-interventions. Long-term data is however still missing.

In chapter 3 we commented on previous work on reproductive outcomes after different
uterine fibroid treatments. Since factors like maternal age can influence pregnancy changes alongside the presence of a uterine fibroid or treatment effect, one should be careful whenpublishing data without taking this in consideration.

In chapter 4 previous studies were analyzed as well, however this time solely focusing on
reproductive outcomes. An important advantage of (MR-) HIFU treatment is the fact that
a pregnancy afterwards is possible. We showed complications did not occur more often
in women treated by (MR-) HIFU. Whether (MR-) HIFU results in more pregnancies for
women suffering with uterine fibroids, is however still unknown due to the limited number of
pregnancies reported.

PART 2: MEASURES TO IMPROVE EFFECTIVITY
In chapter 5 the contribution of a uterus stimulant to treatment efficiency was evaluated.
When a uterus stimulant is administered, contractions of the uterus result in less blood
flow in the tissue that needs to be treated. The aimed temperature can be reached more
quickly, resulting in more efficient treatments. In our article we were able to prove this
effect on a treatment cell level instead of a patient level.

In chapter 6 we reflected on the implementation of uterine fibroid MR-HIFU in our own
non-academic hospital. We evaluated all the hurdles we needed to overcome on different
levels and gave insight on the learning-curve of 25 treatments one should consider when
performing uterine fibroid MR-HIFU due to the technical difficulties of the treatment.

PART 3: SOCIETAL IMPACT
In chapter 7 we are aiming to overcome the most important hurdle for clinical
implementation: the lack of reimbursement. Due to the lack of randomized-controlled
trials on long-term effectiveness of uterine fibroid MR-HIFU, no reimbursement is reached
in the Netherlands. By performing the MYCHOICE study, of which the study protocol can
be found in chapter 7, we aim for clinical implementation and reimbursement.

In chapter 8 we took another look at the future and took the first step in performing a
Life Cycle Assessment of a MR-HIFU treatment to get insights in the sustainability of this
treatment. At this point, unfortunately not all necessary data is available to perform a full Life
Cycle Assessment. We did however inventoried what would be necessary and focused on
the importance to perform such analyses.