P-301 Real life experience with myolysis by radiofrequency in infertile patients with type 2 and 3 fibroids
Authors: Cerrillo M , Martínez-Salazar J , Fernandez C , Vazquez A , Royo P , Muñoz E , Gomez V  H , Requena A , Garcia-Velasco J 
Published: July 2024

Abstract

Study question
Can transvaginal radiofrequency myolysis (TVRF) be a safe alternative to reduce the fibroid volume without interfering with subsequent RA treatment?

Summary answer
RFTV myolysis is a safe and effective alternative for the treatment of type 2-3 uterine fibroids &lt; 4cm that compromise the endometrial cavity.

What is known already
The most common benign tumors among women who are in their reproductive years are uterine fibroids. Although most of them are not symptomatic, when they compromise the endometrial cavity, they can lead to reproductive problems. Type 2 and 3 fibroids that are smaller than 4 cm in diameter can cause compromise to the endometrial cavity and are difficult to remove through laparoscopy/hysteroscopy.

Study design, size, duration
The fibroid volume and % of reduction after 3 months were primary variables. All fibroids were examined with 2D/3D transvaginal ultrasonography to record nº of myomas, volume (the volume of an ellipsoid in cm3 = 4/3 (distance1xdistance2xdistance3), type of fibroid according to the FIGO. The secondary variables were mean procedure time, complications, and reproductive outcome after ART (pregnancy rate (PG), miscarriage Rate (MR), Live born rate (LBR) and obstetrics complications, and type of delivery way.

Participants/materials, setting, methods
We evaluated thirty-four patients between 2019-2023 with type 2-3 fibroids under 4 cm evaluated by 2D/3D ultrasound, confirming that they compromised the uterine cavity and with a complex surgical approach. Myolysis was carried out by TVRF

Main results and the role of chance
The average age of our patients was 42 years (range 37-50). In our patients, 52% had fibroids of type 3, and 48% had fibroids of type 2. According to FIGO classification. The average TVRF time for the patients was 4.17 minutes. The average volume was initially 21 cm3, but it decreased to 10 cm3 after one month, and finally dropped to 4.6 cm3 after three months. The volume reduction was &gt;75% when evaluated three months after the TVRF. No complications were reported during the procedure except for mild pain that was controlled with oral analgesia in 21% of patients, and minimal bleeding. In eight patients, the fibroid was extruded towards the endometrial cavity and removed by hysteroscopy.
Twenty four out of 34 patients (71%) underwent ART, at least 4 months after TVRF. The reproductive outcome was comparable to what was expected, with a 63% pregnancy rate, 17% miscarriage rate, and 50% ongoing pregnancy rate. Live birth rate was 46%, with 83% reaching term pregnancy, and 16% premature births at 36 and 34 weeks. The rate of cesarean section was 66%. Among the obstetric complications, only one case or IUGR was described

Limitations, reasons for caution
The main limitation of these data is retrospective analysis of the date and the small sample size, as this is the earliest date on the impact of TVRF on infertile patients.

Wider implications of the findings
TVRF myolysis is a safe and effective alternative for the infertile women with type 2-3 uterine fibroids &lt; 4 cm that compromise the endometrial cavity that have a complex surgical approach by hysteroscopy/laparoscopy. It appears that TVRF has no impact on reproductive outcomes.

Trial registration number
not applicable