JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):202
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263883

P-190. Radiofrequency Ablation of a Large Uterine Fibroid: A Case Report of Spontaneous Pregnancy

Marta Ribeiro Hentschke¹, Andrey Boeno², Mariana Barth², Júlia Prauchner Castilhos³, Carolina Comissoli Fernandes³, Felipe Fagundes Bassols⁴

¹ Afetiv - Clínica de Reprodução Humana - Porto Alegre – RS - Brasil
² CLÍNICA NASCE - Porto Alegre – RS - Brasil
³ Pontificia Universidade Católica do Rio Grande do Sul - Porto Alegre – RS – Brasil
⁴ MIOMACARE - Porto Alegre – RS – Brasil

Objective: Radiofrequency ablation (RFA), also known as thermal ablation, is a minimally invasive technique for the treatment of uterine fibroids that preserves the uterus, an essential factor for women wishing to maintain fertility. We report a case of spontaneous pregnancy following RFA for a large uterine fibroid, highlighting the technique's potential in fertility preservation.
Methods: Case report.
Results: A 38-year-old woman presented with abnormal uterine bleeding and a history of endometriosis. She reported dysmenorrhea and was not using hormonal contraception. Transvaginal ultrasound revealed a large posterior wall fibroid measuring 9.0 cm (volume: 334.8cm³, FIGO type 2-5). As the patient declined conventional surgery, she was referred for RFA. The procedure, performed under general anesthesia, lasted approximately one hour and was uneventful; the patient was discharged asymptomatic after 3 hours. Ultrasound follow-up 45 days later already showed a reduction in fibroid volume. Approximately 4 months after the procedure, she underwent another ultrasound, which confirmed an intrauterine pregnancy compatible with 8 weeks of gestation. At that time, the posterior fibroid measured 10.7 cm. Prenatal care progressed uneventfully, with normal examinations. Delivery was via elective cesarean section at 39 weeks of gestation, with no complications. A male newborn, weighing 3,210 g and measuring 47.5 cm was born with Apgar scores of 9/10. Four months postpartum, the fibroid measured 3.9 cm (27.5cm³), representing ~90% volume reduction from baseline. The patient opted for an etonogestrel implant. Due to persistent abnormal uterine bleeding unresponsive to NSAIDs, norethisterone 10 mg/day was initiated. Seventeen months postpartum, ultrasound showed a posterior wall fibroid of 4.2 × 4.0 × 3.4 cm (30.4 cm³). The patient remains clinically stable on norethisterone and does not wish to undergo surgery.
Conclusion: RFA efficacy may vary depending on fibroid size, number, and location. In cases of very large fibroids, RFA may not be the most suitable option. This is the first reported case of RFA for fibroid treatment in the state of Rio Grande do Sul. The technique represents a promising, less invasive alternative for managing uterine fibroids while preserving uterine integrity, including in women wishing to maintain reproductive potential.