JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):201
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263884

P-189. Radiofrequency ablation in the treatment of uterine leyomioma in a patient with recurrent implantation failure: a case report

Simone Mattiello¹, Felipe Bassols¹, Laura Mattiello Ribeiro¹, Nilo Frantz¹, Marcos Iuri Roos Kulmann¹

¹ Nilo Frantz Medicina Reprodutiva - Porto Alegre - Rio Grande do Sul - Brasil

Objective: The relationship between uterine fibroids (leiomyoma) and infertility is primarily influenced by the location and size of the fibroids. Intracavitary fibroids (submucosal) or those causing uterine distortion are particularly impactful on implantation potential and reproductive outcomes. Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative for treating uterine fibroids, consisting of an electrode delivering radiofrequency energy to heat and result in coagulative necrosis of the tissue. This case report describes the use of RFA to treat uterine leiomyoma in a patient with recurrent implantation failure.
Methods: A retrospective review of patient medical records, including imaging studies, was conducted to assess the clinical course and outcomes.
Results: A 34-year-old female patient (A. R. G) presented with primary infertility for 3 years. She exhibited diminished ovarian reserve, with anti-Müllerian hormone (AMH) levels of 0.3 ng/ml, irregular menstrual cycles, and an intramural fibroid located on the posterior uterine wall (3.5 cm). The fibroid reached near the endometrium but did not distort the cavity (FIGO classification 3). Her 31-year-old partner (L. H.K) had severe oligospermia, presenting rare motile sperm in the ejaculate and a normal karyotype. The couple underwent three cycles of in vitro fertilization (IVF) using their own gametes, but no embryos were obtained. As a result, egg donation was recommended, yielding three euploid blastocysts (3AA, 3BB, 3BB). The first single embryo transfer (SET), with an endometrial thickness of 9 mm and a trilinear pattern, resulted in a biochemical pregnancy. The second SET, with a similar optimal endometrial response, resulted in a negative b-hCG test. A potential association between the fibroid and implantation failure was discussed. The patient declined surgical treatment and was offered radiofrequency ablation (RFA) before a new attempt. RFA was performed in August 2023, utilizing a transvaginal technique. An ultrasound-guided electrode was inserted into the fibroid, and controlled energy was delivered to induce coagulative necrosis and reduce fibroid volume. Ultrasound evaluation at 60 days post-RFA revealed a 60% reduction in the fibroid size, which was subsequently not visualized during hysteroscopy. The third SET, performed nine months after the RFA, resulted in a clinical pregnancy that progressed without complications. During the first pregnancy ultrasound, the fibroid demonstrated approximately a 90% reduction in size compared to pre-RFA measurements. The patient delivered a healthy baby weighing 3,360 grams via cesarean section on January 11, 2025, at 38 weeks and 1 day of gestation.
Conclusion: Radiofrequency ablation of uterine leiomyoma might be an effective treatment option for patients with recurrent implantation failures associated with fibroids, particularly in cases where surgical intervention is not feasible or preferred. This minimally invasive procedure led to a significant reduction in fibroid size, improving the patient reproductive outcomes and resulting in a successful pregnancy and the birth of a healthy infant. This case highlights the potential of RFA in the management of infertility related to leiomyoma, offering a promising alternative to more invasive surgical options.