Effects of MR-Guided and Ultrasound-Guided Focused Ultrasound Treatment for Adenomyosis on Ovarian Reserve Assessed by Anti-Müllerian Hormone Levels: A Narrative Review

Aim: This narrative review evaluates the current evidence on the impact of high-intensity focused ultrasound (HIFU), including MR-guided (MRgFUS) and ultrasound-guided (USgHIFU) techniques, on ovarian reserve in women treated for adenomyosis, with particular emphasis on anti-Müllerian hormone (AMH) level. Methods: narrative review included evidence from prospective and retrospective studies, randomized trials, and original research in patients with adenomyosis, identified through searches of PubMed/MEDLINE, Embase, Web of Science, and Google Scholar. Results: available studies consistently demonstrate that this treatment does not result in significant changes in AMH concentrations, irrespective of the method used, suggesting preservation of ovarian reserve. Conclusion: In contrast to more invasive treatment options, such as uterine artery embolization or hysterectomy, HIFU acts locally, minimizing the risk of damage to ovarian tissue and vascular supply. This enables the preservation of fertility, which is particularly important for women desiring future childbearing. However, the available evidence is limited by small sample sizes, heterogeneous study populations, and short follow-up periods. Further large-scale, prospective studies with long-term follow-up are needed to confirm the sustained safety of HIFU and its impact on reproductive outcomes.