To investigate the indications and techniques of microwave ablation for uterine fibroids in fertility-seeking patients, and to evaluate its safety and pregnancy outcomes.

This prospective study analyzed 1,600 patients who underwent percutaneous microwave ablation, stratified by fertility desire. For the fertility-seeking group, protective interventions including intrauterine and pelvic saline isolation, as well as vaginal fornix support, were implemented. Patients were followed up to assess pregnancy rates, ovarian reserve (AMH), and obstetric outcomes.

Menstrual patterns, sex hormone levels, and AMH values showed no significant changes post-ablation. Among 104 patients intending to conceive, 78 achieved successful pregnancy (75.0%), resulting in 52 healthy live births. Higher pregnancy success rates were observed in patients with FIGO type 0-IV fibroids and those ≤ 8 cm in diameter. Standardized protective measures effectively prevented thermal injury to the endometrium, serosa, and vaginal mucosa. Patients are advised to use contraception for 3-6 months post-procedure and attempt conception once the fibroid shrinks to ≤ 4 cm and uterine cavity morphology improves.

For fertility-seeking patients, FIGO types 0-6 uterine fibroids measuring ≤ 8 cm in diameter represent favorable indications. Adjunctive techniques during ablation, notably intrauterine catheter-mediated hydrodissection and artificial ascites, effectively preserve the structural integrity of the endometrium, uterine serosa, and ovaries.