Fibroids are commonly treated through surgery, either by laparotomy or laparoscopy. However, in some cases, the location of the fibroid makes conventional surgery more challenging and risky.
This was the situation faced by a patient whose fibroid was located behind the uterus and had already adhered to the intestine. Due to its difficult-to-reach location, removing the fibroid through conventional surgery carried considerable risks. As a solution, the patient underwent High-Intensity Focused Ultrasound (HIFU) treatment at Mandaya Royal Hospital Puri with Dr. Edward Tony Ngantung, Sp.OG.
“Because of its position, the fibroid was actually difficult to remove through laparoscopy. It was located behind the uterus and had already adhered to the intestine. If approached from above, it could damage the uterine wall. If approached from behind, we didn’t know whether the intestine would be affected or not. At first, I felt hopeless and wondered whether it could be treated. Then I found out about HIFU. It truly helped me, and everything went smoothly by God’s grace,” said the patient.
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Fibroid Discovered After Recurrent Miscarriages
The patient shared that she had been married since 2018. Her first pregnancy occurred in 2023, but unfortunately ended in miscarriage because the embryo failed to develop.
In 2025, she became pregnant again. Initially, the pregnancy was confirmed, but the gestational sac could not yet be seen during the examination. Shortly after returning home, she experienced bleeding. When she returned to the doctor, she was informed that this could still occur in early pregnancy. A subsequent examination later revealed that the gestational sac had begun to form.
The patient was prescribed medication and advised to rest. However, the bleeding recurred the following day, and the pregnancy was ultimately lost.
After experiencing two miscarriages, the patient began searching for the underlying cause. Following recommendations from family members and discussions with her husband, she decided to consult Dr. Edward at Mandaya Royal Hospital Puri.
Examination Revealed a Fibroid That Was Difficult to Remove Surgically
During further examinations, Dr. Edward found that the patient’s uterus was enlarged and contained several fibroids. After a comprehensive evaluation, one of the fibroids was identified as being approximately 5 cm in size and located in the posterior (back) portion of the uterus.
According to Dr. Edward, other test results, including blood tests and the partner’s semen analysis, were normal. Therefore, the fibroid was strongly suspected to be the main factor contributing to the patient’s recurrent pregnancy losses.
“After conducting the examination, we found several masses, but the most significant was a 5 cm fibroid located on the posterior side of the uterus. Blood tests and semen analysis were all normal. Therefore, we suspected that the previous pregnancy failures could have been caused by the fibroid,” explained Dr. Edward.
The greatest challenge in this case was the fibroid’s location behind the uterus and its attachment to the intestine. This made surgical removal significantly more difficult and risky. For this reason, Dr. Edward recommended HIFU as a non-surgical treatment alternative.
Why Can Fibroids Cause Infertility or Fertility Problems?
In addition to causing symptoms such as pelvic pain and heavy menstrual bleeding, fibroids can also affect fertility and pregnancy. Some of the potential effects include:
- Blocking the fallopian tubes, making fertilization more difficult.
- Interfering with embryo implantation in the uterine lining.
- Reducing the available space for fetal growth.
- Increasing the risk of placental complications during pregnancy.
- Limiting the oxygen and nutrient supply needed by the fetus.
- Raising the risk of miscarriage and preterm birth.
Understanding HIFU: A Non-Surgical Fibroid Treatment Technology
HIFU (High-Intensity Focused Ultrasound) is a non-invasive treatment technology that uses high-intensity ultrasound waves to precisely destroy fibroid tissue without the need for surgical incisions.
How HIFU Works
The following steps explain how HIFU treats fibroids:
- Ultrasound waves are focused directly on the fibroid tissue.
- The generated heat gradually destroys fibroid cells.
- Healthy surrounding tissues remain protected.
- The procedure is performed without incisions and without removing the uterus.
Advantages of HIFU
Some of the benefits of HIFU include:
- No need for open surgery.
- No surgical scars.
- Lower risk of bleeding.
- Faster recovery compared to surgery.
- Suitable for fibroids located in areas that are difficult to access surgically.
- Helps preserve the uterus for women who still plan to conceive.
In this patient’s case, HIFU was selected because it could effectively treat a fibroid located in a complex area without exposing the patient to the risks of major surgery. Remarkably, just one day after the procedure, the patient was able to get out of bed, walk normally, and was discharged from the hospital.
Over the coming months, the patient will undergo periodic evaluations to monitor the fibroid’s condition. According to Dr. Edward, she may also be able to begin trying to conceive again approximately three to six months after undergoing HIFU treatment.
Dr. Edward Tony Ngantung, Sp.OG: Profile and Practice Schedule at Mandaya Royal Hospital Puri
Dr. Edward Tony Ngantung, Sp.OG, is an obstetrician and gynecologist who manages a wide range of women’s reproductive health concerns, from preconception care to the treatment of gynecological disorders. He earned his medical degree from Sam Ratulangi University before completing his specialist training in Obstetrics and Gynecology at San Juan de Dios Educational Foundation. To fulfill Indonesian medical practice requirements, he also completed an Obstetrics and Gynecology adaptation program at Udayana University.
In his clinical practice, Dr. Edward has experience in fertility programs, prenatal examinations, fetal imaging, contraceptive counseling, pregnancy complication management, benign gynecological conditions, and minimally invasive procedures tailored to each patient’s needs.
Dr. Edward Tony Ngantung, Sp.OG practices at Mandaya Royal Hospital Puri on the following schedule:
- Monday: 2:00 PM – 4:30 PM
- Tuesday: 11:00 AM – 2:00 PM
- Wednesday: 5:00 PM – 8:00 PM
- Thursday: 5:00 PM – 8:00 PM
- Friday: 10:00 AM – 2:00 PM
- Saturday: 9:00 AM – 1:00 PM
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The information provided on this page is intended for educational and general informational purposes only and may not reflect the full range of medical services offered by each physician. To receive care tailored to your specific condition, please consult directly with the relevant doctor.
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