{"paper_id":"96831372-b35c-44a9-a446-cc36f2a9761c","body_text":"EDITORIAL EMBOLISATION (ARTERIAL)\nPregnancy and Uterine Artery Embolisation: Myth Busted\nWarren Clements 1,2,3 • Gerard S. Goh 1,2,3 • Matthew W. Lukies 1,2,4\nReceived: 26 November 2024 / Accepted: 12 December 2024 / Published online: 23 December 2024\n/C211Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe\n(CIRSE) 2024\nKeywords Fibroid /C1Embolization /C1Pregnancy /C1\nAdenomyosis\nUterine artery embolisation (UAE) is an effective option\nfor women with symptomatic fibroids and this has been\nshown with level 1 evidence for over 20 years [ 1]. How-\never, implementation of this treatment into mainstream\nmedicine has been an example of the incredibly difficult\npath that Interventional Radiology (IR) treatments must\ntake when they disrupt the surgical status quo [ 2].\nIn the early days, rightful caution was exercised\nregarding the use of UAE in women wishing to maintain\nfertility. It was vital that safety and efficacy were proven\nbefore issues such as ovarian reserve and placental\nimplantation could be assessed. However, this was often\nmisinterpreted as UAE being contra-indicated in women\ndesiring pregnancy, and embodies the anecdote of ‘ ‘ab-\nsence of evidence does not mean evidence of absence’ ’.\nThere can be a somewhat reticence to approach pregnancy\nat a local clinical level, reinforced by clinical guidelines\nwhich are not sufficiently dynamic to reflect newer\nevidence.\nThere are several problems with generating clinically-\nrelevant data in this space. Pregnancy as a study endpoint is\nextraordinarily hard to measure due to the multifactorial\ncontribution of several patient and non-patient factors\nwhich influence a successful live birth. In addition, women\nwith fibroids have a lower baseline rate of fertility. Existing\nstudies are under powered and yet it is near impossible to\nstudy this when there is a reluctance to refer women under\n40 to an IR. Looking at our own unpublished data, the\nmean age of 46.2 years in our cohort reinforces the notion\nthat referrals are being selected, despite a legal and ethical\nrequirement for UAE to form a part of an informed consent\nprocess for any uterine fibroid surgery.\nHowever, things have changed in recent years. In 2024,\n2 meta-analyses have been published, comparing preg-\nnancy outcomes for women undergoing myomectomy and\nUAE. The study of Peng et al. included 4 randomised trials,\nand showed no difference in the rates of live birth and\nmiscarriage between the treatments [ 3]. The study of\nTzanis et al. included 2 randomised trials and showed no\ndifference in pregnancy rates between the treatments [ 4].\nAs these are meta-analyses of randomised controlled trials,\nwe now have level 1 evidence that shows pregnancy after\nUAE is not just possible, but outcomes comparable to\nmyomectomy. Yet myomectomy for years has been touted\nas the treatment to preserve or even increase fertility in\nsome women. It will take years for this data to be reflected\nin guideline updates and maybe even longer for this to be\n& Warren Clements\nW.clements@alfred.org.au\nGerard S. Goh\nG.goh@alfred.org.au\nMatthew W. Lukies\nmwlukies@gmail.com\n1 Department of Radiology, Alfred Health, 55 Commercial\nRoad, Melbourne, VIC 3004, Australia\n2 Department of Surgery, Monash University School of\nTranslational Medicine, Melbourne 3004, Australia\n3 National Trauma Research Institute, Melbourne 3004,\nAustralia\n4 Department of Medical Imaging, Monash Health, Melbourne,\nAustralia\n123\nCardiovasc Intervent Radiol (2025) 48:583–584\nhttps://doi.org/10.1007/s00270-024-03949-w\n\n\nunderstood and acknowledged by non-IR stakeholders in\nthis clinical space.\nThere are both advantages and disadvantages to UAE,\nand when considering future pregnancy it is always\nimportant to consider the context of invasiveness, recovery,\ntime in hospital, and rate of complications of which dif-\nferent women value these uniquely. There are several\nstudies which show a higher rate of re-intervention after\nUAE than for surgery, even though quality of life scores\nmay be similar [ 5]. We have to also acknowledge the\nevolving unknowns such as the long-term impacts of per-\nmanent particles in the myometrium, similar to how our\nunderstanding of the risks of myometrial scarring after\nmyomectomy or after caesarean section are also evolving.\nThese issues highlight the importance of the mandated\nclinical outpatient IR consultation, including discussion\nabout obstetric history and desire for future pregnancy. The\ncontent of that discussion should be framed around current\nevidence, so that every patient is informed and able to\nmake her own decision based on the best available data.\nWhile patient selection for UAE and informed consent\nremain important topics, IRs must change their language to\nreflect currently available level 1 evidence which supports\npregnancy after UAE at a similar rate to background age-\nmatched population and to women post-myomectomy. All\nIRs have a mandate to end the concept that we only treat\nperi-menopausal patients. In 2024, the pregnancy myth is\nbusted.\nFunding This study was not supported by any funding.\nDeclarations\nConflict of interest The authors declare that they have no conflict of\ninterest.\nEthical Approval For this type of study ethical approval is not\nrequired.\nInformed Consent For this type of study formal consent is not\nrequired.\nConsent for Publication For this type of study, consent for publi-\ncation is not required.\nReferences\n1. Ghanaati H, Sanaati M, Shakiba M, Bakhshandeh H, Ghavami N,\nAro S, Jalali AH, Firouznia K. Pregnancy and its outcomes in\npatients after uterine fibroid embolization: a systematic review and\nmeta-analysis. Cardiovasc Intervent Radiol. 2020;43(8):1122–33.\n2. Reekers JA. The alternative for being an alternative. CVIR\nEndovasc. 2024;7(1):75.\n3. Peng J, Wang J, Shu Q, Luo Y, Wang S, Liu Z. Systematic review\nand meta-analysis of current evidence in uterine artery emboliza-\ntion vs myomectomy for symptomatic uterine fibroids. Sci Rep.\n2024;14(1):19252.\n4. Tzanis AA, Antoniou SA, Gkegkes ID, Iavazzo C. Uterine artery\nembolisation versus myomectomy for the management of women\nwith uterine leiomyomas: a systematic review and meta-analysis.\nAm J Obstet Gynecol. 2024;231:187–1951.\n5. de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij\nSM, Volkers NA, Hehenkamp WJ. Uterine artery embolization vs\nhysterectomy in the treatment of symptomatic uterine fibroids:\n10-year outcomes from the randomized EMMY trial. Am J Obstet\nGynecol. 2016;215(6):745-e1.\nPublisher’s Note Springer Nature remains neutral with regard to\njurisdictional claims in published maps and institutional affiliations.\n123\n584 W. Clements et al.: Pregnancy and Uterine Artery Embolisation...","source_license":"public-domain-us","license_restricted":false}