Clinical investigation of fertility after uterine artery embolization

Olivier Serres-Cousine, Serres-Cousine O, O Serres-Cousiné, Fiene Marie Kuijper, Emmanuel Curis, Curis E, Atashroo D, Diana Atashroo
American journal of obstetrics and gynecology · 2021 · vol. 225(4) , pp. 403.e1–403.e22 · doi:10.1016/j.ajog.2021.05.033 · PMID:34058169 · W3165751096
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This study investigated fertility outcomes in women following uterine artery embolization, reporting the observed pregnancy rates and delivery methods.

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Abstract

BackgroundUterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate.ObjectiveThis study aimed to study the clinical, anatomic, and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy.Study designThis was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic resonance imaging and pelvic ultrasounds were performed before and after uterine artery embolization.ResultsThe overall clinical success rate (ie, resolution of preembolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2%, and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. A total of 108 patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births; 74 children were born at term; 23 were born preterm, on average at 35.12±2.78 weeks. Including preterm births, the mean birthweight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage.ConclusionThis study provided detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomic and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and reevaluate this procedure's indications and limitations for women with a desire to procreate.

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Condition tags

chronic_pelvic_pain

MeSH descriptors

Abortion, Spontaneous Leiomyoma Ovary Pregnancy Rate Premature Birth Uterine Artery Embolization Uterine Neoplasms Abortion, Spontaneous Adult Anemia, Iron-Deficiency Anemia, Iron-Deficiency Female Humans Leiomyoma Leiomyoma Magnetic Resonance Imaging Menorrhagia Menorrhagia Ovary Pelvic Pain

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