A study by Bruce McLucas, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA, and published ahead-of-print in Minimally Invasive Therapy has said that women who desire future fertility could be considered for uterine artery embolization. He reported the outcomes of his patient cohort who became pregnant after the procedure.
McLucas said that premature menopause, hysterectomy and radiation exposures have been identified as barriers to fertility when treating women with uterine artery embolization. However, he added that uterine fibroids themselves are not thought to cause infertility but could be a causative factor of pregnancy loss.
The author advised the participants of the study to wait six months or more after uterine artery embolization before attempting to conceive of which the reported time range before attempting to conceive was 13 months to 108 months (average time of 41 months).
In a retrospective chart review of patients under the age of 40 (44 patients) who wished to spare their fertility that underwent uterine artery embolization from 1996 to 2010, 22 patients reported 28 pregnancies of which three were miscarriages. Three more pregnancies were complicated by premature labour.
McLucas reported that 22 of the 28 pregnancies were normal full-term pregnancies, 16 women had become pregnant once, four had become pregnant twice, and one woman had become pregnant three times. The remaining patients did not conceive.
In the study there was no reported intrauterine growth retardation in the prenatal period, foetal distress during labour, and no problems related to uterine integrity. Two patients reported problems during pregnancy which were borderline oligohydramnios and low lying placenta.
As a fertility-sparing procedure, the authors noted that in their cohort of women who did conceive, overall, 21 out of 24 births proceeded normally without any complications (86.3%).
“Our group of 28 pregnancies is small, but does confirm successful pregnancy after uterine artery embolization,” said McLucas. “Our 47.7% pregnancy rate in women less than 40 years old who achieved a term pregnancy compares favourably with women who underwent myomectomy via a number of techniques.”
According to the author, in his cohort, of the women who did conceive, subsequent birth proceeded normally (86.3%). McLucas compared this to abdominal myomectomy where the term pregnancy rate was in the range of 10–46%, laproscopic myomectomy (16 to 33%), and hysteroscopic mymomectomy (8–35%), which means the implications for uterine artery embolization as a primary treatment for uterine fibroids as a fertility sparing technique is favourable.
“Our preliminary data suggest that fertility is further enhanced in women who underwent uterine fibroid embolization as a first procedure to control myomata,” he added.