In a retrospective, single centre study, the vast majority of patients who underwent uterine artery embolization (UAE) were able to have a successful pregnancy after the procedure. This led Muthusubramanian Rajasekaran (Department of Interventional Radiology, HCG Cancer Centre, Bangalore, India) to conclude that UAE has “satisfactory and acceptable outcomes” concerning fertility and pregnancy amongst patients of reproductive age, as he informed the audience at GEST 2019 (Global Embolization Cancer Symposium Technologies; 9–12 May, New York, USA). pregnant
As a commonly performed interventional radiology procedure, UAE is used to treat a variety of pathologies, including leiomyomas (fibroids), arteriovenous malformations (AVMs) and post-partum haemorrhages. “However”, Rajasekaran told the GEST audience, “the beneficial effects of UAE over the surgical treatment are still up for debate in patients of reproductive age, as the adverse effects of the procedure on fertility and pregnancy are not known”. As such, Rajasekaran and colleagues felt further investigation into the effects of UAE on pregnancy and fertility was warranted.
They conducted a retrospective analysis of their hospital records between January 2012 and January 2018, where they found that 42 patients had undergone UAE for various uterine pathologies. Of these, nine were excluded for being over the age of 35, three were excluded as they did not wish to get pregnant in the future, and two were lost to follow-up. This left 28 patients, with an age range of 22 to 35 years, for the analysis. Fourteen per cent underwent UAE to treat AVMs, 43% had post-partum haemorrhage, and the remaining 43% had fibroids.
Twenty-four (86%) of these 28 patients had at least one successful pregnancy after UAE, and 21% of the patients (six of the 28) had two successful pregnancies following the procedure. The majority of these women—62%, or fifteen of the 28—had normal vaginal delivery, and 38% (nine of the 28) had a caesarean section.
The average time interval for the first pregnancy after UAE was 15 months; the shortest time to pregnancy was six months, and the longest gap between pregnancy and procedure was 30 months. No procedure-related complications were observed in any of these patients.
Of the four (14%) patients who did not get pregnant following UAE, one (4%) did not get pregnant at all, and three (11%) had miscarriages. When asked about whether there were any unifying characteristics of these three patients by moderator Robert Mitchell Ermentrout (Department of Radiology, Emory University School of Medicine, Atlanta, USA) at GEST, Rajasekaran said that when they were evaluating the patients during follow-up, they found nothing that specifically explained why these women in particular were having difficulty with pregnancy.
“The more data we have, the more likely that this will become more standard practice”
An American audience member asked Rajasekaran what the referral rate and process was like in India, and if it is standard practice for gynaecologists to transfer patients across to the interventional radiology department. “We are still finding it hard to convince gynaecologists to refer patients to us”, Rajasekaran said. “The practice in India is for these patients to first go to the gynaecologist, and then it is their role to refer back to us.”
The questioner said that this is similar to the case across most of the USA we well. He elaborated: “There are many patients who hear about UAE from advertisements, and that is actually how we built up a lot of our practice. A lot of gynaecologists have started referring many patients to us, and normally it is because the patient already knows about the procedure and asks about it in their consultation, from what I understand. But there is still a recommendation to have them evaluated for myomectomy if they do desire future fertility, at least in the USA. But I think anecdotally, at least in our experience—so this is unpublished—fertility is certainly a possibility for patients who have had this procedure [UAE], and I think the more data we have, the more likely that this will become more standard practice across the world.” Rajasekaran agreed.