Damage to the uterus is a major concern for women with fibroids who still wish to retain fertility. Many women are seeking out, or are being referred for, uterine fibroid (or artery) embolization (UFE or UAE), but they are not getting all of the facts about both the limitations of the procedure or its long-term effects on fertility.
Countless studies have reviewed the after-effects of embolization treatments for fibroids, and the majority of au-thorities on women’s reproductive health still caution that embolization is not recommended for women who intend to get pregnant. Laparoscopic myomectomy is the procedure of choice for women with fibroids who want to con-ceive. It is common for women who have had embolization procedures to have either faced difficulty getting preg-nant or to have had miscarriages.
It is important to research all treatment options to ensure future fertility, if desired, is protected. Despite more than 20 years in use, embolization treatments for fibroids are still a higher risk to women’s fertility.
Research on the impact of UAE or UFE on Fertility
Pregnancy after uterine artery embolization for fibroids
CONCLUSION: Desired future pregnancy remains a relative contra-indication to UAE for symptomatic fibroids. Obstetric risks after UAE for fibroids include prematurity, intrauterine growth restriction, abnormal placentation, and increased likelihood of cesarean delivery.
Sukhbir S. Singh, Can Fam Physician. 2007 Feb; 53(2): 293–295.
Fertility after uterine artery embolization of fibroids: a systematic review
CONCLUSION: Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base.
Karlsen K1, Hrobjartsson A2, Korsholm M3, Mogensen O4, Humaidan P5, Ravn P3. Arch Gynecol Obstet. 2018 Jan; 297(1):13-25. doi: 10.1007/s00404-017-4566-7. Epub 2017 Oct 20.
Uterine artery embolization: a review of current concepts
CONCLUSION: Reproductive outcomes following uterine artery embolization have been described in several studies, predominantly in retrospective reviews. As uterine artery embolization became more widely performed, outcomes were initially investigated in small case series or case reports. A review by Goldberg et al. examined 53 pregnancies after UAE and 139 pregnancies after laparoscopic myomectomy, concluding that UAE was associated with higher rates of preterm labor and malpresentation [29,30]. However, the UAE patients included in the analysis were, on average, older and had larger uterine leiomyomata than those in the myomectomy group, potentially confounding the results of the review. In 2010, Homer and Saridogan published a review of 277 completed pregnancies after UAE and compared reproductive outcomes to fibroid- containing pregnancies, finding that UAE resulted in a higher rate of miscarriage, delivery by cesarean section, and post-partum hemorrhage .
Keung JJ1, Spies JB2, Caridi TM2. Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:66-73. doi: 10.1016/j.bpobgyn.2017.09.003. Epub 2017 Sep 29.
Embolization of uterine fibroids from the point of view of the gynecologist: pros & cons
CONCLUSION: Past studies have reported a high rate of miscarriage (27%–42%) following UAE. In patients desiring pregnancy, it is strongly recommended to consider the impact of UAE on fertility as well as poorer reproductive outcomes of patients after UAE in all prospective or controlled trials published up-to-date. Only carefully selected and appropriately counselled patients in this age group should be considered for UAE.
Michal Mara and Kristyna Kubinova. Int J Womens Health. 2014; 6: 623–629.
Uterine artery embolization for severye symptomatic fibroids: effects on fertility & symptoms
CONCLUSION: Although UAE was effective in improving bleeding, bulking and pain symptoms, and in sparing the ovarian reserve, no woman in this study delivered successfully after UAE. In spite of 33.4 ± 14.5 months of attempts, only 1 in 31 women became pregnant and she finally miscarried (monthly fecundability rate 0.1% 95% CI 0-0.3%). The low reproductive outcomes reported in the present study suggest that UAE should not be performed routinely in young women of childbearing age with extensive fibroids.
Torre A1, Paillusson B, Fain V, Labauge P, Pelage JP, Fauconnier A. Hum Reprod. 2014 Mar;29(3):490-501
Pregnancy outcomes after uterine artery occlusion: prospective multicentric study
CONCLUSION: Pregnancies of women who were treated with uterine embolization were at significantly increased risk for spontaneous abortion when compared with pregnancies of women treated with LUAO.
Holub Z1, Mara M, Kuzel D, Jabor A, Maskova J, Eim J. Fertil Steril. 2008 Nov;90(5):1886-91. Epub 2007 Dec 26.
Uterine artery embolization for fibroids is associated with miscarriage
CONCLUSION: The risk of miscarriage seems to be increased after UAE. Miscarriage rates were higher in UAE pregnancies (35.2%) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 2.0-3.8). Pregnancies of women who were treated with uterine embolization were at significantly increased risk for spontaneous abortion when compared with pregnancies of women treated with LUAO.
Homer H1, Saridogan E. Fertil Steril. 2010 Jun;94(1):324-30.
Research on UAE or UFE & Large Fibroids
Uterine leiomyomas (fibroids): treatment with uterine artery embolization
CONCLUSION: Subserosal or submucosal fibroids that are pedunculated and have a narrow stalk (stalk <50 percent in diameter in comparison with the largest diameter fibroid) are considered a relative contraindication [for UFE] because these fibroids may detach either intraperitoneally or within the uterine cavity; submucosal fibroids that detach may be expelled vaginally . Detachment may be associated with sterile peritonitis or intrauterine infection.
Sanne M van der Kooij MD PhD, Wouter JK Hehenkamp MD PhD. UpToDate.