Research the Risks of UFE and UAE
Damage to the uterus is a major concern for women with fibroids who 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.
Research on the Impact of UAE or UFE on Fertility
Uterine artery embolization (UAE) is a surgical process in which a catheter is used to deliver small particles that stop the supply of blood to the uterine body. Countless studies have reviewed the aftereffects of embolization treatments for fibroids, and the majority of authorities 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 conceive. It is common for women who have had embolization procedures to have either faced difficulty getting pregnant or to have had miscarriages.
It is important to research all treatment options to ensure that future fertility, if desired, is protected. Despite being used for more than 20 years, embolization treatments for fibroids still pose a higher risk to women’s fertility.
UFE/UAE is not Recommended for Women Who Want to Maintain Fertility
Read the studies below to learn more
Pregnancy after Uterine Artery Embolization for Fibroids
CONCLUSION: Desired future pregnancy remains a relative contraindication to UAE for symptomatic fibroids. Obstetric risks after UAE for fibroids include prematurity, intrauterine growth restriction, abnormal placentation, and increased likelihood of cesarean delivery.
Singh S. 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 K, Hrobjartsson A, Korsholm M, Mogensen O, Humaidan P, Ravn P. Arch Gynecol Obstet. 2018 Jan;297(1):13-25.
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 malpresentation29,30. 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 postpartum hemorrhage31.
Keung JJ, Spies JB, Caridi TM. Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:66-73.
Embolization of Uterine Fibroids from the Point of View of the Gynecologist: Pros and Cons
CONCLUSION: Past studies have reported a high rate of miscarriage (27 percent to 42 percent) following UAE. Women who wish to become pregnant should consider the impact of UAE on fertility and reproductive outcomes. Only patients that have been fully counselled and informed should be considered for this procedure.
Mara M, Kubinova K. Int J Womens Health. 2014;6 623-629.
Uterine Artery Embolization for Severye Symptomatic Fibroids: Effects on Fertility and 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 perfect 95 percent CI 0-0.3 percent). 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 A, 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 Z, Mara M, Kuzel D, Jabor A, Maskova J, Eim J. Fertil Steril. 2008 Nov;90(5):1886-91.
Uterine Artery Embolization for Fibroids is Associated with an Increased Risk of Miscarriage
CONCLUSION: The risk of miscarriage seems to be increased after UAE. Miscarriage rates were higher in UAE pregnancies (35.2 percent) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5 percent) (odds ratio [OR] 2.8; 95 percent 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 H, Saridogan E. Fertil Steril. 2010 Jun;94(1):324-30.
Research on UAE or UFE and 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.
van der Kooij S, Hehenkamp W. UpToDate.