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Uterine fibroid embolization may restore fertility

Uterine fibroid embolization may be an effective, less invasive option than myomectomy in helping women with uterine fibroids get pregnant, according to findings recently published in Radiology.

According to the researchers, one out of every four women with fibroids has problems related to fertility, and fibroids are considered one of the most common causes of pregnancy complications and infertility.

“[Previous research] concluded that [uterine fibroid embolization] is a safe and effective treatment for symptomatic fibroids in selected women who wish to retain their uteri,” João M. Pisco, MD, PhD, department of interventional radiology, Saint-Louis Hospital, Lisbon, Portugal, and colleagues wrote. “However, concerns exist about the effects of [uterine fibroid embolization] on fertility and the likelihood of pregnancy after the procedure.”

To gather more data on uterine fibroid embolization’s impact, researchers first performed a conventional uterine fibroid embolization in which all uterine artery branches were embolized on 199 patients but noted that not all of these patients became pregnant. Researchers then hypothesized a partial uterine fibroid embolization, in which only the small vessels to the uterine fibroids were embolized and the corresponding larger vessels were left patent, and performed this procedure on 160 new patients. The mean age of the participants was 35.9 years.

Pisco and colleagues found that after a median follow-up period of 69 months, 149 of the 359 women became pregnant. The live newborn rate among women who became pregnant was 71.9% (131 of 182) and for 85.5% (112 of 131) of these women, it was their first pregnancy.

In addition, the cumulative probabilities of spontaneous pregnancy at 12 months was 29.5% (95% CI, 25.1-34.5) and at 24 months was 40.1% (95% CI, 35.3- 45.4). Cumulative probabilities of a successful spontaneous pregnancy with a live birth at 12 months was 24.4% (95% CI, 20.3-29.3) and at 24 months was 36.7% (95% CI, 31.9-42). In multivariate analysis, the factors associated independently with increased probability of pregnancy were submucosal location of the fibroid (HR = 4.58; 95% CI, 2.61-8.01) and degree of ischemia greater than or equal to 90% (HR = 2.003; 95% CI, 1.02-4.03). Low morbidity was reported in the women who became pregnant, according to researchers.

“Our study shows that embolization of uterine fibroids can improve fertilization of those women with uterine fibroids who wish to conceive,” Pisco told Healio Family Medicine in an interview. “Up to now there was controversy; it was said that the procedure could not be performed because it compromised fertility.”

In a press release, Pisco suggested that uterine fibroid embolization may become the first-line treatment for women with fibroids who wish to conceive, particularly for those with numerous or very large fibroids.

Previous studies found that though uterine fibroid embolization costs less and results in shorter hospital stays, it is underused in the U.S. compared to hysterectomies, particularly in rural and smaller hospitals. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.