The impact of uterine artery embolization on fertility and pregnancy outcome

Purpose: Current knowledge concerning the use of uterine artery embolization (UAE) in large uterine fibroids is limited with the majority of studies being limited to case reports. The present retrospective study aimed to investigate the impact of UAE on symptoms and tumor size in symptomatic women with at least one large uterine fibroid. Methods: 39 patients undergoing UAE for symptomatic large uterine fibroids (>5cm) were consecutively enrolled in this study. All patients underwent a detailed physical examination and contrast-enhanced pelvic MRI at 3, 6 and 12 months after the procedure. Results: Compared to baseline values (7.8 ± 2.4 cm), the mean diameter of the fibroids significantly reduced at 3rd (5.5 ± 1.7 cm), 6th (4.2 ± 1.3 cm) and 12th (3.1 ± 0.6 cm) months follow-up (p<0.005 for each compared to baseline) implying a 60 % reduction in tumor size at 12 months compared to baseline measurements. At the end of the 12 months follow-up, complete necrosis of the fibroid was achieved in 88%, complete symptom resolution was achieved in 92%, and >50 % reduction in fibroid diameter was acquired in 87 % of the participants. Conclusion: Uterine artery embolization provides 60 % reduction in fibroid volume and a 92 % improvement in fibroid-related symptoms in patients with large fibroids at the end of 12 months follow-up.

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Uterine Artery Embolization and Future Fertility Potential

Women s Health ◽

10.2217/17455057.3.4.449 ◽

2007 ◽

Vol 3 (4) ◽

pp. 449-453

Author(s):

Kee Jiet Ong ◽

Mostafa Metwally ◽

William L Ledger

Keyword(s):

Pregnancy Outcome ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Adverse Pregnancy Outcome ◽

Case Reports ◽

Artery Embolization ◽

Safety And Efficacy ◽

Future Fertility ◽

Adverse Pregnancy

The growing body of evidence concerning the safety and efficacy of uterine artery embolization (UAE) has led to increasing confidence amongst gynecologists and interventional radiologists that UAE can be used safely to treat women with symptomatic fibroids. UAE is clearly preferable for certain subgroups of patients, for example those with increased risks of complications of general anesthesia, those with religious objection to blood transfusion and those wishing to avoid surgical risk. This review of the available literature demonstrates the paucity of information concerning safety and efficacy of UAE for those wishing to conceive. Case reports and series are largely positive. However, there are continuing concerns over the effects of UAE on ovarian and uterine function, and on subsequent pregnancy outcome. More long-term data and randomized controlled trials are required to address these issues. Women who undergo embolization should be told that the effects on pregnancy and the resulting child are uncertain and that there may be long-term implications for the health and development of the offspring. Hence, it is inadvisable to try to conceive following the procedure. Given the available evidence, concern must remain that UAE may lead to significant damage to fertility, with higher risk of miscarriage and adverse pregnancy outcome when compared with open or laparoscopic myomectomy.

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The impact of uterine artery embolization to reduce postpartum hysterectomy

Gynecological Surgery ◽

10.1007/s10397-016-0936-6 ◽

2016 ◽

Vol 13 (3) ◽

pp. 153-158 ◽

Cited By ~ 1

Author(s):

Mee Kristine Aas-Eng ◽

Erik Qvigstad ◽

Nils-Einar Kløw ◽

Kirsten Hald

Keyword(s):

Uterine Artery Embolization ◽

Uterine Artery ◽

Artery Embolization ◽

The Impact ◽

Postpartum Hysterectomy

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Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Adenomyosis: Protocol for the Randomized QUESTA Trial (Preprint)

10.2196/preprints.8512 ◽

2017 ◽

Author(s):

Annefleur Machteld de Bruijn ◽

Paul NM Lohle ◽

Judith AF Huirne ◽

Jolanda de Vries ◽

Moniek Twisk ◽

...

Keyword(s):

Quality Of Life ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Transvaginal Ultrasound ◽

Uterine Disease ◽

Artery Embolization ◽

Randomized Controlled ◽

The Impact

BACKGROUND Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is established as the final treatment option when conservative treatment fails. Uterine artery embolization (UAE) in patients with symptomatic adenomyosis has demonstrated to reduce symptoms and improve quality of life. However, randomized controlled trials are lacking. OBJECTIVE With this study, we aim to evaluate the impact of UAE on Health-Related Quality of Life (HRQOL) in a randomized comparison to hysterectomy in patients with symptomatic adenomyosis. METHODS This is a multicenter non-blinded randomized controlled trial comparing UAE and hysterectomy. Eligible patients are symptomatic premenopausal women without the desire to conceive and who have symptomatic magnetic resonance imaging (MRI)–confirmed pure adenomyosis or dominant adenomyosis accompanied by fibroids. After obtaining informed consent, patients will be randomly allocated to treatment in a 2:1 UAE versus hysterectomy ratio. The primary objective is HRQOL at 6 months following the assigned intervention. Secondary outcomes are technical results, pain management, clinical outcomes, HRQOL, and cost effectiveness during 2 years of follow-up. In addition, transvaginal ultrasound (TVUS) and MRI will be performed at regular intervals after UAE. RESULTS Patient enrollment started November 2015. The follow-up period will be completed two years after inclusion of the last patient. At the time of submission of this article, data cleaning and analyses have not yet started. CONCLUSIONS This trial will provide insight for caretakers and future patients about the effect of UAE compared to the gold standard hysterectomy in the treatment of symptomatic adenomyosis and is therefore expected to improve patients’ wellbeing and quality of life. CLINICALTRIAL Netherlands Trial Register NTR5615; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5615 (Archived by WebCite at http://www.webcitation.org/6xZRyXeIF)

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