Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature

Abstract

Females with symptomatic leiomyomas (fibroids) wishing to maintain fertility are faced with difficult treatment choices. These include uterine fibroid embolization (UFE), myomectomy, hormonal therapy, MRI high intensity focused ultrasound, and myolysis. This review focuses on UFE, one of the most commonly accepted minimally invasive procedural choices among patients with symptomatic fibroids wishing to retain the option of becoming pregnant in the future, and makes comparisons to myomectomy which has historically been the surgical choice for fertility-preserving fibroid treatment. Pubmed and Google Scholar searches using keywords such as: uterine artery embolization, uterine fibroid embolization, pregnancy, complications, infertility were performed between Jan 1, 2019 and May 10, 2019. Publications were chosen based on their inclusion of information pertaining to fertility or pregnancy after UFE without being limited to single case reports. Randomized controlled trials comparing myomectomy and UFE are limited due to study size and confounding variables, but through registry data and familiarity with referring clinicians, UFE has gained wide acceptance. Healthy pregnancies following UFE have been sporadically reported but the actual fertility rate after UFE remains uncertain. Conversely, low birth weight, miscarriage and prematurity have been associated with UFE. Despite inherent risks of possible fertility issues after UFE, the procedure remains an option for females with clinically symptomatic fibroids who desire pregnancy. However, additional research regarding rates of conception and obstetrical risks of infertility following UFE is necessary.

Ultrasound guided percutaneous radiofrequency thermal ablation of symptomatic uterine fibroids — results from a single center and 52 weeks of follow up

“…UAE is a frequently used technique which reduces length of hospital stay and pain compared to the operation and patients rapidly return to the daily usual activities. However, UAE has the risk of reintervention, and lower pregnancy and live birth rates [13].…”

Uterine Artery Embolization Compared with High-intensity Focused Ultrasound Ablation for the Treatment of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis

“…However, a study by Torre et al [41], which included 66 women treated with UAE, showed that only 1 woman became pregnant, and she finally miscarried, although the ovarian reserve was unchanged after UAE, demonstrating that the negative impact on fertility might not be related to ovarian function. A review [42] of pregnancy outcomes after UAE concluded that low birth weight, miscarriage, and prematurity have been associated with UAE. Carranza-Mamane et al [43] also showed that there were lower pregnancy rates, higher miscarriage rates, and more adverse pregnancy outcomes after UAE than after myomectomy.…”

Myomectomy has better reproductive outcomes than uterine artery embolization for patients with symptomatic leiomyomas who wish maintain fertility

“…Six of the articles solely explored pregnancy outcomes after uterine artery embolization. [3][4][5][6][7][8] The remaining two manuscripts were reviews that compared uterine artery embolization to myomectomy. 9,10 Firouznia et.…”

“…Ludwig et al conducted a review focused on uterine fibroid embolization to compare it to the historically suggested myomectomy. 5 Publications were selected based on relevance of information to fertility and pregnancy without being limited to single case reports. The article had 52 references, of which 7 were randomized controlled trials.…”