The influence of uterine artery embolisation on ovarian reserve, fertility, and pregnancy outcomes – a review of literature

Czuczwar, Piotr; Stępniak, Anna; Wrona, Wojciech; Woźniak, Sławomir; Milart, Paweł; Paszkowski, Tomasz

doi:10.5114/pm.2016.65665

Cited by 22 publications

(19 citation statements)

References 41 publications

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“…[6] The effect of UAE on ovarian reserve in younger women has been inconsistent across studies, and therefore remains uncertain, prompting the recommendation that for women desiring future pregnancy, caution should be observed when considering UAE. [13][14][15][16] Our findings are comparable with those reported in studies of younger women who had UAE and ovarian reserve assessed more accurately with serum AMH before and after the procedure. Of note is an initial dip in AMH concentration in the period immediately after the procedure, followed by recovery before a steady natural decline.…”

Section: Discussionsupporting

confidence: 84%

Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

2018

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Background. Uterine fibroids are the most common of the benign gynaecological tumours, the definitive traditional treatment for which is either myomectomy or hysterectomy. Uterine artery embolisation (UAE) offers an alternative non-invasive option for treatment. There remain concerns as to the effects of UAE on ovarian reserve in women desirous of preserving ovarian function. Objectives. To determine the effect of UAE on ovarian reserve, as assessed by anti-Mullerian hormone (AMH) measured before and after embolisation, and to assess the trend in serum AMH in the medium term, up to 12 months post UAE. Methods. A cohort study between October 2012 and May 2015 recruited 40 women with symptomatic uterine fibroids. Serum AMH was measured prior to embolisation and post embolisation, at 2 weeks, 6 months and 12 months. Using descriptive statistics and bivariate analysis, pre-embolisation and post-embolisation AMH concentrations were compared. P<0.05 was considered statistically significant. Results. The median participant age was 38.5 years (range 31-45). Of the women recruited, 47.5% (19) were nulliparous, and 72.5% (29 women) of the total desired a pregnancy in the future. The median (standard deviation) AMH immediately prior to embolisation was 1.3 ng/mL (1.53), and post embolisation at 2 weeks, 0.9 ng/mL (1.98); at 6 months, 2.2 ng/mL (2.63); and 12 months, 3.5 ng/mL (1.54) (p= 0.96). Conclusion. In the short to medium term, UAE for treatment of symptomatic fibroids was not found to be detrimental to ovarian reserve. There is a need for longer-term studies evaluating its effects on fecundity, considering that most women in the present study had a strong desire to maintain their fertility.

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Section: Discussionsupporting

confidence: 84%

Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

2018

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“…UAE is an effective treatment for post‐partum hemorrhage . However, there are concerns that the technique of UAE for RPOC has not been established, and UAE may affect ovarian dysfunction and infertility . In our study, UAE was used because of the large amount of continuous bleeding and severe vascularity in 34 (59.6%) patients.…”

Section: Discussionmentioning

confidence: 93%

“…13,14 However, there are concerns that the technique of UAE for RPOC has not been established, and UAE may affect ovarian dysfunction and infertility. [15][16][17][18][19] In our study, UAE was used because of the large amount of continuous bleeding and severe vascularity in 34 (59.6%) patients. For this reason, patients in the UAE group were more likely have intrauterine vascular lesions at diagnosis ( Table 2).…”

Section: Discussionmentioning

confidence: 98%

Complications and reproductive outcome after uterine artery embolization for retained products of conception

Ohmaru-Nakanishi

Kuramoto

Maehara

et al. 2019

J of Obstet and Gynaecol

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Aim The purpose of this study was to evaluate the complications and reproductive outcome after uterine artery embolization (UAE) for retained products of conception (RPOC). Methods This was a retrospective medical‐records review study of 57 women treated for RPOC. Participants were divided into two groups: women who underwent treatment with UAE (UAE group: n = 32, 56.1%) and those without UAE (control group: n = 25, 43.9%). The complications and reproductive outcomes were compared between the two groups. Information on subsequent pregnancies and their outcomes was available for 30 women who attempted to conceive. Results There were no significant differences in the interval from the last delivery or abortion (40.1 ± 3.4 vs 51.0 ± 5.1 months, respectively; P = 0.16), the rate of severe bleeding under hysteroscopy (18.5 vs 9.1%, respectively; P = 0.65), the conception rate (58.8 vs 61.5%, respectively; P = 1.0) and mean time to conception (9.9 ± 1.6 vs 11.0 ± 2.9 months, respectively; P = 0.17) in women in the UAE group compared with those in the control group. Rates of post‐partum hemorrhage (PPH) and manual removal of placenta (25.0% in the UAE group and 16.7% in the control group, respectively) were higher than the general population. Conclusion Selective UAE for RPOC may be a preferable procedure in women who are suspected as having a risk of severe bleeding under treatment. Women who were treated for RPOC, regardless of UAE, were at risk of PPH and difficulty in removing the placenta in future pregnancies.

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“…Fertility concerns associated with UAE include non‐target embolisation of the ovary, endometrial deterioration from poor perfusion and abnormal placental implantation 49 , 50 . Pregnancy concerns include intrauterine growth restriction, malpresentation, pre‐term labour, uterine rupture, post‐partum haemorrhage and increased risk of caesarean delivery 46 , 50 , 51 . While live births have been reported after the procedure, the evidence regarding the impact of UAE on fertility is poor.…”

Section: Leiomyomasmentioning

confidence: 99%

“…49,50 Pregnancy concerns include intrauterine growth restriction, malpresentation, pre-term labour, uterine rupture, post-partum haemorrhage and increased risk of caesarean delivery. 46,50,51 While live births have been reported after the procedure, the evidence regarding the impact of UAE on fertility is poor. Low-level data from subgroup analyses of small studies suggest slightly improved outcomes with myomectomy (ie, lower rates of miscarriage and higher rates of live births).…”

Section: Minimally Invasive Managementmentioning

confidence: 99%

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Brennan

Hickey

2018

Medical Journal of Australia

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Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

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The influence of uterine artery embolisation on ovarian reserve, fertility, and pregnancy outcomes – a review of literature

Cited by 22 publications

References 41 publications

Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

Complications and reproductive outcome after uterine artery embolization for retained products of conception

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

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