Journal Article

Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors

Kahn, Vanessa, Pelage, Jean Pierre, Limot, Olivier, Fauconnier, Arnaud, Bussierres, Laurence, Torre, Antoine

2017

Overview

Objectives To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE). Methods Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor. Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 μm. Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed. Results Fifteen patients, aged 34.8 years (95%CI 32.2–37.5, median 36.0, q1–q3 29.4–39.5) were included from November 2008 to May 2012. During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%–61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%–85%) and the quality of life score was improved by 112% (95%CI 21%–204%). Uterine volume was reduced by 38% (95%CI 24%–52%). Women were followed for 43.1 months (95%CI 32.4–53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids. Conclusion Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted. Key points • Women without infertility factors showed an encouraging delivery rate after UAE. • For women choosing UAE over abdominal myomectomy, childbearing may not be impaired . • Data are insufficient to definitively recommend UAE as comparable to myomectomy. • Further randomized trials comparing fertility after UAE or myomectomy are warranted.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V,Springer Verlag
• Subject: Adult / Clinical trials / Diagnostic Radiology / Embolization / Female / Fertility / Fibroids / Follow-Up Studies / France - epidemiology / Gelatin / Humans / Hysterectomy / Imaging / Infertility / Infertility - epidemiology / Infertility - etiology / Infertility - physiopathology / Internal Medicine / Interventional Radiology / Leiomyoma, Epithelioid - diagnosis / Leiomyoma, Epithelioid - therapy / Life Sciences / Medicine / Medicine & Public Health / Microspheres / Motivation / Neuroradiology / Patients / Pregnancy / Prospective Studies / Quality of Life / Radiology / Randomization / Risk Assessment - methods / Surgery / Surveys and Questionnaires / Treatment Outcome / Ultrasound / Uterine Artery Embolization - adverse effects / Uterine Neoplasms - complications / Uterine Neoplasms - diagnosis / Uterine Neoplasms - therapy / Uterus / Vascular-Interventional