BACKGROUND AND PURPOSE:

• Serres-Cousine et al. (AJOG, 2021) characterized the clinical, anatomic, and obstetrical results of uterine artery embolization (UAE) in patients of childbearing age not eligible for myomectomy

METHODS:

• Retrospective cohort study
• Participants
  • Women <43 who were treated for symptomatic fibroids and/or adenomyosis between 2003 and 2017
• Exposure
  • Uterine artery embolization (UAE) using fertility-sparing uterine artery embolization technique | Right femoral artery puncture, allowing for successive superselective catheterization of the uterine arteries
  • Ovarian protection in the event of dangerous utero-ovarian anastomosis using a microcoil to protect the ovary or larger particles
• Study design
  • UAE indications: Occurrence of a single fibroid measuring >5 cm and/or several fibroids and/or adenomyosis
  • MRI and pelvic ultrasounds were performed before and after uterine artery embolization
  • Predictors of clinical and obstetric success were determined by logistic regression
• Primary outcome
  • Overall clinical success rate with resolution of preembolization symptoms
    • Heavy menstrual bleeding | Iron-deficiency anemia | Pelvic pressure

RESULTS:

• 398 patients
  • Presented with dangerous utero-ovarian anastomosis: 49.3%
• Overall clinical success rate: 91.2%
• Reduction in myoma volume one year after UAE
  • Mean 73% reduction
• Pregnancy and birth outcomes
  • 158 women desired a pregnancy
    • 65% started at least 1 pregnancy
  • Overall pregnancies: 148
    • 109 Live Births | 23 Preterm
  • Mean gestational age at delivery: 35.12±2.78 weeks
  • Mean birthweight and birth length were within normal limits
• Mode of delivery
  • Rate of cesarean delivery: 46.8% vs 21% in the normal population
• Main predictive factors for obstetrical success
  • Restoration of uterine anatomy with no intracavity distortion (also a major predictive factor for clinical success and was associated with a lower rate of miscarriage)

CONCLUSION:

• The clinical success rate of UAE for this population was 91.2%
• 74% of pregnancies resulted in a live birth
  • 68% of births occurred at term
  • High cesarean rate may be due to obstetricians treating UAE similar to myomectomy scar
• Obstetrical success was mainly predicted by restoration of uterine anatomy and ovarian protection
• The authors state

This study adds to the growing body of literature investigating the effects of UAE on fertility

Further research—notably prospective cohorts and controlled randomized trials — is needed to refine the indications of UAE as a possible therapeutic option based on anatomic and clinical parameters

Learn More – Primary Sources:

Clinical investigation of fertility after uterine artery embolization

Related ObG Topics: