Women younger than age 40 years who undergo uterine artery embolization for the treatment of uterine fibroids have a good chance of maintaining fertility and of having a good pregnancy outcome, even years following the procedure, according to findings from a retrospective chart review.
The findings suggest that for women who desire a future pregnancy, uterine artery embolization may offer advantages over myomectomy, Dr. Bruce McLucas reported at ISET 2013, an international symposium on endovascular therapy.
Of 44 women aged 26-40 years who desired a future pregnancy and who underwent uterine artery embolization between 1996 and 2010, 22 reported a total of 28 pregnancies. One patient had three pregnancies, 4 had two pregnancies, and 17 had one pregnancy.
The pregnancies occurred at a mean of 41 months following treatment (range of 13 to 108 months from treatment to delivery). Only one patient required the use of "additional reproductive techniques," said Dr. McLucas of the University of California, Los Angeles.
Of the 28 pregnancies, 3 resulted in miscarriage, 3 involved preterm labor followed by cesarean delivery, 18 involved cesarean delivery at term, and 4 involved vaginal delivery at term – something that is not possible following myomectomy, he said.
The average birth weight of the babies was a healthy 3 kg, and mean total uterine volume prior to uterine artery embolization was also healthy at 400.6 cm. The average fibroid size prior to the treatment was 8.46 cm.
No perfusion problems occurred during pregnancy or labor, and there were no reports of any intrauterine growth restriction, fetal distress during labor, or problems related to uterine integrity. Also, none of the patients experienced premature menopause as a result of uterine artery embolization.
In fact, only two patients reported problems during pregnancy, and these included borderline oligohydramnios and low-lying placenta.
The pregnancy rate in this study compares favorably with the rate seen in previous studies of women who underwent myomectomy. Because about 10% of myomectomies result in conversion to hysterectomy and because vaginal delivery is not possible following myomectomy, these findings suggest that uterine artery embolization is a viable alternative, Dr. McLucas said.
This is particularly true for those who wish to wait longer than 1 year after the procedure to become pregnant, which is the case for many younger patients, he said. It takes about 6 months for the uterus to heal following myomectomy, and the chances of becoming pregnant are best between and 7 and 12 months following myomectomy. After 12 months, fibroids begin to recur, hindering the chances of conception.
Women should be advised of the small chance of premature ovarian failure (which occurs in about 10 in 1,000 cases) and of hysterectomy (which occurs in about 5 in 1,000 cases) with uterine artery embolization. Nonetheless, the treatment is a good option in those who desire to maintain fertility and to postpone childbearing, he concluded.
Dr. McLucas reported having no financial disclosures.