More than half of women will develop uterine fibroids by the time they reach 50.1 These noncancerous tumors can be the cause of severe menstrual symptoms, leaving many women searching for a cure. Because fibroids are especially common during a woman’s 30s—a time when many women are trying to conceive—finding a treatment that works and preserves fertility can be a challenge.
Uterine fibroid embolization (UFE), a minimally invasive treatment that shrinks fibroids, significantly improves symptoms in 85%–90% of patients;2 and yet it’s still unclear how this procedure affects fertility. But research is emerging. A French study found that women who had UFE performed by way of a limited embolization technique were able to give birth and showed an encouraging delivery rate following treatment.3
The study, published in European Radiology, evaluated the fertility of 15 women who chose to undergo UFE instead of myomectomy, a procedure that surgically removes fibroids and is performed by a gynecologist.3 Women participating in the study were approximately 35 years of age and had no known infertility factors.
Unlike myomectomy, UFE is performed by an interventional radiologist—a type of doctor who uses specialized imaging equipment to see inside the body and treat disease without surgery. A nick is made in the wrist or groin area to access the blood vessels leading to the uterine arteries. By inserting a thin tube called a catheter into the uterine arteries, tiny particles are then injected and block the fibroids’ blood supply, causing them to shrink and symptoms to subside.
Whether or not UFE should be used as a first-line fibroid treatment for women trying to get pregnant is still debated in the medical community. Concerns over how UFE will affect ovarian reserve—the ovaries’ ability to produce viable eggs—and the uterine lining as well as uterine muscle tissue have been expressed.3 Because of this, UFE is commonly recommended as a second-line treatment or for women who are not candidates for myomectomy.3
Taking into consideration these concerns and to better support future fertility, the researchers of this study used a fertility-sparing technique that specifically targets vessels only surrounding the fibroids but spares nearby normal myometrial arteries, or the arteries that flow to unaffected smooth muscle tissue of the uterine wall. “Women without infertility factors suffering from symptomatic fibroids were durably treated by a limited fertility-sparing [UFE] and experienced a substantial rate of subsequent fertility,” the researchers write. “For women choosing [UFE] over abdominal myomectomy, childbearing may not be impaired.”3
During the year following UFE, nine women who were actively trying to conceive had five babies.3 After about three and a half years, data show eight women gave birth to 10 babies.
Ovarian reserve was also tracked as well as uterus size and quality of life after the procedure. The researchers found that ovarian reserve remained stable, fibroid symptoms improved by 66%, and uterine size was reduced by 38%.3 Completed questionnaires showed that quality of life scores improved by 112%. Five women experienced recurring symptoms, needing further treatment.
Despite the positive results seen, the authors also noted that because only select vessels are embolized when using this technique—unlike with traditional UFE—there might be a risk for symptom recurrence in the future, requiring a second treatment.3 In this study, however, UFE was seen to control fibroid symptoms and preserve fertility, allowing women to complete their families.
At this time, myomectomy is often recommended as the fibroid treatment for women wanting to conceive, and the researchers note that more studies are needed before UFE can be recommended as a first-line treatment.3 But this study provides hope and another potential option for women who need immediate relief from fibroid symptoms and who want to retain their fertility.
REFERENCES
- Office on Women’s Health, U.S. Department of Health and Human Services. (2019, Apr 1). Uterine Fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
- Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675–
- Torre, A., Fauconnier, A., Kahn, V., et al. (2017). Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur Radiol, Jul;27(7):2850–
