Uterine fibroids are the most frequently seen noncancerous tumors of the female reproductive system, affecting nearly 70% of white women and over 80% of black women by age 50.1 Given their frequency, how these uterine growths impact fertility is an important topic—but one that isn’t entirely understood.
Just as important as understanding how this condition may affect your ability to conceive is choosing a fibroid treatment that protects it. Currently, surgically removing fibroids—a procedure called myomectomy—is considered the only treatment recommended to women thought to suffer from fibroid-related infertility. But according to a study published in the journal Radiology, minimally invasive uterine fibroid embolization (UFE) may help restore fertility in women with uterine fibroids who were previously unable to conceive.2
“Exploring UFE as a treatment option for women who desire pregnancy is of major importance,” explains João Martins Pisco, MD, PhD, from the Department of Interventional Radiology at Saint Louis Hospital in Lisbon, Portugal, and study co-author. “It’s a minimally invasive technique performed under local anesthesia with shorter hospital stay.”
Unlike surgery, UFE only requires a small puncture in the wrist or groin area. A doctor called an interventional radiologist then inserts a small tube called a catheter. With the use of real-time imaging, the catheter is guided through the arteries that lead to the uterine arteries. Tiny particles called embolic are injected into the uterine arteries, blocking blood flow to the fibroids. This process, called embolization, leaves fibroids without a blood supply, causing them to gradually shrink over time.
Even though UFE is less invasive than surgery, it still isn’t fully supported by the medical community as a fibroid treatment option for women wanting to become pregnant. Concerns the procedure may impede circulation to the uterine lining and the ovaries has categorized UFE as a treatment option only for women who don’t desire future pregnancy.
To gain more knowledge on this issue, Dr. Pisco and his colleagues examined pregnancy rates following UFE among 359 women with fibroids and/or adenomyosis who were previously unable to conceive.2 Adenomyosis causes the inner uterine lining to abnormally grow into the wall of the uterus, which can also negatively impact fertility.
Of the women participating in the study, 160 underwent partial embolization—a technique where only the small vessels are embolized, leaving the large vessels intact—instead of conventional UFE to potentially better preserve fertility.2 Conventional UFE embolizes all uterine artery branches.
All women were followed up for an average of almost 6 years.2 During this time, 149 women became pregnant (41.5%) at least once, and 131 women gave birth to 150 babies. For over 85% of these women, it was their first pregnancy. Since the time of writing the study, more pregnancies and newborns have been recorded. Obstetric complication rates were low at 23.1% for conventional UFE and 14.6% for partial UFE; however, it was noted that these rates are comparable with rates of the general population.
Neither conventional nor partial UFE seemed to negatively affect fertility but instead may have restored it. “Several of these women weren’t able to conceive despite having been submitted to IVF and many to myomectomy,” Dr. Pisco says. “They were only able to conceive after a UFE procedure.”
What’s more, UFE had a clinical success rate of almost 79% in treating fibroid-related symptoms, such as heavy menstrual bleeding and pelvic pain and pressure.2 Even though partial UFE only embolizes small artery branches, it still cut off blood supply to the dominant fibroid by more than 90% and wasn’t linked with higher rates of repeat intervention. Throughout the study, UFE was repeated in 28 women whose MRI scans showed incomplete treatment, with 11 of these patients going on to get pregnant for the first time.
This is good news especially as research in this area continues. Partial embolization might be able to reduce blood supply to the fibroids without limiting circulation to the uterus and ovarian arteries, potentially allowing for a better pregnancy rate and lower complication rate.2 A study comparing partial and conventional UFE is the next step.
Giving women who want to protect their fertility or restore it, as Dr. Pisco mentions, is important particularly for those who aren’t the best candidates for myomectomy or who have had no prior success with the surgery. “UFE is the only effective option when a woman has multiple fibroids or fibroids that are very large,” Dr. Pisco notes. Myomectomy may also be difficult if large fibroids are located within the uterine wall—a type called intramural—or just under the inner uterine lining—a type called submucosal.2 For these patients, having UFE as an option is essential.
In this study, an increased likelihood of pregnancy following UFE was linked to having a dominant submucosal fibroid as well as when UFE restricted fibroid blood supply by 90% or more, which both conventional and partial approaches are capable of doing.2 Treating fibroids to this degree, the study explains, stops them from growing and allows them to continue to shrink during pregnancy.
Whether UFE holds a place as a viable treatment for women desiring pregnancy is still being investigated. But with UFE research constantly unfolding, the number of options we have is increasing, as is our hope for something better.
ABOUT THE AUTHOR Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad, and volunteering in her community. She is a paid consultant of Merit Medical.
ABOUT THE DOCTOR João Martins Pisco, MD, PhD, is director of interventional radiology at St. Louis Hospital, chief radiologist at Hospital Pulido Valente, and professor of radiology at New University of Lisbon in Lisbon, Portugal. He is a world-renowned expert in embolization procedures and treats patients all over the globe. In addition to his practice, Dr. Pisco lectures regularly at international medical conferences and has written thousands of published book chapters and papers.
- Baird, D. D., Dunson, D. B., Hill, M. C., et al. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence.Am J Obstet Gynecol, Jan; 188(1), 100–107.
- Pisco, J. M., Duarte, M., Bilhim, T., et al. (2017). Spontaneous pregnancy with a live birth after conventional and partial uterine fibroid embolization. Radiology, Oct; 285(1):302-310.