Impact Of Uterine Fibroid Embolization on Fertility Outcome

Abstract

Background: Uterine fibroid embolization (UFE) represents a minimally invasive technique for treating fibroids by occluding the blood flow to the fibroid itself and serves as an alternative to surgical procedures such as hysterectomy or myomectomy. UFE has treatment effectiveness, but the implications for fertility are unknown; therefore, women who want to maintain the ability to conceive will often choose to undergo a myomectomy. Risks may also accompany UFE, such as damage to the ovaries or allowing fibroids to degrade at a much slower rate, which may affect future pregnancies. Prior research has conflicting results, with some studies indicating similar pregnancy rates versus myomectomy and other research suggesting that UFE leads to increased risks for miscarriage or preterm birth. The purpose of this study is to address these conflicting findings and to compare the outcomes of UFE and myomectomy for fertility outcomes.

Objectives: The study contrasts the effects of UFE and myomectomy on fertility outcomes, including pregnancy, live births, miscarriage, and complications. It also evaluates the anatomical and functional recovery of the ovaries and uterus after UFE.

Methodology: A retrospective cohort study compared 50 women aged 27–50 who underwent either UFE or myomectomy. Reproductive outcomes, including pregnancy, live birth, preterm birth, spontaneous abortion, ectopic pregnancy, and stillbirth, were analyzed.

Results: This study assessed 50 females (mean age 38.6 years) with uterine fibroids and examined post-uterine fibroid embolization (UFE) pregnancy outcomes. Of these, 54% achieved pregnancy, with 74% of pregnancies resulting in live births. However, there were high rates of cesarean delivery (60%) and preterm birth (30%), and 10% of the population used in vitro fertilization (IVF) for pregnancy (to assess fibroid impact on fertility treatment outcomes). The study captures pregnancy outcomes with significant obstetrical risk factors, individualized prenatal surveillance, and multi-disciplinary care for maternal and neonatal safety. It exemplifies the challenges faced during the transition of women with fibroids from UFE to their reproductive health.

Conclusion: UFE is a valid, minimally invasive alternative to myomectomy for fibroid treatment but may pose more significant risks to fertility outcomes. The study highlights the need for randomized controlled trials to clarify UFE's role in fertility preservation and guide clinical decision-making for women balancing minimally invasive treatment with long-term reproductive goals.

Advances in knowledge: This research reveals that uterine fibroid embolization (UFE) allows pregnancy in 54% of women (74% live births), comparable to surgery, but with increased risk of preterm birth (30%) and C-sections (60%), assisting women in making informed treatment decisions