Olivier Serres-Cousine1, Fiene Marie Kuijper2, Emmanuel Curis3, Diana Atashroo4. 1. CH Béziers, 34500 Béziers, France; Clinique du Parc, 34170 Castelnau-le-Lez, France. Electronic address: osc.radio.int@gmail.com. 2. École Normale Supérieure Ulm, Département de Biologie, 75005 Paris, France; Université Paris Descartes, Faculté de Médecine, 75006 Paris, France. 3. Université de Paris, Laboratoire de biomathématiques plateau iB2EA 7537-BioSTM, Faculté de pharmacie, 75006, Paris, France; Service de Biostatistique et Information Médicale, Hôpital Saint-Louis, AP-HP, 75010, Paris, France. 4. Department of Obstetrics and Gynecology, Stanford University School of Medicine, California, USA.
Abstract
BACKGROUND: Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate. OBJECTIVE: To study the clinical, anatomical and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy. STUDY DESIGN: This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic Resonance Imaging and pelvic ultrasounds were performed before and after uterine artery embolization. RESULTS: The overall clinical success rate (i.e. resolution of pre-embolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2% and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. One hundred eight patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births. Seventy-four children were born at term; 23 were born preterm, on average at 35.12 ± 2.78 weeks. Including preterm births, the mean birth weight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage. CONCLUSION: This study provides detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomical and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and re-evaluate this procedure's indications and limitations for women with a desire to procreate.
BACKGROUND: Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate. OBJECTIVE: To study the clinical, anatomical and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy. STUDY DESIGN: This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic Resonance Imaging and pelvic ultrasounds were performed before and after uterine artery embolization. RESULTS: The overall clinical success rate (i.e. resolution of pre-embolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2% and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. One hundred eight patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births. Seventy-four children were born at term; 23 were born preterm, on average at 35.12 ± 2.78 weeks. Including preterm births, the mean birth weight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage. CONCLUSION: This study provides detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomical and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and re-evaluate this procedure's indications and limitations for women with a desire to procreate.