Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors.

Torre, Antoine; Fauconnier, Arnaud; Kahn, Vanessa; Limot, Olivier; Bussierres, Laurence; Pelage, Jean; Pelage, Jean Pierre

<bold>Objectives: </bold>To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE).<bold>Methods: </bold>Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor. Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 μm. Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed.<bold>Results: </bold>Fifteen patients, aged 34.8 years (95%CI 32.2-37.5, median 36.0, q1-q3 29.4-39.5) were included from November 2008 to May 2012. During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%-61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%-85%) and the quality of life score was improved by 112% (95%CI 21%-204%). Uterine volume was reduced by 38% (95%CI 24%-52%). Women were followed for 43.1 months (95%CI 32.4-53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids.<bold>Conclusion: </bold>Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted.<bold>Key Points: </bold>• Women without infertility factors showed an encouraging delivery rate after UAE. • For women choosing UAE over abdominal myomectomy, childbearing may not be impaired. • Data are insufficient to definitively recommend UAE as comparable to myomectomy. • Further randomized trials comparing fertility after UAE or myomectomy are warranted.

FRANCE; UTERINE fibroid treatment; OVARIAN reserve; UTERINE myomectomy; HUMAN fertility; QUALITY of life; INFERTILITY treatment; RANDOMIZED controlled trials; THERAPEUTIC embolization; UTERINE fibroids; COMPARATIVE studies; FERTILITY; INFERTILITY; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; QUESTIONNAIRES; RESEARCH; RISK assessment; STATISTICAL sampling; EVALUATION research; TREATMENT effectiveness; UTERINE tumors; UTERINE artery; DISEASE complications; DIAGNOSIS; TUMOR treatment

European Radiology, 2017, Vol 27, Issue 7, p2850

0938-7994

Academic Journal

10.1007/s00330-016-4681-z