Uterine artery embolization and fertility

In January 2003, the Food and Drug Administration approved the use of miniature acrylic copolymer beads to be used for treating symptomatic uterine fibroids. This procedure is known as uterine artery embolization or UAE. The uterine artery embolization procedure entails inserting a catheter through the femoral artery and into the uterine artery, where the beads are injected. These beads are carried by the blood flow to the fibroids where the blood vessels are smaller. The beads become lodged in the blood vessel where they reduce or prevent further blood flow to the fibroid. Without nourishment by the blood, the fibroid should in theory “die” resulting in shrinkage and reduction of symptoms.

The approval by the FDA and the study on which approval was based suggest that this treatment was a reasonable alternative to hysterectomy for those women with symptomatic fibroids. However, the FDA review of the literature, adverse event reports, and patient registry data indicated possible problems with uterine artery embolization including premature menopause and cessation of uterine bleeding.

Recently, results of a Dutch multi-center study presented at the annual meeting of the Cardiovascular and Interventional Radiological Society of Europe affirms great concern about the function of the ovaries after these procedures.

In the Dutch study, 177 women with symptomatic fibroids were randomized to uterine artery embolization or hysterectomy. Ovarian function was measured by assessment of the blood levels of anti-Mullerian hormone or AMH. Anti-Mullerian hormone is a relatively new and reliable quantitative marker of ovarian reserve. It reflects the number of oocytes a woman has left. AMH levels declined rapidly in both groups of women, those who had a hysterectomy and those who had UAE. The decline was much more rapid than would be expected based on aging in women who did not have either procedure.

Of course, decline in fertility is not an issue for most women who undergo hysterectomy for fibroids but may be important if women are choosing uterine artery embolization as a means to preserve their uterus and child bearing potential.

Interestingly, about one in four women who had uterine artery embolization underwent a hysterectomy within two years due to recurrence of symptoms.

It is also unclear what impact UAE may have on a developing pregnancy. some studies suggest there may be a higher incidence of complications and adverse outcomes. It is therefore not recommended at the current time that women with symptomatic fibroids who are interested in preserving their fertility should consider other options.

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