UTERINE FIBROID EMBOLIZATION HELPS RESTORE FERTILITY

A minimally invasive treatment may help restore fertility in women with uterine fibroids, according to a new study published online in the Radiology magazine.

Uterine fibroids (myomas) made partly of muscle tissue and develop in or around the uterus, are considere one of the most common cause of infertility and pregnancy-related complications.

Previous research has found that one in four women with fibroids have fertility-related problems. The standard treatment option for these women is myomectomy or surgical removal of the fibroids.

However, myomectomy is not always possible or effective and can lead to major complications, including hysterectomy, according to study co-author João Martins Pisco, MD, Ph.D., of the Department of Interventional Radiology at Saint Louis Hospital in Lisbon Portugal.

Uterine fibroid embolization (UFE) is a less invasive option that involves the injection of an embolic agent, typically made up of very small particles, into the uterine arteries to block the blood supply to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers. EMU can be performed in patients with a previous myomectomy or in vitro fertilization (IVF).

Despite its less invasive nature, EMU has not yet been fully adopted in the medical community as a fertility-preserving treatment for women with symptomatic fibroids due to concerns that the procedure may cause inadequate blood flow to the endometrium or to the lining of the uterus, and the ovaries.

For the new study, Dr. Pisco and colleagues evaluated pregnancy rates in 359 women with uterine fibroids who were unable to conceive and who underwent conventional or partial UME. In conventional EMU, all branches of the uterine artery are embolized. However, the partial procedure requires treatment of only the vessels small to the fibroids, without affecting the corresponding larger vessels. Partial EMU can help reduce the risks of infertility associated with conventional EMU.

After an average follow-up of nearly 6 years, 149 of the 359 women, or 41.5% had gotten pregnant one or more times, and 131 gave birth to a total of 150 babies. It was the first pregnancy for more than 85% of the women who gave birth.

"Our findings show that EMU is a fertility-restoring procedure for women with uterine fibroids who wish to conceive, and pregnancy after EMU appears to be safe with low morbidity," said Dr. Pisco.

Dr. Pisco suggested that EMU may become the first-line treatment for women with fibroids who want to conceive, particularly those with numerous or very large fibroids. Such patients have a fibroid recurrence rate of more than 60% after myomectomy, making UFE an important option.

The researchers are continuing treatments and compiling data. As of the time of writing, there have been 12 additional pregnancies.

"In our study there are now almost 200 newborns after UFE," said Dr. Pisco. "Our next step will be a randomized study comparing the results of partial and conventional UFE."

By la Sociedad Radiológica de América del Norte.