The purpose of this study was to evaluate whether the size, location, or number of fibroids affects therapeutic efficacy or complications of uterine artery embolization (UAE). Patients with symptomatic uterine fibroids (n = 101) were treated by selective bilateral UAE using 500- to 710-mum polyvinyl alcohol (PVA) particles. Baseline measures of clinical symptoms, sonography, and MRI taken before the procedure were compared to those taken 1, 3, 6, and 12 months later. Complications and outcomes were analyzed for associations with fibroid size, location, and number. Reductions in mean fibroid volume were similar in patients with single (66.6 +/- 21.5%) and multiple (67.4 +/- 25.0%) fibroids (p-value = 0.83). Menstrual improvement occurred in patients with single (93.3%) and multiple (72.2%) fibroids (p = 0.18). Changes in submucosal and other fibroids were not significantly different between the two groups (p's > 0.56). Linear regression analysis between primary fibroid volume as independent variable and percentage reduction of fibroid volume after 1 year yielded an R(2) of 0.083 and the model coefficient was not statistically significant (p = 0.072). Multivariate regression models revealed no statistically or clinically significant coefficients or odds ratios for three independent variables (primary fibroid size, total number, and fibroid location) and all outcome variables (percent reduction of uterus and fibroid volumes in 1 year, improvement of clinical symptoms [menstrual, bulk related, and urinary] in 1 year, and complications after UAE). In conclusion, neither the success rate nor the probability of complications was affected by the primary fibroid size, location, or total number of fibroids.

[12,13], and cervical ectopic pregnancy [14][15][16] has been reported.The effects of embolization on ovarian function are important when preservation of fertility is desired. Few articles have focused on the effect of UAE for fibroids and its outcome on future fertility and pregnancy. To the best of our knowledge, pregnancy after UAE has been described in the literature in the form of case reports [17][18][19][20], a review article [21], and retrospective reports of case series [22][23][24][25][26][27][28][29]. As of March 2008, more than 170 patients worldwide had become pregnant after UAE. At a university-affiliated referral hospital in Iran, we evaluated the pregnancies of women who underwent UAE for symptomatic fibroids and desired to become pregnant. Subjects and Methods From Wo m e n's I m ag i ng • O r ig i n a l R e s e a rc h Uterine fibroids are among the most common benign tumors of the female pelvis that cause abnormal menstrual bleeding. Uterine artery embolization (UAE) in the management of uterine myomas was first reported by Ravina et al. in 1995 [1]. Their promising results were confirmed in several uncontrolled cohort studies, which showed an approximately 50% decrease in uterine volume and relief of symptoms in 80-90% of patients [2]. The advantages of UAE include lower cost and more rapid recovery than can be achieved with conventional therapies [3][4][5]. The efficacy of uterine embolization in the management of pelvic hemorrhage has been well documented in obstetrics and gynecology [6][7][8]. Successful pregnancy outcome after embolization for obstetric hemorrhage [9,10] Please see the commentary on this article, which appears on the following pages. W O M E N ' S I M A G I N G PROOF Copyrighted Material For Review Only • Not for DistributionPage Copy OBJECTIVE. The purpose of this study was to report on pregnancies and their outcome after uterine artery embolization for uterine fibroids. SUBJECTS AND METHODS. From 2001 to 2004, 102 patients (mean age, [± SD]35.7 ± 6.4 years; range, 20-48 years) with symptomatic uterine fibroids underwent uterine artery embolization with 500-to 710-µm polyvinyl alcohol particles. The mean uterine volume was 552 ± 649 cm 3 (range, 94-4,656 cm 3 ), and the dominant fibroid size was 228 ± 359 cm 3 (range, 14-2,618 cm 3 ) before the procedure. During the 2-year follow-up period, the patients were asked whether they were trying to achieve pregnancy and whether they were successful. We obtained pregnancy and obstetric records of the pregnant women from physicians' offices and hospitals.RESULTS. Among 102 women who underwent bilateral uterine artery embolization, 23 (22.5%) were seeking to become pregnant, and 14 of the 23 (61%) became pregnant, nine having been nulliparous. One patient had two pregnancies. Fourteen pregnancies were spontaneous, and one was achieved by zygote intrafallopian transfer. Two miscarriages occurred, one in the 12th and one in the 16th week of gestation. The other 13 pregnancies went to term, were uncomplicated, and ended in elective...

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