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, J.P.

doi:10.1007/s00330-016-4681-z

Cited by 44 publications

(44 citation statements)

References 41 publications

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“…However, UAE might also impair the blood supply of the ovary and the function of the intima, causing permanent infertility. UAE was reported to be associated with a remarkably increased incidence of miscarriage and abnormal placenta . Therefore, the American Association of Obstetricians and Gynecologists does not recommend UAE to patients with uterine fibroid, who wish to become pregnant.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with uterine fibroids treated with ultrasound‐guided high‐intensity focused ultrasound

Zha¹,

Chen²,

Wu³

et al. 2017

BJOG

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Objective To investigate the effect of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids on pregnancy.Design A retrospective observational study.Setting Department of Gynaecology in a single centre in China.Population Patients with uterine fibroids who wish to become pregnant.Methods Patients with uterine fibroids who wished become pregnant and have children, were treated using HIFU from April 2011 to March 2016 at Chongqing Haifu Hospital. Pregnancy outcomes were analysed.Main outcome measures Pregnancy outcomes after undergoing USgHIFU.Results After the HIFU treatment, the 78 patients had 80 pregnancies, in which 76 cases were natural pregnancies and four were test-tube pregnancies. Of the 78 patients who became pregnant, nine patients had complicated primary or secondary infertility before the HIFU treatment, 13 patients had had at least two miscarriages or missed miscarriages, one patient had had a stillbirth; none had undergone other special treatment. After the HIFU treatment, the average time to pregnancy was 5.6 AE 2.7 months. There were 15 cases of full-term normal delivery and 56 cases of caesarean, including three cases of premature caesarean. After the treatment, three patients had a miscarriage (one patient's progesterone level was lower than the normal value; and the other two miscarriages were for unknown reasons), two patients became pregnant 3 months after complete curettage of uterine cavity and had full-term normal deliveries, one patient planned to use contraception after complete curettage of the uterine cavity; and one patient had her labour induced (after 13-weeks pregnancy). The fetuses of all the patients developed well during both the pregnancy and child-bearing without uterine rapture or perinatal and postpartum complications.Conclusion HIFU treatment can effectively treat patients with uterine fibroids who wish to have children; it could significantly reduce the preparation period for pregnancy after the operation. It can also improve the fertility of patients with a history of infertility and abnormal pregnancy and child-bearing, with no additional obstetric risks.Keywords High-intensity focused ultrasound, pregnancy, uterine fibroid.Tweetable abstract As a noninvasive therapeutic technique, HIFU safely can be used to treat patients with uterine fibroids who wish to become pregnant.

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Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with uterine fibroids treated with ultrasound‐guided high‐intensity focused ultrasound

Zha¹,

Chen²,

Wu³

et al. 2017

BJOG

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“…Torre et al 23 confirmed lower fertility rate, explaining different complications of embolization: the need of hysterectomy after uterus necrosis (0.2%–2%), 25 – 27 persistent amenorrhea (2%–5%) 26 – 29 caused by ovarian insufficiency 25 , 26 , 30 or endometrium atrophy. 31 …”

Section: Discussionmentioning

confidence: 95%

“…Vilos et al demonstrated that the rate of pregnancy after UAE is lower than after surgical myomectomy, so they recommend embolization only for women that do not desire future pregnancy 22 , 23 as a second-line treatment, or in case of contraindication to surgical myomectomy. 24 …”

Section: Discussionmentioning

confidence: 99%

Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report

Guida¹,

Maffucci²,

Iannuzzi³

et al. 2018

IJWH

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ObjectiveThis paper reports on a rare case of pregnancy after uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM). Debate exists about persistence of fertility in women after UAE. Adverse effects of this technique can modify both uterine echostructure, inducing necrosis and infarction, endometrial atrophy and uterine artery rupture, and ovarian reserve, causing persistent amenorrhea. Ovarian reserve appears to be affected by UAE in pre-menopausal women. However, younger ovaries (according to biological ovarian age) exhibit a greater capacity for recovery after ovarian damage. Therefore, larger studies are needed for more conclusive results.Case reportA 28-year-old woman was admitted to our department due to life-threatening uterine bleeding, resulting in tachycardia, pallor, and sweating. The patient came with a history of two spontaneous miscarriages. After sonography and computed tomography, AVMs were identified at uterine fundus and anterior wall.ConclusionThe pathogenesis of infertility after UAE is not yet known. The peculiarity of this case was that, only few months later, the patient became pregnant and gave birth to a live fetus at 37 weeks with cesarean delivery.

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“…In another study, women without infertility factors showed an encouraging delivery rate after UAE. Furthermore, UAE may not impair fertility when compared with abdominal myomectomy, however, data is insufficient to recommend UAE in nulliparous [12].…”

Section: Discussionmentioning

confidence: 99%

Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy—A Case Report and Review of Literature

Hirides¹,

Michalis²,

Athanasios³

et al. 2019

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Background: Submucosal fibroids account for approximately 15-20 percent of total fibroids. Rarely, they prolapse. Common size is 2-6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was "delivered" transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.

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

Cited by 44 publications

References 41 publications

Pregnancy outcomes in patients with uterine fibroids treated with ultrasound‐guided high‐intensity focused ultrasound

Pregnancy outcomes in patients with uterine fibroids treated with ultrasound‐guided high‐intensity focused ultrasound

Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report

Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy—A Case Report and Review of Literature

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