The effect of uterine artery embolization on fertility preservation in the treatment of symptomatic uterine fibroids
DOI:
https://doi.org/10.12775/JEHS.2023.27.01.010Keywords
uterine fibroids, uterine artery embolization, fertility preservation, ovarian reserveAbstract
Introduction: Uterine fibroids are the most common benign tumors of the uterus. Most often they are asymptomatic, but in their course there may be ailments such as: abnormal bleeding, anaemia, pain, constipation, problems with urination. These tumors are also one of the many causes of infertility. They are most often detected during a standard ultrasound examination. Pharmacological, minimally invasive and surgical treatment is currently available.
Aim: The aim of our study was to review scientific articles in order to demonstrate whether the treatment of uterine fibroids with uterine artery embolization has an impact on fertility and pregnancy outcomes.
Materials and methods: Review of the latest PubMed literature, Google Scholar in the period 2017 - 2023 and evaluation of available randomized controlled trials using uterine artery embolization in terms of fertility preservation by assessing ovarian reserve, number of pregnancies, miscarriages and perinatal complications.
Conclusions: Uterine artery embolization is a safe and effective method in reducing symptoms associated with uterine fibroids. This procedure shortens hospitalization and recovery time compared to myomectomy or hysterectomy. Unfortunately, for women who want children, this method is not recommended due to the risk of reduced ovarian reserve and miscarriage, premature birth, placental abnormality, and severe postpartum hemorrhage.
References
Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3-9.
Bulun SE. Uterine fibroids. N Engl J Med. 2013;369(14):1344-55.
Stewart EA. Clinical practice. Uterine fibroids. N Engl J Med. 201;372(17):1646-55.
Marsh EE, Ekpo GE, Cardozo ER, Brocks M, Dune T, Cohen LS. Racial differences in fibroid prevalence and ultrasound findings in asymptomatic young women (18-30 years old): a pilot study. Fertil Steril. 2013;99(7):1951-7.
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100-7.
Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, Al-Hendy A. Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocr Rev. 2022;43(4):678-719.
Marsh EE, Brocks ME, Ghant MS, Recht HS, Simon M. Prevalence and knowledge of heavy menstrual bleeding among African American women. Int J Gynaecol Obstet. 2014;125(1):56-59.
Stewart EA, Nowak RA. Uterine Fibroids: Hiding in Plain Sight. Physiology (Bethesda). 2022;37(1):16-27.
Poulsen BB, Munk T, Rudnicki M, Ravn P. Uterine fibroids. Ugeskr Laeger. 2017;179(43):V04170287.
De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100-107.
Kwas K, Nowakowska A, Fornalczyk A, Krzycka M, Nowak A, Wilczyński J, Szubert M. Impact of Contraception on Uterine Fibroids. Medicina (Kaunas). 2021;57(7):717.
Roșu GA, Ionescu CA, Călin FD, Dimitriu M, Pleș L, Matei A, Navolan DB. Prognostic value of the location of submucosal uterine leiomyomas in infertility. Exp Ther Med. 2021;22(6):1482.
Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215-23.
Gambadauro P. Dealing with uterine fibroids in reproductive medicine. J Obstet Gynaecol. 2012;32(3):210-6.
Brady PC, Stanic AK, Styer AK. Uterine fibroids and subfertility: an update on the role of myomectomy. Curr Opin ObstetGynecol. 2013;25(3):255-9.
Carranza-Mamane B, Havelock J, Hemmings R; Reproductive Endocrinologyand Infertility Committee; Special Contributor. The management of uterine fibroids in women with otherwise unexplained infertility. J ObstetGynaecolCan. 2015;37(3):277-285.
Litta P, Conte L, De Marchi F, Saccardi C, Angioni S. Pregnancy outcome after hysteroscopic myomectomy. Gynecol Endocrinol. 2014;30(2):149-52.
Levy G, Hill MJ, Beall S, Zarek SM, Segars JH, Catherino WH. Leiomyoma: genetics, assisted reproduction, pregnancy and therapeutic advances. J Assist Reprod Genet. 2012;29(8):703-12.
Sarıdoğan E, Sarıdoğan E. Management of fibroids prior to in vitro fertilization/intracytoplasmic sperm injection: A pragmatic approach. J Turk Ger Gynecol Assoc. 2019;20(1):55-59.
Purohit P, Vigneswaran K. Fibroids and Infertility. CurrObstetGynecol Rep. 2016;5:81-88.
Zepiridis LI, Grimbizis GF, Tarlatzis BC. Infertility and uterine fibroids. Best Pract Res Clin ObstetGynaecol. 2016;34:66-73.
Ikhena DE, Bulun SE. Literature Review on the Role of Uterine Fibroids in Endometrial Function. ReprodSci. 2018;25(5):635-643.
Unlu C, Celik O, Celik N, Otlu B. Expression of Endometrial Receptivity Genes Increase After Myomectomy of Intramural Leiomyomas not Distorting the Endometrial Cavity. Reprod Sci. 2016;23(1):31-41.
Ben-Nagi J, Miell J, Mavrelos D, Naftalin J, Lee C, Jurkovic D. Endometrial implantation factors in women with submucous uterine fibroids. Reprod Biomed Online. 2010;21(5):610-5.
Doherty LF, Taylor HS. Leiomyoma-derived transforming growth factor-β impairs bone morphogenetic protein-2-mediated endometrial receptivity. FertilSteril. 2015;103(3):845-52.
Ciarmela P, Islam MS, Reis FM, Gray PC, Bloise E, Petraglia F, Vale W, Castellucci M. Growth factors and myometrium: biological effects in uterine fibroid and possible clinical implications. Hum Reprod Update. 2011;17(6):772-90.
Sevostyanova O, Lisovskaya T, Chistyakova G, Kiseleva M, Sevostyanova N, Remizova I, Buev Y. Proinflammatory mediators and reproductive failure in women with uterine fibroids. Gynecol Endocrinol. 2020;36(sup1):33-35.
Matei A, Ionescu C, Gorun F, Gheorghiu D, Rosu GA, Dan A, Sima RM, Furau CG, Ilinca C, Navolan D. Insights on Hysteroscopic Procedures and Their Place in Romanian Gynecologic Practice-The Experience of Two Medical Units. Diagnostics (Basel). 2020;10(5):281.
Bittencourt CA, Dos Santos Simões R, Bernardo WM, Fuchs LFP, Soares Júnior JM, Pastore AR, Baracat EC. Accuracy of saline contrast sonohysterography in detection of endometrial polyps and submucosal leiomyomas in women of reproductive age with abnormal uterine bleeding: systematic review and meta-analysis. UltrasoundObstetGynecol. 2017;50(1):32-39.
Ghant MS, Sengoba KS, Recht H, Cameron KA, Lawson AK, Marsh EE. Beyond the physical: a qualitative assessment of the burden of symptomatic uterine fibroids on women's emotional and psychosocial health. J Psychosom Res. 2015;78(5):499-503.
Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.
American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008;112(2 Pt 1):387-400.
Singh SS, Belland L. Contemporary management of uterine fibroids: focus on emerging medical treatments. Curr Med Res Opin. 2015;31(1):1-12.
de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, Hehenkamp WJ. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016;215(6):745.e1-745.e12.
Serres-Cousine O, Kuijper FM, Curis E, Atashroo D. Clinical investigation of fertility after uterine artery embolization. Am J Obstet Gynecol. 2021;225(4):403.e1-403.e22.
Practice Committee of the American Society for Reproductive Medicine. Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline. FertilSteril. 2017;108(3):416-425.
Laughlin-Tommaso SK. Alternatives to Hysterectomy: Management of Uterine Fibroids. ObstetGynecol Clin North Am. 2016;43(3):397-413.
Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, Derrien J, Giraudet G, Kahn V, Koskas M, Legendre G, Lucot JP, Niro J, Panel P, Pelage JP, Fernandez H; CNGOF (French College of Gynecology and Obstetrics). Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J ObstetGynecolReprod Biol. 2012;165(2):156-64.
Liang S, Chen Y, Wang Q, Chen H, Cui C, Xu X, Zhang Q, Zhang C. Prevalence and associated factors of infertility among 20-49 year old women in Henan Province, China. Reprod Health. 2021;18(1):254.
Xu W, You Y, Yu T, Li J. Insights into Modifiable Risk Factors of Infertility: A Mendelian Randomization Study. Nutrients. 2022;14(19):4042.
Goldberg J, Pereira L, Berghella V, Diamond J, Daraï E, Seinera P, Seracchioli R. Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am J ObstetGynecol. 2004;191(1):18-21.
Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. FertilSteril. 2010;94(1):324-30.
Pisco JM, Duarte M, Bilhim T, Branco J, Cirurgião F, Forjaz M, Fernandes L, Pereira J, Costa N, Pisco JBM, Oliveira AG. Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization. Radiology. 2017;285(1):302-310.
McLucas B, Voorhees WD 3rd, Elliott S. Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol. 2016;25(1):1-7.
McLucas B, Danzer H, Wambach C, Lee C. Ovarian reserve following uterine artery embolization in women of reproductive age: a preliminary report. Minim Invasive Ther Allied Technol. 2013;22(1):45-9.
Jegaden M, Bleas C, Debras E, Couet D, Pourcelot AG, Capmas P, Fernandez H. Asherman Syndrome after Uterine Artery Embolization: A Cohort Study about Surgery Management and Fertility Outcomes. J Minim Invasive Gynecol. 2023;21:S1553-4650(23)00060-2.
Czuczwar P, Stepniak A, Milart P, Paszkowski T, Wozniak S. Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve - an observational study. J Ovarian Res. 2018;11(1):45.
Carranza-Mamane B, Havelock J, Hemmings R; REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY COMMITTEE; SPECIAL CONTRIBUTOR. The management of uterine fibroids in women with otherwise unexplained infertility. J ObstetGynaecol Can. 2015;37(3):277-285.
Karlsen K, Hrobjartsson A, Korsholm M, Mogensen O, Humaidan P, Ravn P. Fertility after uterine artery embolization of fibroids: a systematic review. Arch Gynecol Obstet. 2018;297(1):13-25.
Carranza-Mamane B, Havelock J, Hemmings R; REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY COMMITTEE; SPECIAL CONTRIBUTOR. The management of uterine fibroids in women with otherwise unexplained infertility. J ObstetGynaecol Can. 2015;37(3):277-285.
Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc InterventRadiol. 2008;31(1):73-85.
Hovsepian DM, Ratts VS, Rodriguez M, Huang JS, Aubuchon MG, Pilgram TK. A prospective comparison of the impact of uterine artery embolization, myomectomy, and hysterectomy on ovarian function. J VascIntervRadiol. 2006;17(7):1111-5.
Hehenkamp WJ, Volkers NA, Broekmans FJ, de Jong FH, Themmen AP, Birnie E, Reekers JA, Ankum WM. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod. 2007;22(7):1996-2005.
Mohan PP, Hamblin MH, Vogelzang RL. Uterine artery embolization and its effect on fertility. J VascIntervRadiol. 2013;24(7):925-30.
El Shamy T, Amer SAK, Mohamed AA, James C, Jayaprakasan K. The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis. Acta ObstetGynecol Scand. 2020;99(1):16-23.
Ruiz Labarta FJ, Pintado Recarte MP, González Leyte M, Arribas CB, Álvarez Luque A, Cuñarro López Y, García-Montero C, Fraile-Martinez O, Ortega MA, De León-Luis JA. Uterine Artery Embolization of Uterine Arteriovenous Malformation: A Systematic Review of Success Rate, Complications, and Posterior Pregnancy Outcomes. J Pers Med. 2022;12(7):1098.
Soro MP, Denys A, de Rham M, Baud D. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol. 2017;27(2):749-762.
Hacking N, Vigneswaran G, Maclean D, Bryant T, Umranikar S, Cheong Y, Modi S. The impact on Anti-Mullerian Hormone (AMH), uterine fibroid size and uterine artery patency following Uterine Fibroid Embolization (UFE) with a resorbable embolic agent. Hum Fertil (Camb). 2022;25(5):881-887
McLucas B, Voorhees WD 3rd, Snyder SA. Anti-Müllerian hormone levels before and after uterine artery embolization. Minim Invasive Ther Allied Technol. 2018;27(3):186-190.
Seifer DB, Baker VL, Leader B. Age-specific serum anti-Müllerian hormone values for 17,120 women presenting to fertility centers within the United States. FertilSteril. 2011;95(2):747-50.
Sanders AP, Norris S, Tulandi T, Murji A. Reproductive Outcomes Following Uterine Artery Occlusion at the Time of Myomectomy: Systematic Review and Meta-analysis. J ObstetGynaecol Can. 2020;42(6):787-797.e2
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Copyright (c) 2023 Magdalena Zapała, Agnieszka Środoń, Monika Łapaj, Joanna Wilk, Małgorzata Maria Cholewa, Małgorzata Chyćko, Agata Kromer, Katarzyna Cichoń, Agnieszka Gawryś, Julia Czarnota
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