Uterine artery embolization (UAE) or uterine fibroid embolization (UFE) is a minimally invasive alternative to traditional surgical interventions for treating uterine fibroids that is increasingly growing popular.
UAE is a non-surgical procedure used to treat uterine fibroids by blocking the blood vessels that supply them. The technique involves the injection of embolic agents, such as tiny particles or beads, into the uterine arteries, cutting off the blood flow to the fibroids. This causes the fibroids to shrink and alleviate symptoms such as heavy menstrual bleeding and pelvic pain.
The procedure is performed by a board certified vascular and interventional radiologist, using real-time imaging to guide the catheter through the blood vessels to the targeted uterine arteries. UFE has gained popularity due to its minimally invasive nature, shorter recovery times, and lower risks compared to traditional surgical approaches like myomectomy. Read more about the UFE procedure here.
Effect of UFE on Fertility
One of the primary concerns by patients who want to conceive is associated with UAE and its impact on fertility. Based on old studies on a small number of patients, questions have been raised about the potential effects on the uterus’s reproductive function. While the available research provides valuable insights, it’s important to note that this remains a topic of ongoing debate.
Studies Evaluating Fertility and UFE
Several studies have explored the relationship between UFE and fertility outcomes. Understanding the findings of these studies is crucial for healthcare providers and women considering UFE as a treatment option:
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Results from a Prospective Study by Mara et al. (2018): This study aimed to assess the impact of UFE on fertility by examining a cohort of women attempting to conceive after the procedure. The results suggested that fertility outcomes were generally favorable, with a significant proportion of women achieving successful pregnancies. However, it’s essential to note that individual outcomes may vary.
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A Meta-Analysis by Tropeano et al. (2014): This meta-analysis aimed to evaluate the existing literature on UFE and fertility. The findings suggested that while pregnancy rates following UAE were encouraging, the risk of complications such as miscarriage and preterm birth might be slightly elevated compared to those who did not undergo the procedure. Although this is already a risk and seen in patients who are pregnant with untreated fibroids.
If fertility is of primary concern for you, please contact our office to setup an appointment. Our physician also performs fertility sparing partial UFE as opposed to the traditional UFE.
Potential Risks of UFE: Mechanisms and Considerations
1. Uterine Ischemia and Its Implications:
The key concern regarding fertility after UAE is the induced ischemia in the uterine tissue. Ischemia, or reduced blood flow, can have implications for the overall health of the uterus and its ability to support a pregnancy. This is more commonly seen at academic teaching hospitals and large medical centers where physicians place too many embolic beads into the blood flow. Most hospital perform very few embolization per year compared to a specialized center. And this low volume of procedures may be split between the Interventional Radiologists on staff. This low number of embolizations can lead to more aggressive and unnecessary treatments. Our Board-Certified Doctor performs selective embolization so that there are only beads placed into the fibroids sparing the uterus. This is seen on patients’ post-operative MRIs that demonstrate preserved blood flow to the uterus.
2. Impact on Endometrial Lining:
Some studies have suggested that UAE may lead to changes in the endometrial lining, potentially affecting implantation and the overall success of pregnancy. However, the clinical significance of these changes remains a subject of ongoing research. This may also be due to the improper sizing or aggressiveness of the embolization. Make sure to seek a physician who specializes and performs a high number of embolizations to minimize risk. Interventional Radiologists at major hospitals are busy with cancer care, infections, blood clots and other emergent procedures, and may not have the focus and experience of performing a high number of embolizations specifically for fibroids.
3. Patient Selection and Fibroid Characteristics:
The success of fertility after UAE may depend on patient selection and specific fibroid characteristics. Factors such as the size and location of fibroids, as well as the overall health of the uterus, play a role in determining the likelihood of achieving a successful pregnancy.
4. Timing of Pregnancy Attempts:
The optimal timing for attempting pregnancy after UAE is a crucial consideration. While some studies suggest favorable outcomes, it is generally recommended to wait for a certain period after the procedure to allow the uterus to recover and to ensure the best chances of a healthy pregnancy.
UFE and Fertility: Outcomes
Uterine artery embolization has proven to be a highly effective and minimally invasive option for treating symptomatic uterine fibroids. Current research suggests that fertility outcomes following UAE are generally favorable, with many women successfully conceiving and carrying pregnancies to term. Many of whom were never previously pregnant.
Given the ongoing debate and variability in individual responses, shared decision-making between healthcare providers and patients is crucial when considering UAE for the treatment of fibroids, particularly in the context of fertility preservation. Counseling should involve a comprehensive discussion of potential risks, benefits, and alternative treatment options.
If you want to have the UFE procedure but have concerns regarding fertility, our physician also performs fertility sparing partial UFE, you can read here how this varies from the traditional UFE procedure.
If you have fibroids and are looking to see if non-surgical UFE can save you surgery while preserving your fertility, set up an appointment with our specialist to discuss your situation.
We are Here to Help
Request an appointment to meet with our fibroid specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each woman is an individual and should discuss the potential risks and benefits of fibroid embolization and other Treatments with our doctor to decide which option is best for her.
Appointments are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here.
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Mara, M., Fucikova, Z., Kuzel, D., Maskova, J., & Dundr, P. (2018). Uterine fibroid embolization and its effect on fertility. Acta Radiologica, 59(7), 832–837.
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Tropeano, G., Di Stasi, C., Litwicka, K., & Romano, D. (2014). Uterine fibroid embolization for symptomatic fibroids: Short-term versus mid-term changes in general and uterine artery-specific symptom and quality of life scores. Radiology Research and Practice, 2014, 516706. doi:10.1155/2014/516706.
