UTERINE FIBROID EMBOLIZATION (UFE) – Fertility
The decision to undergo UFE if future pregnancy is desired is a complex one to make and should be made only after consultation with your gynecologist, an infertility specialist (if applicable), and an interventional radiologist. One of the reasons why this decision is so difficult is that so much of the information needed to make a truly informed decision is not yet known. Fibroids can cause infertility, but infertility due solely to the presence of fibroids is uncommon and it is often difficult to determine the contribution that fibroids are making to an individual patient’s infertility. If fibroids are thought to be responsible for infertility, than reducing the size of the fibroids may help improve chances for conception and a successful pregnancy, although this has not been proven or supported by any studies performed to date.
It is well known that many patients worldwide have become pregnant after UFE, including several patients who have undergone UFE at our institution. One problem with establishing a “pregnancy rate” after UFE is that it is difficult if not impossible to determine the number of patients actively trying to become pregnant after this procedure. However, several articles have now been published in the literature which have reported successful pregnancies thereby confirming the fact that UFE by no means automatically interferes with a patient’s ability to become pregnant and to carry a pregnancy successfully to term.
While this is encouraging, we also know that many things can happen after UFE that can potentially affect future pregnancy. The goal of UFE is to block the flow of blood in the uterine arteries and blood flow to the uterus is required for a successful pregnancy. While we know that flow does return in these arteries, the degree to which this happens varies among individual patients and may or may not be sufficient for pregnancy. After UFE, the wall of the uterus may potentially be weakened and it is not possible to know if this weakness will become a problem during pregnancy or during delivery. It is also known that UFE can potentially result in decreased blood flow to the ovaries, which in some patients can lead to reduced ovarian function and loss of normal menstrual cycles or menopause. While this is a rare event in patients <45 years of age, it can be devastating to a patient planning on pregnancy after UFE. Ultimately, it is safe to say that at the present time, the long-term effects of UFE on the preservation of fertility and the ability of a patient to become pregnant and carry a pregnancy to term is not yet fully known.
For these reasons, we recommend that most patients desiring future fertility should seek an opinion regarding the role of myomectomy in their care. We consider myomectomy to be the first choice to consider in patients desiring future fertility because the ability of this procedure to both address symptoms and preserve fertility has been established in several reports published in the medical literature. While our own experience and the experience of almost every other high volume center in the country has been very encouraging, it is difficult to primarily recommend UFE in any patient wishing to preserve their fertility. That said, this experience does allow us to confidently offer UFE to patients that are not candidates for or do not wish to undergo a myomectomy.
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