Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors
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To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE).
Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor.
Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 μm.
Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed.
Fifteen patients, aged 34.8 years (95%CI 32.2–37.5, median 36.0, q1–q3 29.4–39.5) were included from November 2008 to May 2012.
During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%–61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%–85%) and the quality of life score was improved by 112% (95%CI 21%–204%). Uterine volume was reduced by 38% (95%CI 24%–52%).
Women were followed for 43.1 months (95%CI 32.4–53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids.
Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted.
• Women without infertility factors showed an encouraging delivery rate after UAE.
• For women choosing UAE over abdominal myomectomy, childbearing may not be impaired.
• Data are insufficient to definitively recommend UAE as comparable to myomectomy.
• Further randomized trials comparing fertility after UAE or myomectomy are warranted.
KeywordsLeiomyoma Uterine artery embolization Symptoms Fertility Clinical trial
follicle stimulation hormone
magnetic resonance imaging
oocytes donation programme
uterine artery embolization
symptom and quality of life questionnaire validated for fibroids
95% confidence intervals
The authors thank Doctor Benedicte Paillusson, Doctor Penelope Labauge and all the staff of the gynecology and radiology departments of the Poissy Hospital for their skilled technical assistance. The authors thank Curt Cornell for his kind help in reviewing the English of the paper, and Sylvain Goupil, from the Clinical Research Department of Assistance Public Hôpitaux de Paris, for his help in constituting the database.
This study was supported by an institutional grant (CIRC) from “Assistance Publique - Hospitaux de Paris”. The sponsor had no role in study design, data collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.
All procedures performed in the women included in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors declare there is no potential conflict of interest, of a financial or any other nature.
Clinical trial P071006 (February 2009, https://clinicaltrials.gov)
The scientific guarantor of this publication is Professor Arnaud FAUCONNIER. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational, multicenter study.
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