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Fertility after uterine artery embolization of fibroids: a systematic review

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Abstract

Purpose

The impact of uterine artery embolization (UAE) for the purpose of diminishing the effect of uterine fibroids on fertility is unclear. We have investigated the reported rates of pregnancy and miscarriage after treatment of uterine fibroids with UAE.

Materials and methods

We searched for relevant information in PubMed and Embase for randomized controlled trials (RCT), controlled clinical trials, comparative before–after trials, cohort studies, case–control studies and case series where UAE treatment of premenopausal women was performed for uterine fibroids with and where a control intervention was included. The PRISMA guideline was used to do a systematic review using the main outcomes pregnancy rate and miscarriage rate. Risk of bias was assessed by the Cochrane risk of bias tool or by ROBINS-I. The quality of evidence was assessed by the GRADE approach.

Results

We included 17 studies (989 patients): 1 RCT, 2 cohort studies, and 14 case series. Pregnancy rates after UAE were 50% in the RCT and 51 and 69% in the cohort studies. Among the case series median pregnancy rate was 29%. Miscarriage rates were 64% in the RCT. Miscarriage rates at 56 and 34% were found in the cohort studies after UAE. The median miscarriage rate was 25% in the case series.

Conclusion

Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy. However, we found very low quality of evidence regarding the assessed outcomes and the reported proportions are uncertain. There is a need for improved prospective randomized studies to improve the evidence base.

Systematic review registration number: CRD42016036661.

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Acknowledgements

This review received an un-restricted Grant from The University of Southern Denmark.

Author information

Authors and Affiliations

  1. Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 10, 10.sal, 5000, Odense C, Denmark

    K. Karlsen, M. Korsholm & P. Ravn

  2. Center for Evidence-Based Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark

    A. Hrobjartsson

  3. Department of Gynaecology, Karolinska Institute Stockholm and the University of Southern Denmark, Karolinska University Hospital Stockholm, Stockholm, Sweden

    O. Mogensen

  4. Faculty of Health, The Fertility Clinic, Skive Regional Hospital, Aarhus University, Skive, Denmark

    P. Humaidan

Authors
  1. K. Karlsen
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  2. A. Hrobjartsson
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  3. M. Korsholm
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  4. O. Mogensen
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  5. P. Humaidan
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  6. P. Ravn
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Contributions

KK: Data curation, formal analysis, methodology, project administration, and writing original draft. AH: Methodology, supervision, writing review, and editing. MK: Data curation, formal analysis, writing review, and editing. OM: Supervision, writing review, and editing. PH: Supervision, writing review, and editing. PR: Formal analysis, supervision, writing review, and editing.

Corresponding author

Correspondence to K. Karlsen.

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All authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Karlsen, K., Hrobjartsson, A., Korsholm, M. et al. Fertility after uterine artery embolization of fibroids: a systematic review. Arch Gynecol Obstet 297, 13–25 (2018). https://doi.org/10.1007/s00404-017-4566-7

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  • DOI: https://doi.org/10.1007/s00404-017-4566-7

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