Uterine Fibroid Embolization (UFE) is a minimally invasive procedure designed to treat symptomatic uterine fibroids, which are benign muscle tumors of the uterus. For many women diagnosed with these growths, especially those in their reproductive years, the immediate question is how treatment options might affect their ability to conceive and carry a pregnancy. This has led to research focused on understanding the relationship between UFE and fertility. The current medical understanding examines the procedure’s mechanism and its specific effects on the reproductive system.
Understanding Uterine Fibroid Embolization
UFE is an image-guided, non-surgical treatment performed by an interventional radiologist. The procedure involves making a small puncture, typically in the groin, to access the femoral artery. A thin, flexible catheter is then inserted and guided using X-ray imaging until it reaches the uterine arteries, which supply blood to the uterus and the fibroids.
Once positioned, tiny embolic agents, often microscopic beads, are injected into the arteries. These particles travel downstream and become lodged in the smaller vessels that feed the fibroids. This action effectively cuts off the blood supply to the tumors, causing them to shrink and eventually die, leading to a significant reduction in fibroid-related symptoms. The procedure is designed to be selective, targeting the highly vascular fibroids while preserving blood flow to the surrounding healthy uterine tissue.
The Specific Impact of UFE on Fertility
The question of whether UFE causes infertility lacks a simple answer, as research findings are often mixed and dependent on patient-specific factors. The primary concern is that embolic agents could inadvertently travel to the ovarian arteries through tiny collateral blood vessels that connect the uterine and ovarian blood supplies. This potential “non-target embolization” can compromise ovarian function by reducing blood flow to the ovaries.
Impairment of ovarian function may manifest as a reduction in ovarian reserve, which is the quantity and quality of remaining eggs. While some studies using markers like Anti-Müllerian Hormone (AMH) suggest UFE does not significantly affect ovarian reserve in women under 40, a small risk of premature ovarian failure remains a possibility. This risk, often cited between 1% and 3%, is higher for those closer to the age of natural menopause.
A second concern involves potential compromise to the endometrium, the lining of the uterus. Although the procedure intends to preserve the uterine blood supply, the overall reduction in blood flow after UFE may impair the lining’s ability to support a pregnancy. A diminished endometrial environment could hinder the successful implantation of an embryo, potentially leading to fertility challenges. For women prioritizing future pregnancy, medical professionals advise caution when considering UFE as a first-line treatment.
Comparing UFE to Myomectomy for Future Pregnancy
Myomectomy, the surgical removal of fibroids, has traditionally been the preferred treatment for women who wish to retain their fertility. Myomectomy aims to physically excise the fibroids while leaving the uterus intact, often resulting in strong post-procedure conception rates. However, it is a surgical procedure that requires a longer recovery time and carries risks such as post-operative scarring, adhesion formation, and potential blood loss.
UFE is less invasive and offers a significantly shorter recovery period, typically within one to two weeks, compared to the multiple weeks required for myomectomy. A trade-off is that myomectomy may create scar tissue on the uterine wall, which carries a small but serious risk of uterine rupture during future labor and delivery. In contrast, UFE avoids surgical incisions into the uterus, eliminating the risk of rupture due to a surgical scar.
The choice between the two methods balances invasiveness and potential complications, as studies on post-procedure pregnancy rates sometimes show comparable outcomes. While myomectomy is often associated with a lower rate of miscarriage, UFE may be a better option for women with numerous fibroids that would make surgical removal technically complex. Both procedures require careful discussion with a specialist to weigh the respective risks against individual fertility goals.
Pregnancy Outcomes Following UFE
For women who successfully conceive after UFE, the focus shifts to potential risks during the pregnancy itself. Available data suggests that pregnancies following UFE may be associated with increased rates of certain complications compared to the general obstetric population. These risks are likely related to the underlying fibroid condition and the lasting effects of the embolization on the uterine environment.
Reported complications include a higher incidence of miscarriage, with rates in some studies ranging between 22% and 30%. There is also an increased risk of pre-term delivery, which occurs before 37 weeks of gestation. Potential issues with the placenta and the risk of postpartum hemorrhage have also been observed. These issues include:
- Abnormal placentation or placenta previa.
- Heavy bleeding after delivery.
These complications may be more pronounced because women who opt for UFE often have complex fibroid burdens or are older, making them an atypical obstetric group. Given the potential for these elevated risks, consulting with a reproductive specialist is important before deciding on a fibroid treatment if a future pregnancy is desired. A specialist can help assess individual risk factors and guide the decision toward the most fertility-sparing option.