Uterine fibroid embolization (UFE) is a minimally invasive treatment option for uterine fibroids, which are benign growths in the uterus that commonly cause symptoms like heavy bleeding and pelvic pain. This procedure has grown in popularity because it offers a uterine-sparing alternative to major surgery, such as a hysterectomy. For women who still desire to have children, the central concern regarding this treatment is its potential impact on the ability to conceive and safely carry a pregnancy. While UFE effectively treats fibroid symptoms, its use in patients planning future pregnancy requires a careful examination of current medical evidence.
Understanding Uterine Fibroid Embolization
Uterine fibroid embolization is an image-guided, non-surgical procedure performed by an interventional radiologist. A thin, flexible catheter is inserted into an artery, typically in the groin or wrist. Using X-ray guidance, the physician navigates the catheter through the blood vessels until it reaches the uterine arteries, which are the main blood supply to the fibroids.
Once positioned, tiny embolic agents, often microscopic beads, are injected. These particles travel into the small arteries supplying the fibroids and block the blood flow. Cutting off the blood supply causes the tumors to shrink and die over a period of months. The goal is to alleviate symptoms while preserving the uterus.
UFE and Conception Rates
Some research suggests that the fertility rate following UFE is comparable to that of myomectomy, the surgical removal of fibroids. For example, one study reported a fertility rate of 58.1% for women who underwent UFE, marginally higher than the 57% rate observed after myomectomy in the same population.
Other investigations have raised concerns, pointing to a potentially lower overall pregnancy rate after UFE compared to myomectomy. The procedure reduces blood flow to the uterus, which may theoretically cause changes in the uterine lining that could affect embryo implantation. However, for many women whose fibroids caused infertility, UFE successfully restores the ability to conceive by shrinking the tumors.
Patient-specific factors also influence the likelihood of conception after UFE. A woman’s age is important, as there is an age-related risk that UFE could impair ovarian function. Women over 45 face a documented risk of premature amenorrhea following the procedure. Therefore, the decision to pursue UFE when future fertility is a goal must be highly individualized.
Gestational Risks Following UFE
Pregnancies following UFE may be associated with an increased risk of specific gestational complications compared to women without prior treatment or those who had a myomectomy. These risks include higher rates of miscarriage (spontaneous abortion). Some UFE cohorts have reported miscarriage rates around 11.1%.
Another concern is the increased likelihood of preterm delivery (birth before 37 weeks of gestation). Studies comparing UFE patients to those who underwent myomectomy have found elevated odds for preterm birth in the UFE group. Potential placental complications, such as abnormal placentation, are also linked to the procedure’s effects on the uterine blood supply and lining.
Despite these risks, the majority of pregnancies following UFE result in a successful delivery. The risk profile necessitates closer monitoring by an obstetrician. In one large study, the rates for preterm delivery were approximately 10% and low birth weight was 13.3%, indicating that many pregnancies proceed without major incident.
Comparing UFE to Fertility-Preserving Procedures
When fertility preservation is the primary goal, myomectomy (surgical removal of fibroids while leaving the uterus intact) has historically been the preferred treatment. Myomectomy is generally the gold standard because it allows for direct removal of the fibroids and repair of the uterine wall, which minimizes long-term pregnancy risks. However, myomectomy is an invasive surgery that requires a longer recovery period and carries a risk of fibroid recurrence.
UFE is a less invasive procedure with a significantly faster recovery time. It is particularly useful for women who have numerous fibroids or fibroids in locations that make surgical removal difficult. Furthermore, UFE may allow for a future vaginal delivery, while myomectomy often necessitates a Cesarean section due to the risk of uterine rupture.
The choice between UFE and myomectomy should be a shared decision between the patient and her healthcare team. This decision weighs the benefits of faster recovery and less invasiveness against the potential for higher gestational risks. While UFE may require a reintervention more frequently than myomectomy, it remains a viable option for women who prioritize a non-surgical approach.