Topics of Interest

Pregnancy after Uterine Fibroid Embolization

Journal: Fertil Steril. 2010 Sep 24. [Epub ahead of print]

Authors: Pisco JM, Duarte M, Bilhim T, Cirurgião F, Oliveira AG.

Study from: Department of Radiology, St. Louis Hospital; New University of Lisbon, Portugal.

Problem: The safety of pregnancy following embolization (UAE) is uncertain because there have been few publications examining this issue.

Study: In a single hospital in Portugal, UAE was performed in 74 patients who wanted to become pregnant.

Results: Of the 74 women who wanted to become pregnant, 44 of them became pregnant (59.5%). Thirty-nine women completed pregnancies resulted in 33 successful live births (84.6%), four miscarriages (10.3%), one induced abortion, and one stillbirth. Two women delivered early, at 36 weeks (6.1%), and five babies were low birth-weight. At the time of publication, five other women had ongoing pregnancies.

Authors’ Conclusions: Pregnancy after UAE appears to be safe.

Dr. Parker’s Comments: Although this is a small study (only 44 pregnant women), it is reassuring. An earlier study from Toronto found a slightly higher risk of bleeding from the placenta or difficulty removing the placentas after delivery in women who had UAE. The current study did not find these problems. Unfortunately, there are very few studies of women who have had a myomectomy before getting pregnant to see if there were any problems with their pregnancies.

Many interventional radiologists do not perform UAE for women who wish to get pregnant and I wonder if this new information will change their opinions. Personally, I will advise women about this study and suggest that there is less reason to be nervous about getting pregnant after UAE. It would be nice to have more information to help advise women regarding the outcomes of pregnancies for women who get pregnant with fibroids, and for women who have had UAE or myomectomies.

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2 Comments

  1. Nelly
    Posted January 16, 2011 at 5:17 pm | Permalink

    Would the number of myomas and location have any influence on which method of treatment would be better, if the patient wished to retain her ability to have children?
    I read that intramural myomas are most effectively treated by UAE, and that for multiple myomas UAE is also a better option that myomectomy as many resections can do more harm to the uterine wall and have more negative effects on fertility than UAE?

  2. Posted January 28, 2011 at 8:54 pm | Permalink

    The only fibroids that clearly interfere with fertility are those that bulge into the uterine cavity. No large study has looked at size or number of fibroids, so we really don’t know the answer to this question. Most interventional radiologists do not recommend UAE for women who wish to get pregnant due to a few satudies that found a slight increased risk of complications, although one recent study showed good results. Fibroids push the normal uterine muscle away, but do not destroy the muscle. Therefore, it is always possible for a skilled myomectomy surgeon to reconstruct the uterus. There are no studies that compare fertility after UAE and myomectomy.

    Bill Parker, MD

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in San Diego, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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