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Women with fibroids who want to get pregnant need to research all treatment options to ensure their future fertility is protected. Despite more than 20 years in use, embolization treatments (also known as Uterine Artery Embolization, UAE or Uterine Fibroid Embolization, UFE), for fibroids are still a higher risk for women who want to conceive.
“Countless studies have reviewed the after-effects of embolization treatments for fibroids, and the majority of authorities on women’s reproductive health still caution that embolization is not recommended for women who intend to get pregnant,” said Paul MacKoul, MD. “Laparoscopic myomectomy is the procedure of choice for women with fibroids who want to conceive. Sadly, we see many patients who have had embolization treatments who wanted to be able to have children but, were advised by their OBGYN that UFE was a safe option for them. It is common for these women to have either faced difficulty getting pregnant or to have had miscarriages after having UFE.”
While UFE has been shown to provide short-term benefits in controlling bleeding associated with fibroids, the long-term effects are less positive. The reintervention rate (meaning patients who needed additional treatment after UFE, including additional UFE, myomectomy or hysterectomy procedures) was higher than laparoscopic myomectomy.
Pregnancy Complications After UFE: Peer-reviewed Studies
After undergoing embolization treatments, multiple studies have shown women have difficulty conceiving due to impaired ovarian reserve and have a higher risk of complications during pregnancy including placental abruption, miscarriage, and pre-term births.
The American College of Obstetricians and Gynecologists (ACOG) committee issued an opinion in 2004 based on a review of existing medical literature at the time, which stated that while UFE is appropriate for treating women with fibroids for short-term relief of bulk-related symptoms (frequent urination, bloating, pain), due to the lack of evidence to ensure a woman’s ability to retain fertility, the recommendation was to avoid UFE or UAE treatments. From the ACOG Committee Opinion Uterine artery embolization: “There is insufficient evidence to ensure [uterine artery embolization] safety in women desiring to retain their fertility, and pregnancy-related outcomes remain understudied.”
Subsequent research has continued to show a lack of confidence in embolization procedures as a treatment for women who wish to maintain fertility.
A 2014 study, Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms conducted by Torre A, et al., reviewed 66 women who were treated with UAE who desired a future pregnancy. “…no woman in this study delivered successfully after UAE.” One in 31 women (those who were actively trying to get pregnant) became pregnant, and she miscarried. The low reproductive outcomes reported in the present study suggest that UAE should not be performed routinely in young women of childbearing age with extensive fibroids.
In January 2018, a meta-analysis of 17 studies reviewed by Karlsen K., et al., found that the negative effects on fertility are a contraindication for embolization. Fertility after uterine artery embolization of fibroids: a systematic review: “Pregnancy rate was found to be lower and miscarriage rate higher after UAE than after myomectomy.”
UpToDate, the premier source of evidence-based clinical recommendations states that the ideal candidate for embolization has heavy menstrual bleeding, is premenopausal, and has no desire for future pregnancy.
The LAAM Myomectomy Is the Procedure of Choice for Women Seeking Fertility
The fibroid removal procedure of choice for maintaining fertility is a laparoscopic myomectomy performed by a skilled minimally invasive GYN specialist.
Myomectomy is a surgical procedure that removes the fibroids from the uterus. If a myomectomy is performed as a laparoscopic procedure, depending on the placement and size of the incisions, it can provide patients immediate relief with faster recovery than even UFE procedures.
Some laparoscopic myomectomy procedures are limited in the size or number of fibroids that can be removed due to the size of the incisions, but these smaller incisions are part of the reason for the faster recovery. By comparison, open myomectomies are more thorough than standard laparoscopic procedures, both in removal and repair of the uterus but, can take between 6-8 weeks for recovery. The LAAM myomectomy is a hybrid approach, which takes the best of both surgical techniques: smaller incisions of a laparoscopic procedure and the thoroughness of the open procedure.
Using advanced techniques to control for blood loss and to improve visibility, the LAAM laparoscopic assisted abdominal myomectomy is one of the most minimally invasive fibroid removal procedures that also ensures removal of all fibroids. Patients with large fibroids or small, hard to see fibroids, can be treated thoroughly with LAAM.
The additional advantage of LAAM is that the uterus is repaired by hand, ensuring that once it heals, the uterus can be strong enough to maintain a pregnancy. Patients experience long-term relief of symptoms and have improve mobility faster after the fibroid removal procedure, which aids in recovery. LAAM is performed as an outpatient procedure, so there is no hospital stay. Women recover at home and are back to themselves in 10-14 days. With controlled blood loss and improved visibility, the procedure is performed efficiently, which means less time under anesthesia compared to other myomectomy techniques.
CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. CIGC minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind. Book a consultation at The Center for Innovative GYN Care or call 888-787-4379.