Uterine Fibroid Embolisation – Potential Impact on Fertility and Pregnancy Outcome

Abstract

The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes.

Zusammenfassung

Aktueller Therapiestandard bei Frauen mit Kinderwunsch zur Behandlung von Myomen ist die möglichst wenig invasive, operative Myomenukleation. Die Uterusarterienembolisation (UAE) zur Myomtherapie wird immer wieder als ebenfalls minimalinvasive Therapiemöglichkeit diskutiert. Die Übersichtsarbeit wertet die Literatur der letzten 10 Jahre zum Thema „Myomembolisation – Einfluss auf Fertilität und Schwangerschaft“ aus, wobei sowohl eine mögliche, mit der Intervention verbundene Strahlenbelastung der Ovarien, mögliche Störungen der Ovarialfunktion infolge der UAE als auch mögliche Auswirkungen auf Schwangerschaft und Geburt auf der Basis der vorliegenden Literatur ausführlich diskutiert werden. Die bisher publizierten mindestens 337 Schwangerschaften nach UAE wurden ausgewertet. Als Reviewergebnis kann die UAE von Myomen nur für Frauen mit myomassoziierten Fertilitätsproblemen empfohlen werden, die chirurgischen Maßnahmen ablehnen oder die ein inakzeptabel hohes chirurgisches Risiko aufweisen, denn vorliegende Fallserien und Studien zeigen, dass eine UAE zumindest das Abortrisiko deutlich erhöht; für weitere geburtshilfliche Outcome-Parameter gibt es Hinweise auf pathologisch erhöhte Werte. Es liegen weiterhin nur wenige prospektive Studien vor, deren Ergebnisse mit der erforderlichen Evidenz eine Aussage über den Einfluss der UAE-Therapie auf Fertilitätsrate und Schwangerschaftsausgang zulassen.

Key words

embolisation - myoma - fertility - pregnancy - birth

Schlüsselwörter

Embolisation - Myom - Fertilität - Schwangerschaft - Geburt

• References

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