Fibroids and fertility

Bilateral uterine artery embolisation (UAE) is being increasingly adopted as a non-surgical treatment for fibroids. The main reason women give for wishing to avoid surgery is the desire to retain their fertility potential. However, there is virtually no data about how uterine artery embolisation (UAE) affects fertility. In an attempt to provide some information about this, we contacted several large centres to find out how many pregnancies had been recorded. We were able to identify at least 14 pregnancies out of 1000 UFE procedures. Therefore, in an attempt to establish a true denominator for women trying to conceive, we looked at reproductive factors in our own group of 192 patients undergoing UAE and identified 66 patients who were <40 years old. Only 17 were known to be trying to conceive. Significant complications were recorded in six patients that would be likely causes of subfertility. A review of the literature shows that patients undergoing surgical myomectomy have a 50% cumulative pregnancy rate following surgery. In view of the limited data on UAE patients, current evidence would suggest that myomectomy may be a better treatment option for the subgroup of women <40 years of age who are actively trying to conceive.