Uterine Fibroids are one of the most common anatomic findings encountered in reproductive-aged women. Depending upon their size and location, fibroids, or myomata, can be responsible for a wide range of symptoms, including pelvic pain and heavy menstrual bleeding. When the fibroids grow to a degree that they press upon other organs such as the intestines or bladder, patients may even begin to experience constipation, bloating, and urinary frequency. In advanced case, especially with fibroids found deep within the uterine wall, significant anemia can also occur.
The association of uterine fibroids and pregnancy potential is one that is not clearly understood in many cases. Certainly when fibroids grow to the point that they obstruct one or both of the fallopian tubes, infertility results. Additionally, fibroids that grow into the cavity of the uterus where pregnancies implant (i.e. submucus or intracavitary) are associated with a higher rate of miscarriage. Along these lines, the treatment of this condition is more controversial when childbearing is still desired. While surgery (myomectomy), has always been the mainstay of fibroid therapy in patients with future fertility desires, newer, less invasive procedures have recently emerged. One such option is Uterine Artery Embolization, or Uterine Fibroid Embolization (UFE). In this procedure, a catheter is passed by a trained radiologist into a blood vessel in the patient’s groin, and plastic or gelatin particles are injected through this catheter into the arteries that supply blood to the fibroids in the uterus. This will stop the blood flow to those fibroids which over time causes them to shrink and thus relieves the symptoms they are causing. Nevertheless, this procedure has been considered to be contraindicated in patients desiring pregnancy due to the risk of miscarriage, ovarian compromise, and other factors that may prevent successful implantation.
However, a recent study by Dr. Joao-Martins Pisco found that the fertility rate in women undergoing UFE was comparable to those reported for myomectomy; 58% vs. 57%. Dr. Pisco, an interventional radiologist at St. Louis Hospital in Lisbon, reported on 74 women who underwent UFE, all of whom were informed ahead of time about the uncertain effect it had on fertility and pregnancy. None of the patients had been able to conceive prior to UFE, yet more than half of the women; i.e. 58%, had spontaneous pregnancies following the procedure. Of these patients, 84% had successful live births, and at the time of the report, 7 of the remaining pregnancies were still ongoing.
The above study sheds a new light on the modern day treatment of uterine fibroids. The advantages of procedures such as UFE over traditional surgery include a much shorter recovery time (~ 1 week vs. 6 – 8 weeks with surgery), no significant blood loss, no abdominal incisions, and generally only one overnight stay in the hospital. While Dr. Pisco points out that larger multicenter studies are needed in this area, the findings of his research have tremendous, exciting potential in shaping the current recommendations for treating uterine fibroids in women desiring future pregnancy.