By Alicia Armeli
For many women with fibroids, the desire for future pregnancy is an important part of the fibroid treatment decision-making process. If you’ve been told surgery is your only option, keep reading. Uterine fibroid embolization (UFE) is a minimally invasive procedure with an approximate 90% cure rate that research also shows can be a safe option for women who desire future pregnancy.1
“I was 32 and the only option I was given was hysterectomy.”
Over a decade ago, LaMechee was diagnosed with uterine fibroids, but like most women, her fibroids weren’t a problem—until they were. “My fibroid symptoms got progressively worse in my late twenties. I had pain and heavy cycles to the point that my lips would turn blue,” recalls LaMechee Favors of Atlanta, GA. “I went from working full-time to working two weeks out of the month. I knew I needed treatment, but I waited. I was 32 and the only option I was given was hysterectomy. I knew I wanted children in the future.”
The surgical removal of the uterus, also known as hysterectomy, is the second most frequently performed major surgical procedure in the United States among reproductive-aged women.2 According to the American College of Obstetricians and Gynecologists, the most common reason for the procedure is to treat symptomatic fibroids, a type of noncancerous growth that develops in the wall of the uterus.3 And even though fibroids aren’t always symptomatic, for some women they can be the cause of heavy periods, urinary frequency, and pelvic pain and pressure.
For women like LaMechee whose experience with fibroids was severe, finding out surgery was her only path to relief was disheartening to say the least. “At that time I had one child. My gynecologist told me I should forget about having more children and that one child was enough,” LaMechee explains. “He said he would go ahead and schedule the surgery, but I kept thinking there had to be something other than hysterectomy. I started to research my options and that’s when I found UFE.”
Uterine Fibroid Embolization
Unlike surgery, UFE is an outpatient, minimally invasive procedure that involves injecting tiny embolic particles into the uterine arteries to deprive fibroids of blood. Once their circulation is blocked, fibroids begin to shrink and symptoms disappear. “I was really excited when I was told I didn’t need to be cut open for UFE,” LaMechee remembers. “The procedure was painless. I only needed a week to recover. I haven’t had an abnormal cycle since. And I still had the hope of becoming pregnant in the future.”
In the medical community, UFE has been considered a controversial treatment for women wanting to conceive. The possibility of insufficient blood flow to the lining of the uterus and the ovaries has been a concern. And yet, the clinical evidence in favor of UFE has been increasing steadily since 2000.4
Ovary Function After UFE
The ovaries produce the necessary hormones to conceive. Any procedure working within the reproductive tract leaves many women wondering if their ovarian function will be affected. As with any medical procedure, there are always risks. But in the case of UFE, the risk of ovarian failure has been seen mostly among older women who are closer to menopause.5,6,7
Studies that have looked at changes in hormone levels indicative of ovarian decline, such as follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH), have found it to be more common among women in their 40s.5,6 Data taken from the national FIBROID registry showed that only 7% of women 1-year after UFE no longer menstruated.7 Over 85% of these women were older than 45.
Why does this happen? It’s not entirely understood, but what has been noted is the intricate network of blood vessels that exists between the uterus and the ovaries. During treatment, it’s possible to disrupt this blood flow.5 Reports show the majority of women younger than 40 who experience any disruption in ovarian circulation post-UFE only experience this temporarily, whereas women who are closer to menopause may already be vulnerable to ovarian damage, leaving a small percentage not as capable of recovering normal ovarian function.5,6
Fertility After UFE
Having a healthy pregnancy and delivery are both possible after UFE. A 2017 study published in the journal Radiology investigated 359 women with fibroids unable to conceive who then underwent UFE.8 The researchers of the study followed up after an average of about six years. In that time, 149 women, or 41.5%, became pregnant at least once and 131 women gave birth to a total of 150 babies. It was the first pregnancy for over 85% of these women. Of the women with unsuccessful pregnancies, miscarriage was the most common reason.
The researchers concluded that UFE can be recommended to women with fibroids as a treatment option that restores fertility.8 And the good news keeps coming. Since the time of this study, there have been 12 more pregnancies resulting in two ongoing pregnancies and eight live births.
Pregnancy risks linked to UFE should be noted and can include preterm birth, abnormal presentation of the baby at delivery, c-section, low birth weight, and post-partum bleeding; but women with these complications also were seen to have additional risk factors, such as age.9 Other data have shown women younger than 40 maintaining pregnancies and giving birth without complication.10
Last year, a study published in the International Journal of Biomedicine showed that the frequency of pregnancy and delivery complications among women who have had UFE for fibroid treatment isn’t significantly different from healthy women without fibroids.11 What’s more, these complication rates were much lower in comparison to women with fibroids who haven’t had UFE but were treated with either medical therapy or had no other treatment at all. The researchers concluded that UFE is an effective fibroid treatment for women of reproductive age who desire pregnancy.
UFE and the Gift of Time
Despite these optimistic findings, surgically removing fibroids, a procedure called myomectomy, is considered standard fibroid treatment for women wanting to conceive—even though UFE and myomectomy have comparable fertility rates at 58.1% and 57%, respectively.12
Myomectomy is also linked to high fibroid recurrence rates, putting a woman at risk for multiple surgeries in her lifetime.1,13 But probably one of the biggest advantages UFE has in comparison to myomectomy is the gift of time. Gynecologists commonly encourage women to try getting pregnant during the six month ‘golden period’ after myomectomy when fibroids are least likely to recur.1,14 This advice isn’t always timely, as wanting immediate relief and being ready for a baby don’t always coincide. UFE, on the other hand, effectively alleviates symptoms without pressuring women to become pregnant right away.
“Before deciding on UFE, Dr. Lipman explained all my options. I knew I didn’t want surgery and I also wasn’t in the position to have a baby right away,” LaMechee continues. “As soon as I had the procedure, I went to work full-time in the airline industry. I could provide for my family appropriately. Five years later I met my husband.”
Happily Ever After
Wanting a baby together, LaMechee and her husband started trying to conceive. After a year and a half, she became pregnant with her second miracle at 41. “My pregnancy went well. It was considered high risk because of my age and because I work a very physically demanding job, lifting 30 to 40 pounds at a time,” LaMechee says. “Because I couldn’t lift what my job required me to lift, I stopped working around month six.”
Besides being diagnosed with abnormal placentation, LaMechee describes her pregnancy as uneventful. The only change she had to make was opting out of a home birth and delivering in the hospital—a small price to pay for a baby boy LaMechee says is her “total joy.”
“I have an amazing, bright little boy. His name is Aariston,” LaMechee beams. “It has been life changing. There was a time when I settled on the idea of not having more children. Now I’m in a relationship with a man I love. I have two children—one is ready to graduate. I lead a completely different life.”
It has been 10 years since LaMechee had UFE and she remains symptom-free. “Dr. Lipman changed my life. He cares about his patients. If I had known then what I know now, I would’ve done it sooner.”
1. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol, 25(1): 1-7.
2. National Women’s Health Network. (2015). Hysterectomy. Retreived from https://www.nwhn.org/hysterectomy/
3. The American College of Obstetricians and Gynecologists. (2015). Frequently Asked Questions: Special Procedures (Hysterectomy). Retrieved from http://www.acog.org/Patients/FAQs/Hysterectomy
4. Ravina, J. H., Vigneron, N. C., Aymard, A., et al. (2000). Pregnancy after embolization of uterine myoma: report of 12 cases. Fertil Steril, 73(6): 1241–1243.
5. Kaump, G. & Spies, J. (2013). The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol, Apr; 24(4): 459-467.
6. Kim, C. W., Shim, H. S., Jang, H., et al. (2016). The effects of uterine artery embolization on ovarian reserve. Eur J Obstet Gynecol Reprod Biol, Nov; 206: 172-176.
7. Spies, J. B., Myers, E. R., Worthington-Kirsch, R., et al. (2005). The FIBROID registry: symptom and quality of life status 1 year after therapy. Obstet Gynecol, Dec; 106(6): 1309-1318.
8. Pisco, J. M., Duarte, M., Bilhim, T., et al. (2017). Spontaneous pregnancy with a live birth after conventional and partial uterine fibroid embolization. Radiology, Jun; 13: 161495.
9. Goldberg, J., Pereira, L., Berghella, V., et al. (2004). Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am J Obstet Gynecol, 191(1): 18–21.
10. McLucas, B. (2013). Pregnancy following uterine artery embolization: an update. Minim Invasive Ther Allied Technol, 22: 39-44.
11. Dobrokhotova, J. E., Grishin, I. I., Ibragimova, D. M., et al. (2016). Uterine artery embolization and pregnancy.
actual and controversial issues of gestation terms and delivery. IJBM, 6(1): 33-37.
12. Pisco J. M., Duarte, M., Bilhim, T., et al. (2010). The Outcome of Pregnancy Following Uterine Fibroid Embolization [Abstract 50]. New University of Lisbon, Lisbon, Portugal. SIR Annual Scientific Meeting, March 13, 2010.
13. Reed, S. D., Newton, K. M., Thompson, L. B., et al. (2006). The incidence of repeat uterine surgery following myomectomy. J Womens Health, Nov; 15(9): 1046–52.
14. Candiani, G. B., Fedele, L., Parazzini, F., et al. (1991). Risk of recurrence after myomectomy. Br J Obstet Gynaecol, Apr; 98(4): 385–389.