The traditional treatment of uterine fibroids in patients who wish to become pregnant is surgical removal by myomectomy. However, the minimally invasive interventional procedure of uterine fibroid embolization has a lower complication rate and has a comparable fertility rate to myomectomy after treatment, according to researchers from the United Arab Emirates.
Uterine fibroids
Uterine fibroids are benign tumors in the uterus that can cause prolonged, heavy menstrual bleeding that can be severe enough to cause anemia or require transfusion. Patients may also have disabling pelvic pain and pressure, urinary frequency, pain during intercourse, miscarriage, interference with fertility, and an abnormally large uterus resembling pregnancy.
Dr. Jamal Alkoteesh Dr. Jamal Alkoteesh is the chief of interventional radiology and chairman of radiology at Al Ain Hospital in the United Arab Emirates. Approximately 15% to 30% of Arabic women who are 35 and older have uterine fibroids. An increasing number of women are delaying pregnancy until their late 30s, which is also the most likely time for fibroids to develop.
The impact of uterine fibroids on pregnancy, the risk, and type of complications appear to be related to their size, number, and location. Certainly, infertility results when fibroids grow large enough that they obstruct one or both of the fallopian tubes. Additionally, fibroids are associated with a higher rate of miscarriage when they grow into the cavity of the uterus where embryos implant (i.e., submucus or intracavitary). The traditional treatment of uterine fibroids in patients who wish to become pregnant is surgical removal by myomectomy. This treatment is usually effective, particularly if the fibroid is single and subserosal in location, the fibroids are in small number, and they are small or medium in size.
The traditional treatment of uterine fibroids in patients who wish to become pregnant is surgical removal by myomectomy. This treatment is usually effective, particularly if the fibroid is single and subserosal in location, the fibroids are in small number, and they are small or medium in size.
The minimally invasive interventional radiology procedure of uterine fibroid embolization (UFE) has a lower complication rate than myomectomy. It may be performed if a woman has a single fibroid, many fibroids, or large-sized fibroids and a gynecologist cannot rule out a hysterectomy during myomectomy, myomectomy is unsuccessful, or when fibroids recur after myomectomy. The procedure may also be performed for women who want to avoid surgical removal for culture reasons, surgically high-risk women with fibroids, women of any age with fibroids who want to preserve their uterus and avoid the psychological trauma of hysterectomy, and, more important, in unmarried virgin women with fibroids.
34-year-old woman with uterine fibroid treated by UFE A 34-year-old woman presented with menorrhagia for nine days. The patient also had rheumatic mitral valve stenosis. Ultrasound scan of the uterus before embolization showed a 10 x 8-cm uterine fibroid with tense vascularity, which was treated by UFE. All images courtesy of Dr. Jamal Alkoteesh. Key findings & Arab Health 2016
Uterine fibroid embolization blocks blood supply to treat painful uterine fibroids, and the procedure has a comparable fertility rate to myomectomy for women who want to conceive, according to what is thought to be the first study on the subject in the Middle East. The study was conducted by our group at Al Ain Hospital and presented ahead of print at the 2016 Arab Health Conference in Dubai, United Arab Emirates, in January and also presented at the Abu Dhabi annual gynecology conference in October 2015 and the Cleveland Clinic Abu Dhabi radiology conference in November 2015.
Left uterine fibroid embolization in progress. Left uterine fibroid embolization in progress. In this study, most women opted for UFE as a fertility treatment after failure of myomectomy or in vitro fertilization, or because hysterectomy was the only suggested option. Of the 210 patients who received UFE treatment, 35 women younger than the age of 40 wanted to conceive and had been unable.
Premature menopause, hysterectomy, and radiation exposures have been identified as barriers to fertility when treating women with UFE, and they might occur with other known UFE complications in a very small number of patients, less than 4%. However, uterine fibroids themselves rarely cause infertility, but they may be a causative factor of pregnancy loss. The study participants were advised to wait six months or more after UFE before attempting to conceive, of which the reported time range before attempting to conceive was seven to 33 months (average 20 months).
Patient who became pregnant eight months post UFE Patient who became pregnant eight months post UFE. Obstetric third-trimester ultrasound images of a single fetus at age of 31 weeks 1 day and also at 34 weeks 1 day by last menstrual period (LMP). The previously embolized fibroid now measured 8.2 x 7.8 x 7.6 cm with degenerative changes.
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