Fertility After Uterine Artery Embolization of Fibroids: A Systematic Review

Karlsen, K., Hrobjartsson, A., Korsholm, M., Mogensen, O., Humaidan, P., & Ravn, P. (2018). Fertility after uterine artery embolization of fibroids: A systematic review. Archives of Gynecology and Obstetrics; 297, 13 – 25.

This article is a systematic review that examines the effect of uterine artery embolization on fertility, measured by rates of successful fertilization and miscarriage. Interestingly, they also compared these measures to the same ones in patients who were treated with myomectomy.

The researchers included 17 studies for a total of 989 participants, consisting of 1 randomized control trial, 2 cohort studies, and 14 case series. They found that pregnancy rates after the uterine artery emobolization were 50%, 51%, and 69% in the randomized control trial, cohort studies, and case series, respectively. They also found that the rates of miscarriage were 64%, 56%, and 34% respectively. The rates of pregnancy were lower in patients whose fibroids were treated with uterine artery embolization than with myomectomy, and the rates of miscarriage were higher than those treated with myomectomy.

I chose this article as it applied to the patient I presented in my second site visit, who had a history of recurrent fibroids treated with myomectomy that were now causing severely symptomatic iron-deficiency anemia secondary to menorrhagia. It was also very recently published and applied the Cochrane methodology in article selection. However, the researchers acknowledged that the quality of the available literature was not high and the study was published in Denmark. In addition, with only 989 participants, there is a limited amount of power being lent to the result.