SIR: Pregnancy Possible After Fibroid Embolization By Kristina Fiore, Staff Writer, MedPage Today
Published: March 15, 2011
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
-------------------------------------------------------------------------------------------
Explain that a small, single-center study found women who underwent uterine fibroid embolization (UFE) had a subsequent fertility rate comparable to that of surgical removal of fibroids.
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
TAMPA -- Fertility rates after uterine fibroid embolization (UFE) are comparable to those following myomectomy, researchers said here.
In a small, single-center study, women who had the procedure had a subsequent fertility rate of 58.1%, Joao Martins Pisco, MD, of St. Louis Hospital in Lisbon, Portugal, and colleagues reported at the Society of Interventional Radiology (SIR) meeting here.
That compares with a rate of about 57% for surgical removal of fibroids, Pisco said.
"UFE should not be contraindicated in patients who want to conceive," he said. "They should be able to choose between surgical options and UFE."
Pisco referred to 2004 guidelines from the American College of Obstetricians and Gynecologists, which advise that UFE should not be used if the patient wants to get pregnant. Instead, myomectomy, or full surgical removal of fibroids, is considered the gold standard in women who wish to conceive.
But John Lipman, MD, of Emory University in Atlanta and a spokesperson for SIR who was not involved in the study, noted that patients have about a 50% reduced fertility after their first myomectomy, which declines even more after subsequent procedures.
So, to evaluate fertility rates after UFE, the researchers performed the procedure on 743 patients, 74 of whom wanted to preserve their ability to become pregnant.
None of those women could successfully conceive at the time of UFE, and their mean age was 36.2 years.
Uterine arteries were embolized with either polyvinyl alcohol particles (26 patients) or embozene microspheres (three patients).
The procedure was x-ray-guided and done under local anesthesia, but Pisco noted that "if [the] patient wants to get pregnant, we do the embolization in a different way, . . . using a lower x-ray time, and we embolize only vessels giving blood to fibroids."
Among those 74 patients, 43 became pregnant after the procedure, for a total fertility rate of 58.1%, compared with a rate of 57% for patients with myomectomy.
Their mean time to conception was 10.8 months.
Pisco reported a total of 36 finished pregnancies, with 30 successful live births.
The remaining pregnancies had the following results:
13.8% had spontaneous miscarriage
10% had preterm delivery
13.3% had low birth weight
There were no significant neonatal problems, Pisco said.
Seven other women have ongoing pregnancies with normal evolution and are waiting for term.
Lipman, who wasn't involved in the study, called the pregnancies "remarkable."
"We've been told that you can't do UFE on patients who want to get pregnant," he said.
He cautioned, however, that patient selection is important, especially the woman's age.
"You have to look at each patient. You have to assess if she's symptomatic, and second, you have to ask, what is her chance of truly getting pregnant?" he said.
Pisco said larger randomized, controlled trials should be done comparing UFE and myomectomy.
The researchers reported no conflicts of interest.
妊娠・出産希望者に対するUAEは
1）低線量で行う。
2）マイルドな塞栓にとどめる。
ということです。
UAEは塞栓物質で行うものではなく、“腕”と“心”で行うものなのです。
