Fibroids and Fertility: A Comparison of Myomectomy and Uterine Artery Embolization on Fertility and Reproductive Outcomes. Issue 8 (August 2022) - Zanolli, Nicole C.
Abstract : Importance: Leiomyomata, or fibroids, are a common gynecological problem affecting many women of reproductive age. Historically, myomectomy is offered to women with symptomatic fibroids who desire to preserve fertility. More recently, uterine artery embolization (UAE) has been explored as another fertility-sparing option. Objective: This review aims to provide an in-depth summary of the effects on fertility and reproductive outcomes following myomectomy and UAE for the treatment of symptomatic fibroids. Evidence Acquisition: Articles were obtained from PubMed using search terms myomectomy, uterine artery embolization, and fertility, as well as American Society of Reproductive Medicine practice committee reports. References from identified sources were searched to allow for thorough review. Results: While myomectomy and UAE are both fertility-sparing options for women with fibroids, reproductive outcomes following myomectomy are superior to UAE with higher rates of clinical pregnancy and live births and lower rates of spontaneous abortion, abnormal placentation, preterm labor, and malpresentation. Conclusions: Myomectomy should be offered to women with symptomatic submucosal or cavity-distorting fibroids who have a strong desire for a future pregnancy. For women who are not appropriate surgical candidates, UAE can be offered, although detrimental effects on future fertility should be disclosed. Relevance: A thorough understanding of the efficacy of both myomectomy and UAE, as well as their impact on future fertility, allows for improved counseling when deciding the optimal intervention for women with fibroids who desire future fertility. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, the learner should be better able to describe the pathophysiology and clinical presentation of fibroids, with an emphasis on their impact on fertility; compare the indications, procedural techniques, and outcomes following myomectomy and UAE; and explain fertility and pregnancy outcomes following both myomectomy and UAE.