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An increasing number of women are delaying pregnancy until their late thirties, which is also the most likely time for fibroids to develop. There is conflicting evidence in the medical literature regarding the impact of fibroids on pregnancy; however, the risk and type of complication appear to be related to the size, number and location. Women may not know they have fibroids (asymptomatic) and undergo fertilization in vitro treatments rather than getting treatment for fibroids. “Women should know that uterine fibroids may be a cause of infertility spontaneous abortion and that their treatment is mandatory, and that UFE may be the only effective treatment. However, the guarantee of pregnancy after UFE cannot be assured.
The conventional treatment of uterine fibroids in patients who wish to become pregnant is myomectomy, which is surgical fibroid removal. This treatment is usually effective, particularly if the fibroids are in small number and of small or medium size. UFE, which has a lower complication rate than myomectomy, may be performed if a woman has multiple fibroids or large-sized fibroids and a gynecologist cannot rule out a hysterectomy (uterus removal) during myomectomy or if myomectomy is unsuccessful. If a patient has multiple myomas or large myomas UFE may the unique and safe method of treatment. In our experience the possibility of pregnancy following embolization are similar to those after myomectomy.
Many women opted for UFE as a fertility treatment after failure of myomectomy or fertilization in vitro or because hysterectomy was the only suggested option. From the patients treated at Saint Louis Hospital, 74 wanted to conceive and had been unable. Of those 74 women, 44 (average age of 35) became pregnant; the time between UFE and conception ranging from 2 to 22 months. At this time, there have been 36 completed pregnancies, resulting in 30 healthy births; eight women are still pregnant.
Most of the pregnancies after uterine fibroid embolization had good outcomes with few complications. The complication rate of the pregnancies was expected to be higher than the general population because these were high-risk patients who had already undergone fertility treatments and were unable to conceive. However, the percentage of the spontaneous abortions (11.8 percent), pre-term delivery (10.7 percent) and low birth weight (14.3 percent) was the same as the general population.