If fertility is a consideration, choose myomectomy over UFE.(Gynecologic Surgery)(uterine fibroid embolization)

TORONTO -- Fibroid patients who want to preserve or improve their chances of having children should undergo uterine fibroid embolization only if they are not good candidates for myomectomy, Dr. Gary P. Siskin told his colleagues at the annual meeting of the Society of Interventional Radiology.

He cautioned that, although the minimally invasive procedure has several advantages over myomectomy in treating fibroids (leiomyomas), uterine fibroid embolization (UFE) carries a higher risk of pregnancy complications than its surgical alternative.

"Based on [available] data, myomectomy is a procedure that can potentially help patients with fibroids have a child. In my opinion, this remains the preferred first option for these women," said Dr. Siskin, chief of vascular and interventional radiology at the Albany (N.Y.) Medical Center.

The anatomic and physiologic effects of fibroids on the uterine cavity include distortion of the endometrial cavity and reduction of uterine contractility, both of which interfere with placental implantation, thereby increasing the risk of spontaneous abortion and preterm labor. Nevertheless, Dr. Siskin said the direct impact of fibroids on fertility remains a controversial subject.

Fibroids are present in about 5%-10% of patients who are considered to be infertile and have been identified as the sole cause of infertility in 2% of these patients. In addition, the incidence of fibroids increases as a woman approaches menopause--when her fertility is in sharpest decline. However, many women with fibroids do achieve conception, though there may be complications.

Dr. Siskin pointed to the significant amount of postmyomectomy data suggesting a connection between fibroids and fertility. In particular, one comprehensive review of 23 studies in 1998 found an overall ...