Pregnancy Following Uterine Artery Embolization with Polyvinyl Alcohol Particles for Patients with Uterine Fibroid or Adenomyosis
Man Deuk Kim,1 Nahk Keun Kim,2 Hee Jin Kim,1 Mee Hwa Lee2
1Departments of Diagnostic Radiology, Bundang CHA General Hospital, College of Medicine, Pochon CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Kyonggi-do 463-712, Republic of Korea 2Departments of Obstetric & Gynecology, Bundang CHA General Hospital, College of Medicine, Pochon CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Kyonggi-do 463-712, Republic of Korea
Abstract
Purpose: To determine whether uterine fibroid embolization (UFE) with polyvinyl alcohol (PVA) particles affects fertility in women desiring future pregnancy. Methods: Of 288 patients managed with UFE with PVA particles for uterine myoma or adenomyosis between 1998 and 2001, 94 patients were enrolled in this study. The age range of participants was 20–40 years. The data were collected through review of medical records and telephone interviews. Mean duration of follow-up duration was 35 months (range 22–60 months). Patients using contraception and single women were excluded, and the chance of infertility caused by possible spousal infertility or other factors was disregarded. Contrast-enhanced magnetic resonance imaging was performed in all patients before and after UFE, and the size of PVA particles used was 255–700 lm. Results: Among 94 patients who underwent UFE with PVA, 74 were on contraceptives, 6 had been single until the point of interview, and 8 were lost to follow-up. Of the remaining 6 patients who desired future pregnancy, 5 (83%) succeeded in becoming pregnant (1 patient became pregnant twice). Of a total of 8 pregnancies, 6 were planned pregnancies and 2 occurred after contraception failed. Five deliveries were vaginal, and 2 were by elective cesarean. Artificial abortion was performed in 1 case of unplanned pregnancy. There was 1 case of premature rupture of membrane (PROM) followed by preterm labor and delivery of an infant who was small-for-gestational-age. After UFE, mean volume reduction rates of the uterus and fibroid were 36.6% (range 0 to 62.6%) and 69.3% (range 36.3% to 93.3%), respectively. Conclusions: Although the absolute number of cases was small, UFE with PVA particles ultimately did not affect fertility in the women who underwent the procedure. Key words: Arteries, chemotherapeutic embolization— Arteries, uterine—Pregnancy—Uterine neoplasms, thera¬peutic radiology Uterine fibroid embolization (UFE) has been reported to be effective in managing symptoms caused by uterine myo¬mas [1–3]. Polyvinyl alcohol (PVA) particles are com¬monly used for UFE because of their high embolization effect. However, the effects of UFE with PVA particles on fertility and a woman's ability to maintain an intrauterine gestation are still uncertain. Only a few reports exist that concern pregnancy and UFE with PVA particles [4]. Moreover, many gynecologists and interventionalists are reluctant to perform UFE in patients desiring future pregnancy. Some experts [5] have tried gelatin sponge particles instead of PVA particles in women of child¬bearing age, but this technique has not yet been generally accepted. The aim of this study was to determine whether UFE with PVA particles affects fertility in patients desir¬ing future pregnancy.
Materials and Methods
Of 288 patients at CHA General Hospital in Korea managed with UFE using PVA particles for uterine myoma or adenomyosis be¬tween 1998 and 2001, 94 were enrolled in this study; participants ranged in age from 20 to 40 years. We excluded women >40 years
