On the special issue of pregnancy after UFE:

Keep in mind that your chance of getting pregnant after a hysterectomy is zero.

No one can say yet what the chances are after UFE, but they are better than zero. Of the several small studies that address this issue, it appears, as of 2011, that about half of women who want to get pregnant after UFE are able to do so.

I was at a meeting with the FDA a couple of years ago along with a handful of other IR doctors. They asked us if we thought the data was sufficient to begin to recommend UFE over myomectomy to women who want to get pregnant. I had to say no. While I believe that UFE is the better choice, the data to prove that does not yet exist.

If you want more details please read on.

The team that first performed UFE has reported on nine women who became pregnant after UFE. The group in California that first performed UFE in the US have also reported on a series of 14 women who became pregnant after UFE. 10 babies have been delivered. 2 women are still pregnant. Another from Canada reports on 24 pregnancies after UFE and the 14 babies that have so far been delivered. And another report from Portugal (Pisco J. presented at 2010 SIR meeting) showed that of 74 women undergoing UFE wanting to get pregnant, 43 conceived (62%). Of those 43, 1 women elected to have an abortion, 4 women had miscarriage, and 30 women had successful live births. 7 were still pregnant at the time of the report.

These studies account for 61 children who would not have been here without UFE as an alternative to hysterectomy! Many more children have been born to women who had prior UFE than are included in these small studies.  The vast majority of my patients do not want to get pregnant, so I cannot rely on my own experience to assure you or dissuade you; I just do not have a simple answer.

The UFE procedure involves treating the entire uterus. So the muscle of the uterus as well as the endometrium and cervix (or at least part of the cervix) gets treated. Also, the ovaries tend to get stunned, but they almost always recover. I am going to spell out why these effects can be bad for a pregnancy. It does not mean it will happen, it is just what could happen. 

The muscle seems to do just fine, but many OB/GYNs worry that the muscle might get sort of brittle due to diffuse scar tissue that almost certainly occurs following UFE. The same way the wall gets brittle at the C-sxn scar. Some women who try to go through labor after having a C-sxn will have their uterus rupture at the scar line during contractions. This is why most women who have had prior c-sxn will have, at their next pregnancy, an elective C-sxn rather than even try to deliver vaginally.  And this is why the majority of women who get pregnant after UFE also get an elective s C-sxn. I think this is overly cautious...the diffuse nature of the scar after UFE does not set up a fracture line like cutting through the uterus. While there is a case report in the word literature of uterine rupture after UFE, that woman was not even pregnant. Millions of women have had UFE without this complication. You just do not hear about uterine rupture after UFE. 

The more realistic issue for pregnancy is the damage to the endometrium. After UFE the endometrium dies and sloughs, causing a tacky brown discharge for a few days or weeks. And then it recovers. Remember, the endometrium normally dies and sloughs every month, that is your period. But what about this special type of period we cause with a UFE? Studies have shown that some women get scaring in the endometrium after UFE.  Too much scarring might interfere with implantation (when the fertilized egg attaches to the wall to start developing). If there is no implantation you will never even know you had a fertilized egg. If there is implantation but it is less than optimal you could miscarry. We know that women miscarry more often after UFE than if they have a normal healthy uterus.  But they miscarry a lot less than women with living fibroids. In other words the chance of miscarriage goes down after UFE, but not all the way to normal. This persistent elevation of miscarriage risk may be due to the endometrial scaring. Also, a trend that is seen in studies of pregnancy after UFE is that the placenta can be in the wrong place (ex: placenta previa) and this may be an effect of the endometrial scarring. But it is just a trend in the data, meaning it is not significant to the point that I can even say it is real. (That is part of what is frustrating about the lack of data). Another possible problem is that not enough blood gets to the placenta after UFE, so a fetus might not develop properly. But this theoretical problem has not turned into a real problem...you just do not hear about it. 

That the cervix gets partially embolized could in theory interfere with the ability to hold the baby. As stated above, we know that women miscarry more often after UFE than if they have a normal healthy uterus.  Maybe this is an effect on the cervix, rather than the endometrium.   

Finally, the ovaries can be damaged with UFE. If they are damaged enough they could stop producing the hormones or the eggs needed for pregnancy to occur. This however, is very unlikely to happen to a woman under 40. 

That said, here is a report on that study from Portugal that was presented at my society's annual meeting last year

Pisco J. presented the following at 2010 SIR meeting:

"TAMPA, Fla -- March 15, 2010 -- Uterine fibroid embolisation (UFE) may be a first-choice treatment for women who want to become pregnant, contrary to previous findings that favoured myomectomy for women interested in becoming pregnant but who have benign tumours of the uterus, according to researchers here at the Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting.

The complication rates of the pregnancies in the study were surprisingly similar to the rates of the general population, said Joao Martins Pisco, MD, St. Louis Hospital, Lisbon, Portugal.

“UFE is not a contraindication for patients who want to conceive,” Dr. Pisco said on March 14. “UFE may be the single effective treatment in some patients with uterine fibroids.”

The study included 743 women who underwent UFE procedures, mainly after failure of a myomectomy or because hysterectomy was suggested as the only other option. The fertility rate of the women was 58.1%, which is comparable to the rates for those who undergo myomectomy the -- gold standard for symptomatic fibroids in women who want to get pregnant, Dr. Pisco said.

UFE has advantages over myomectomy in certain cases. Women with multiple or large fibroids could face difficulties with myomectomy because it might involve removal of too much of the uterus. UFE can avoid this problem because it involves merely releasing tiny particles into the blood vessels that feed the tumours.

Of the 743 women in the study, 74 wanted to become pregnant but had been unable to do so. Subsequently 43 of the women (58%) became pregnant. Their average age was 35 years. The time between the UFE and conception ranged from 2 to 22 months.

The study reported 36 completed pregnancies -- 30 successful live births, 5 abortions (1 induced and 4 spontaneous), and 1 stillbirth. Seven of the pregnancies are ongoing. The percentages of spontaneous abortions (11.1%), preterm delivery (10.0%), and low-birthweight babies (13.3%) were similar to the general population."

As you can see, there is no easy answer, no definite right or wrong way to proceed. You just have to gather the information until you feel you can make a choice and decide.

If my fibroids are keeping me from getting pregnant, can I have this procedure to increase my chances of pregnancy?

For now we perform UFE for women who have symptomatic fibroids, do not want to become pregnant, and want to avoid hysterectomy.

Believe it or not, research has not been able to definitively show that fibroids interfere with pregnancy. Many doctors, myself included, and patients believe they can. Some research indicates improved ability to carry a pregnancy to term after myomectomy (surgical removal of the fibroids). We are optimistic that women will also be able to carry a pregnancy to term after UFE. 

As soon as better data is available we will analyze it and, if appropriate, offer UFE for infertility. But for now we still recommend myomectomy if your primary symptom is infertility. If your gynecologist tells you that you are not a candidate for myomectomy we can proceed with UFE. I recommend you wait at least 6 months after UFE before attempting to get pregnant. One of my patients who had never been able to conceive was told she could not have myomectomy due to the nature of her fibroids. 4 years after her UFE she decided to try, became pregnant, and delivered a healthy son. She is now considering a second child! 

For more information, please contact me by e-mail or by phone 210.616.7780.  Or visit the Society of Interventional Radiology web site and follow the links about UFE.

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This page was last updated onSaturday, May 07, 2011