Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2024; 12(15): 2551-2559
Published online May 26, 2024. doi: 10.12998/wjcc.v12.i15.2551
Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment: A prospective study
Jing-Lei Liu, Zhi-Hui Liang, Bao Cui, Jian-Yu Liu, Li Sun
Jing-Lei Liu, Zhi-Hui Liang, Bao Cui, Jian-Yu Liu, Department of Interventional Treatment, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
Li Sun, Department of Obstetrics and Gynecology, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, Hebei Province, China
Author contributions: Liu JL and Sun L conceptualized the study, Sun L and Liang ZH contributed to data collection, Liu JL drafted the initial manuscript, and Bao C made contributions to formal analysis. Liu JY provided guidance for the study, while Liu JL, Sun L, and Liang ZH contributed to methodology and visualization. Sun L validated the research; and all authors participated in this study, and jointly reviewed and edited the manuscript.
Supported by Key Project of Medical Science Research in Hebei Province, China, No. 20160005.
Institutional review board statement: This study has been approved and reviewed by the Ethics Committee of the 980th (Norman Bethune International Peace) Hospital of the Joint Logistics Support Force of the People's Liberation Army of China
Clinical trial registration statement: This study is registered at (https://www.researchregistry.com). The registration identification number is Researchregistry9803.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that there is no disclosure of interest relationship.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Sun, MD, Associate Chief Physician, Department of Obstetrics and Gynecology, 980 (Bethune International Peace) Hospital of PLA Joint Logistics Support Forces, No. 398 Zhongshan West Road, Shijiazhuang 050082, Hebei Province, China. sunl0117@126.com
Received: December 19, 2023
Revised: January 10, 2024
Accepted: April 3, 2024
Published online: May 26, 2024
Processing time: 147 Days and 7.1 Hours
Abstract
BACKGROUND

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques.

AIM

To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE).

METHODS

This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment.

RESULTS

The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment.

CONCLUSION

UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Keywords: Uterine fibroids; Uterine artery embolization; Ovarian function; Fertility; Pregnancy outcome; Embolic agent

Core Tip: Uterine fibroids are benign tumors affecting 80% of women and are treated by medical or surgical intervention. We compared ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). The primary outcome was ovarian function, while the secondary outcome was fertility. There were no significant differences between the two groups in terms of the primary and secondary endpoints at any time-point during the follow-up period. UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.