Uterine Artery Embolization & Pregnancy Risks

When we talk about uterine artery embolization and pregnancy, we tend to say that it’s a fertility-preserving therapy, and that pregnancy after uterine artery embolization is very much possible. Uterine artery embolization is a minimally invasive procedure involving the injection of micro-sized particles into the blood vessels that supply the fibroids. When injected, the beads cut off blood supply to the fibroids, causing them to shrink to a fraction of their original size. The procedure is highly targeted and only has localized effects on the uterus where the beads are injected. For most women, uterine artery embolization keeps the uterus intact, functional, and capable of rearing children.

If uterine artery embolization keeps the uterus intact, then why all this talk of pregnancy complications? When uterine artery embolization first started becoming a mainstream therapy, studies emerged that attributed certain obstetric complications to the residual effects of the procedure. These included:

• Miscarriage: child is lost spontaneously prior to birth
• Preterm delivery: child is born early
• Intra-uterine growth restriction: child does not grow to normal size in the uterus
• Malpresentation: child is positioned incorrectly leading up to childbirth
• Postpartum hemorrhage: heavy bleeding after childbirth
• Abnormal placentation: condition in which the placenta grows into the wall of the uterus, which can cause severe hemorrhage during childbirth

These complications occur in the general population and are not exclusive to women with fibroids or women who’ve undergone uterine artery embolization, but early data suggested that these complications occurred at a marginally higher rate following uterine artery embolization than when fibroids were treated with other uterus-preserving therapies like myomectomy [1].

It’s important to keep in mind that uterine artery embolization only shrinks fibroids by about 50%, and this is more often than not sufficient to relieve symptoms. Some physicians and researchers have argued that pregnancy complications could be attributed to larger fibroids in general and aren’t necessarily caused by any residual effects of uterine artery embolization. Rather, it could be that embolization does not shrink the fibroids enough to where they no longer obstruct features of the uterus during pregnancy. Regardless, the debate continues on whether or not these complications are even more common in women following uterine artery embolization, as we discuss below.

Following this study, the American College of Obstetricians and Gynecologists released the following statement on uterine artery embolization in Feburary of 2004: “There is insufficient evidence in the current literature to ensure safety in women desiring to retain their fertility. Furthermore, pregnancy-related outcomes remain understudied in women wishing to retain fertility.” [1] This statement wasn’t ruling out uterine artery embolization by any means, but it did make it clear that we didn’t know enough about the effects of the procedure to recommend it (or reject it) as a fertility-preserving treatment option for uterine fibroids.

This negative press has since been balanced out by much more positive findings, and some studies have even reported a 100% successful pregnancy rate following uterine artery embolization. [2] McLucas published his findings in 2012 on 44 women desiring to get pregnant after uterine artery embolization. They reported that 48% of the women in their study successfully became pregnant, and all of the women in this subset had uncomplicated pregnancies and perfectly healthy newborns. Another noteworthy finding from this study was that many of the women fell pregnant multiple years after their embolization procedure. [3] Findings like these would suggest that pregnancy complications following uterine artery embolization are the exception and not the norm.

With all of this competing evidence, it should be noted that these studies are quite small and of relatively low quality to the extant that some professional medical organizations, such as the Royal College of Obstetricians and Gynaecologists and the Royal College of Radiologists in England, have stated that “it is impossible to make an evidence-based recommendation about treatment for women with fibroids who wish to maintain their fertility.” [4] In reviewing the evidence ourselves, we feel that this is an appropriate summary of what we know about different fibroid treatments and pregnancy.

It’s also important to keep in mind that every patient is different, as is every procedure and operator. There may be technical differences in how an embolization is conducted at different fibroid centers, for example, and the technique has certainly improved since its introduction at the turn of the millennium.

Is Uterine Artery Embolization Right For Me?

If you’re still nervous about the potential effects of uterine artery embolization on your future pregnancy, know that many women have had perfectly healthy pregnancies following uterine artery embolization. And while pregnancy outcomes should certainly be a big factor in your decision, they’re not the only factor. Uterine artery embolization is also the least invasive treatment option for uterine fibroids, and also provides the fastest recovery, making it ideal for busy women and women that want to avoid invasive surgery.

Is pregnancy after uterine artery embolization possible?

Yes, pregnancy after uterine artery embolization is possible. Several studies have reported high rates of successful, healthy pregnancies following the procedure, and at ProFibroidMD, we’ve personally been witness to successful, healthy pregnancies following uterine artery embolization.

Which fibroid treatment option is best for future pregnancy?

Both uterine artery embolization and myomectomy are viable options to retain fertility. There is ongoing debate about which is the better option, but high quality comparative data is lacking that confidently sets one treatment apart from the other (see above). Some studies have indicated that uterine artery embolization leads to more complicated pregnancies, while other studies indicate the opposite. Simultaneously, some medical researchers have described that the window for pregnancy prior to fibroid recurrence is far shorter following a myomectomy than uterine embolization [5], which would make embolization the superior option.

Does uterine artery embolization increase my chances of having a complicated pregnancy?

Given the mix of evidence, we don’t know if uterine artery embolization increases your risk of having a complicated pregnancy. If it does, it’s a marginal increase at most. Early studies on the subject suggested that uterine artery embolization did indeed increase the rate of pregnancy complications, but more recent work has shown the opposite. Professional medical organizations like the American College of Obstetricians and Gynecologists are also neutral on the topic, stating that there’s a lack of evidence to recommend any of the current fibroid treatments for fertility preservation or uncomplicated pregnancy.

What is the pregnancy rate after uterine artery embolization?

McLucas published a study in 2010 on 44 women desiring to get pregnant after uterine artery embolization. They reported that 48% of the women in their study successfully became pregnant, and that all of the women in this subset had uncomplicated pregnancies and perfectly healthy newborns [3]. However, pregnancy rates vary from study to study, with some reporting higher figures and some reporting lower. Fertility is multifactorial and cannot be solely attributed to fibroids or fibroid treatment. Further, every treatment center is different in their approach to uterine artery embolization and their patient population, and large-scale, high-quality studies have not looked at pregnancy rates after embolization, so any individual report should be looked at as preliminary data.

Can I get uterine artery embolization during pregnancy?

Due to safety concerns, the vast majority of medical organizations, institutions, and fibroid treatment centers strongly recommend against undergoing fibroid treatment while pregnant.

Do you have additional questions? If you’re in Southern California, don’t hesitate to get in touch with us at ProFibroidMD. We’re more than happy to provide clarity on your fibroids and your options.