Pregnancy outcomes following treatment for fibroids: Uterine fibroid embolization versus laparoscopic myomectomy

Jay Goldberg, Leonardo Pereira

Research output: Contribution to journalReview article

85 Scopus citations

Abstract

PURPOSE OF REVIEW: The management of uterine fibroids in patients requiring treatment who desire future fertility remains controversial. Myomectomy has been the most common operative procedure to improve pregnancy rates and outcomes. Uterine fibroid embolization is an increasingly popular, minimally invasive treatment for fibroids. This review aims to provide critical analysis of available data on pregnancy following myomectomy and uterine artery embolization. RECENT FINDINGS: Patients with distorted uterine cavities due to submucosal fibroids of more than 2 cm have higher pregnancy rates following hysteroscopic resection. Pregnancy rates following myomectomy, both via laparoscopy and laparotomy, are in the 50-60% range, with most having good outcomes. Pregnancy rates following uterine artery embolization have not been established. Pregnancies following uterine artery embolization had higher rates of preterm delivery (odds ratio 6.2, 95% confidence interval 1.4-27.7) and malpresentation (odds ratio 4.3, 95% confidence interval 1.0-20.5) than pregnancies following laparoscopic myomectomy. SUMMARY: Both myomectomy and uterine artery embolization are safe and effective fibroid treatments, which should be discussed with appropriate candidates. Pregnancy complications, most importantly preterm delivery, spontaneous abortion, abnormal placentation and postpartum hemorrhage, are increased following uterine artery embolization compared to myomectomy. Although most pregnancies following uterine artery embolization have good outcomes, myomectomy should be recommended as the treatment of choice over uterine artery embolization in most patients desiring future fertility.

Original languageEnglish (US)
Pages (from-to)402-406
Number of pages5
JournalCurrent Opinion in Obstetrics and Gynecology
Volume18
Issue number4
DOIs
StatePublished - Aug 1 2006

Keywords

  • Fibroid
  • Laparscopic myomectomy
  • Pregnancy
  • Uterine artery embolization
  • Uterine fibroid embolization

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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