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|Female Reconstructive Surgery|
Because of the very real potential for any one of the following items to occur, most interventional radiologists do NOT recommend uterine fibroid embolization for women wishing to retain their fertility for future childbirth except under special circumstances.
|1.||Shared blood flow from uterine to ovarian artery or vice versa (results in embolization of the ovary and menopause OR leading to possible failure of the UAE to treat the fibroids). This phenomenon is called anastomoses.|
|2.||Misembolization of ovarian artery (resulting in menopause).|
|3.||Infection requiring hysterectomy.|
|4.||Complete necrotization of the uterus (resulting in hysterectomy).|
|5.||"Problems" with the endometrium (possibly reduced blood flow) that interferes with implantation of eggs.|
|6.||Uterine rupture during a term pregnancy (loss of baby AND uterus).|
|7.||Onset of menopause prematurely for unknown/unidentified causes (possibly reduced blood flow to the ovaries).|
Yes, these are all very real potential consequences of uterine fibroid embolization. Items 1-3 have already occurred and are well documented. Items 4-7 are all theoretically possible but have not been documented as having occurred as yet. Publishing in a medical journal can take as long as 6 months to a year--sometimes longer, however.
Who was the first?
Contrary to what Nancy Snyderman, Medical News Correspondent, proclaimed on ABC TV's Good Morning America on October 5, 1999, Leslie Miles was NOT the first woman in the world to have given birth after uterine artery embolization.
On 2/25/97, Dr. Harold Mitty submitted a case review of 12 women who had undergone emergency UAE in 1990-1995. He specifically looked at the impact of UAE on menses and pregnancy and reported 3 women as having conceived post UAE.
In Europe, J H Ravina "officially" reported the results of his 1993+ studies on uterine artery embolization on July 28, 1997 and it was subsequently published in La Press Medicale in France on 2/21/98. As part of that paper he reported 4 patients who became pregnant. Two miscarried, 1 had twins via c-section, and 1 gave birth to a full-term normal baby. All born prior to 7/28/97 -- the date his paper was accepted for publication.
In addition, uterine artery embolization has been around for over 20 years and I'm quite certain that many other, undocumented, "unofficial" cases of pregnancy have occurred post UAE. Probably hundreds--maybe more.
Ms. Snyderman grossly exaggerated and elevated Leslie Miles' case from being the first "officially" reported in the United States to being the first in the world. Isn't it incredible how quick and easy it is to transmit misinformation to millions of people? Thanks to what I know about UFE compared to ABC's presentation of this story, I will never, EVER trust medical information presented on popular TV again.
Also, keep in mind that information on incidents such as those listed above are not always openly shared or published. (Actually, this is a true statement regardless of the medical procedure involved.)
A single uterine rupture resulting in hysterectomy has occurred in England. This case involved an infarcted fibroid and the woman was NOT pregnant at the time. As it stands, until such a case is officially reported, it can only be speculated that uterine rupture is a possibility during a term pregnancy post UFE.
Early onset of menopause is also troublesome in terms of fertility because a European panel recently reported that as many as 10% of women undergoing UFE have entered into menopause within one year post procedure. Researchers in the United States are now reporting a "rough" figure of 5%. However, more long-term studies are required to determine whether this is truly a collateral result of the UFE or a natural occurrence due to the age of women undergoing this procedure.
Regardless of all of the above concerns, ABC Good Morning America chose to broadcast a rather glowing report on fertility retention with UFE. Yes, there have been a dozen or so successful pregnancies and the women this has happened to are, by and large, ecstatic.
Before walking down this path, however, you may want to consider the risks very carefully and compare them against the risks of other procedures for treatment of your uterine fibroids. In addition, you might want to consider the use of gelfoam instead of polyvinyl alcohol particles as this embolic material has been speculated as showing potentially less permanency and possibly bears less risk towards preventing pregnancy entirely over the remainder of your childbearing years.
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This page last updated Saturday, February 02, 2002