The management of uterine fibroids in women desiring future fertility remains one of the most contentious topics in contemporary gynecology. As the average age of first-time mothers increases, the prevalence of symptomatic leiomyomas during reproductive years has risen concurrently. UFE has gained popularity due to its shorter recovery period and avoidance of major abdominal surgery; however, its long-term impact on the myometrium and endometrium is not fully characterized. Understanding the comparative efficacy of these interventions is critical for developing evidence-based counseling protocols. This study addresses a vital gap in clinical knowledge by providing high-powered, comparative data on obstetric safety and success. By refining the selection criteria for uterine-sparing procedures, clinicians can better preserve the reproductive potential of patients, ultimately reducing the burden of fibroid-related infertility and improving maternal-fetal safety in subsequent pregnancies.
To evaluate and compare the long-term fertility outcomes, including live birth rates and pregnancy complications, in women undergoing uterine fibroid embolization versus surgical myomectomy.
A multicenter retrospective cohort study was conducted involving 640 women aged 25–42 years diagnosed with symptomatic intramural or subserosal fibroids (>4 cm). Participants were divided into two groups: those undergoing UFE (n=312) using tris-acryl gelatin microspheres and those undergoing abdominal or laparoscopic myomectomy (n=328). Exclusion criteria included male factor infertility or known tubal disease. Follow-up spanned 48 months post-procedure. Primary endpoints were the cumulative live birth rate and time to conception. Secondary endpoints included miscarriage rates before 20 weeks, preterm delivery, and placental complications. Ovarian reserve was assessed via Anti-Müllerian Hormone (AMH) levels at 6 and 12 months. Statistical analysis utilized Kaplan-Meier curves for pregnancy rates and Cox proportional hazard models to calculate Odds Ratios (OR) with 95% Confidence Intervals (CI), adjusting for age and fibroid volume.
Over the 48-month follow-up, 159 pregnancies were recorded in the myomectomy group versus 83 in the UFE group. The cumulative live birth rate was significantly higher after myomectomy (48.4%) than after UFE (26.7%; p < 0.001). After adjusting for baseline variables, the Odds Ratio (OR) for a live birth following myomectomy compared to UFE was 2.14 (95% CI, 1.58–2.89). Miscarriage rates were substantially higher in the UFE cohort (35.2%) compared to the myomectomy cohort (18.1%; p < 0.01). Obstetric complications were more frequent in the UFE group, including a higher incidence of malpresentation (OR 3.2; 95% CI, 1.4–7.1) and placental abruption (OR 2.8; 95% CI, 1.1–6.9). AMH levels showed a transient decline in the UFE group at 6 months (mean reduction of 0.85 ng/mL, p=0.04) which partially recovered by 12 months, whereas the myomectomy group showed no significant change in ovarian reserve markers.
The data demonstrate that myomectomy remains the superior intervention for women seeking future pregnancy, yielding significantly higher live birth rates and lower risks of obstetric complications compared to UFE. The increased odds of miscarriage and placental abnormalities following UFE suggest that the procedure may alter the intrauterine environment or impair uterine-placental perfusion. While UFE offers benefits in terms of recovery time and reduced perioperative morbidity, its role in reproductive medicine should be limited to symptomatic patients who have completed childbearing or those with high surgical risks. Clinical guidelines should be updated to reflect the 1.8-fold higher likelihood of successful delivery following surgical excision. Shared decision-making must include a detailed discussion of these evidence-based reproductive trade-offs to ensure patient autonomy and optimized obstetric outcomes.