A 36-year-old woman with symptomatic fibroids (menorrhagia, bulk symptoms, uterus 16-week size) desires future fertility. Uterine artery embolization (UAE) is proposed. Compared to myomectomy, which statement about UAE outcomes for fertility is MOST accurate based on current evidence?
- A UAE and myomectomy have equivalent live birth rates and miscarriage rates for women desiring pregnancy
- B UAE achieves superior symptomatic control with equal fertility outcomes, making it first-choice for fertility-desiring women
- C UAE is associated with lower live birth rates and higher miscarriage rates compared to myomectomy; myomectomy is preferred for fertility preservation ✓
- D UAE is contraindicated in all women desiring future fertility regardless of fibroid number or size
Explanation
Multiple systematic reviews and the REST trial data indicate that uterine artery embolization is associated with lower live birth rates (approximately 50% lower) and higher miscarriage rates compared to myomectomy in women desiring future fertility. The proposed mechanisms include: ovarian radiation exposure from fluoroscopy affecting ovarian reserve, endometrial ischemia impairing implantation, and risk of intrauterine adhesions after myoma infarction. While UAE provides excellent symptom relief and avoids surgery, current guidelines (RCOG, ACOG, ESHRE) recommend myomectomy as preferred treatment when future fertility is desired. UAE is not absolutely contraindicated (D is overstated) but should be avoided when possible in fertility-seeking women.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.