Uterine artery embolization for severe symptomatic fibroids: effects on fertility and symptoms

Extract

Sir,

We read with interest the paper by Torre et al. (2014) but would like to raise a number of concerns. They conclude that uterine artery embolization (UAE) should not be offered to women of reproductive age as it could be detrimental to their fertility prospects. We strongly contend that the only legitimate conclusion they could reach from the data obtained from their study cohort is that UAE does not improve fertility prospects in women whose prospects were, at best, dismal, while the treatment significantly improved their symptoms.

Torre et al. studied a relatively small (for purposes of fertility outcomes) cohort of women with extensive fibroid disease, the majority of whom had had previous surgical interventions, and for whom further, or de novo, surgical intervention was either refused or advised against. These women were symptomatic and for that alone they needed some form of intervention. Implicit in the way the paper is written is that these women wished to preserve their uterus, even when, as in 50% of the study population, they had given up on their fertility aspirations. The authors’ suggestion would deny these women a treatment modality that could, by improving their symptoms, significantly improve their quality of life.