Fertility outcomes after uterine artery embolization for symptomatic leiomyomas.

BACKGROUND: Uterine artery embolization (UAE) is a recognized treatment for symptomatic fibroids, but its impact on fertility remains controversial. This study aimed to assess live birth rates, pregnancy outcomes, and obstetric complications in patients attempting pregnancy after UAE. MATERIALS AND METHODS: We conducted a retrospective monocentric study including women aged 18-45 years treated by UAE for symptomatic fibroids between June 2007 and March 2021. Patients who attempted pregnancy post-procedure were identified and analyzed. The primary outcome was the live birth rate; secondary outcomes included pregnancy rate and obstetric complications. Statistical analyses were performed according to the STROBE guidelines. RESULTS: Among 210 included patients, 46 attempted pregnancy (22%). The mean age of this fertility population was 40 years. Thirteen women (28%) began at least one pregnancy after UAE, resulting in 12 births overall in 9 mothers. All live births were delivered via cesarean section, and no fatal obstetric complications occurred in this cohort. The miscarriage rate (23%) and other obstetric outcomes were consistent with general population trends for similar age groups. UAE demonstrated high symptom resolution, with 70% of patients requiring no further interventions for fibroids. CONCLUSION: Fertility may be preserved in a subset of women with complex surgical histories or high-risk surgical profiles undergoing UAE for symptomatic fibroids. TRIAL REGISTRATION: NCT05271981.