[Uterine artery embolization for leiomyoma: complications and effects on fertility]

Uterine artery embolization (UAE) for leiomyoma is becoming accepted as an alternative to surgical treatment. However, gynecologists who have treated follow-up patients are greatly concerned about the postoperative course after UAE. One significant complication after UAE is infection owing to obstruction resulting from the sloughing of necrotic fibroids that interfere with the passage of intrauterine discharge. In our UAE procedures, the incidence of infection requiring hospitalization was 3.6%, and one patient (0.22%) had to undergo hysterectomy. Transcervical resection (TCR) using hysteroscopy is an extremely effective surgical intervention for removing necrotic fibroids for reserve of the uterus. However, additional treatment for intrauterine abnormalities after UAE may rest on whether or not the hysteroscopic procedure was performed. Although ovarian function after UAE seems to be maintained in patients < or = 44 years of age, serious complications include intrauterine adhesions that appear as amenorrhea or hypomenorrhea and lead to infertility. The results of our hysteroscopic evaluation after UAE in 7 patients who wished to conceive was intrauterine adhesion in four patients, subendometrial liner scar in one patient, and yellowing of the endometrium in three patients. However, in spite of impairment of the endometrium, the pregnancy rate after UAE in our study was 5/10(50.0%). It is essential that the indications of UAE for patients who wish to conceive be decided according to careful individual evaluation, and cautious follow-up is necessary.