Pregnancy outcome after uterine artery embolization for uterine adenomyosis: A systematic review

Uterine adenomyosis involves the growth of endometrial gland and stroma within the uterine musculature. Patients with uterine adenomyosis experience heavy painful periods, deep dyspareunia and subfertility, reducing their overall quality of life. Hysterectomy is usually the recommended treatment for such patients. Whilst uterine artery embolization (UAE) offers a suitable, fertility-preserving alternative, for patients who have not completed their families, its impacts on pregnancy outcomes have not yet been explored or studied in women with pure adenomyosis.

The objective of the current study was to assess pregnancy and live birth rates in women with pure adenomyosis, treated with UAE.

A comprehensive systematic review of the published literature, in Pubmed, Embase, Cochrane, Google Scholar, Scopus and ClinicalTrials.gov, was performed from January 2000 until January 2025.

All the published and unpublished literature in English language, describing pregnancy outcome after uterine artery embolization for pure uterine adenomyosis, were eligible for inclusion in the study.

Data about preconception characteristics, pregnancy, obstetrics and neonatal outcomes were extracted and analyzed according to the study design source and pregnancy viability.

We identified nine papers, with a total cohort of 578 patients, of which 208 desiring fertility. Women were aged 18-52, with a mean follow up of 46.3 months after UAE. We concluded a pregnancy rate of 41.20% (n = 28) and a live birth rate of 95.70% (n = 23) in this cohort. Of these, seven studies reported obstetric and/or neonatal complications, including preterm, premature rupture of membranes, hemorrhage during delivery, low birth weight and neonatal deaths.

The current study showed that the pregnancy rates after uterine artery embolization are comparable to assisted conception clinical success rates for women with uterine adenomyosis, but with markedly higher live birth rates. UAE provides a foundation for further studies and research, directly assessing pregnancy outcomes and indirectly assessing the fertility potential in women with pure adenomyosis, with the potential to influence uterine adenomyosis treatment guidelines. Our research provides a foundation on which healthcare professionals can effectively counsel and treat fertility preserving women with pure uterine adenomyosis.