Hilights From Fertility And Sterility

Stopping The Blood Supply To Uterine Fibroid Tumors Reduces Their Size And Relieves Symptoms; Majority Of Patients Are Pleased With This Alternative To Surgery(1)

In an extensive, multi-center clinical treatment trial, Canadian researchers evaluated the outcomes of 538 cases of uterine artery embolization for fibroids. Between 20% and 50% of women develop uterine fibroids, benign tumors in the muscular tissue of the uterus that can seriously impact their health and well-being. Common symptoms of fibroids include severe pelvic pain, longer and heavier periods, an enlarged uterus, and a more frequent need to urinate. Fibroids are usually treated surgically, either by removing the tumors or by removing the uterus. Patients, however, prefer to have their fibroids treated as conservatively as possible in order to avoid the risks and complications of surgery and, in the case of many pre-menopausal patients, to try to preserve their fertility.

The researchers, led by Gaylene Pron, PhD, of the University of Toronto, distributed questionnaires on symptoms and the way they impacted patients’ lives to 555 patients before they underwent uterine artery embolization (UAE), a procedure in which the blood supply to the fibroid tumors is blocked, causing them to shrink and recede. Three months after surgery, patients reported their degree of symptom improvement, the reduction of fibroids’ impact on their lives, and satisfaction with the treatment. The patients were also examined using ultrasound before UAE and three months after UAE to determine the reduction in volume of their fibroids and their uteruses. Uterine volumes were reduced an average of 35%; fibroid volume was reduced 42% on average. Many patients reported a reduction in menstrual pain (83%), a reduction of excessive menstrual flow (77%), and a reduction in the urgency and frequency of their need to urinate (86%). The measured life-impact of fibroids was also significantly reduced for the great majority of patients. Ninety-one percent of patients treated with UAE expressed satisfaction with it. A possible side effect of UAE is the cessation of menstruation, which, in this trial, was observed to be highly age dependant. While about 3% of women under 40 undergoing UAE ceased menstruating, around 41% of women 50 and older stopped getting their periods.

“The extent of this trial is impressive and the results very encouraging,” commented Sandra Carson, MD, President of the American Society for Reproductive Medicine. “Uterine Artery Embolization is not without complication, but may be a welcome alternative to surgery in those women who have completed their childbearing.”

How To Reduce The Frequency Of Multiple Births: The Debate Continues

In the January 2003 issue of Fertility and Sterility, the journal of the American Society for Reproductive Medicine, several authors address the issue of assisted reproductive technologies contributing to the increase in multiple births. In this section, Howard Jones, Jr., MD, one of the pioneers of IVF in the US, discusses the ways in which the utilization of ovulation induction, with and without IVF, can lead to multiple pregnancies. And in pieces by Richard Dickey, MD, PhD, Marc Fritz, MD and Steven Ory, MD, and Zev Rosenwaks, MD and Pak Chung, MD, the debate continues as to the necessity, or lack thereof, practicability, or impracticability of Practice Guidelines to advise physicians on the treatment of patients with certain characteristics, especially those undergoing ovulation induction, so as to decrease the chances of multiple pregnancy.

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References:

For more information, contact Eleanor Nicoll at 202/863-2439 or enicoll@asrm-dc.org or Sean Tipton at 202/8632494 or stipton@asrm-dc.org

1 (Pron, et al., The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life and Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids, Fertility and Sterility, Vol.79, No.1, January 2003.)