Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy
1 Department of Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands 2 Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands 3 Department of Gynaecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands 4 Department of Internal Medicine, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands 5 Department of Public Health Epidemiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
6 Correspondence address. Tel: +31-20-5663740; Fax: +31-20-5669119; E-mail: w.j.k.hehenkamp{at}amc.nl
BACKGROUND: Ovarian failure as a complication of uterine artery embolization (UAE) for symptomatic uterine fibroids has raised concerns about this new treatment modality.
METHODS: We investigated the occurrence of ovarian reserve reduction in a randomized trial comparing UAE and hysterectomy by measuring follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH). A total of 177 pre-menopausal women with menorrhagia due to uterine fibroids were included (UAE: n = 88; hysterectomy: n = 89). FSH and AMH were measured at baseline and at several time-points during the 24 months follow-up period. Follow-up AMH levels were also compared to the expected decrease due to ovarian ageing during the observational period.
RESULTS: FSH increased significantly compared to baseline in both groups after 24 months follow-up (within group analysis: UAE: + 12.1; P = 0.001; hysterectomy: + 16.3; P < 0.0001). No differences in FSH values between the groups were found (P = 0.32). At 24 months after treatment the number of patients with FSH levels > 40 IU/l was 14/80 in the UAE group and 17/73 in the hysterectomy group (relative risk = 0.75; P = 0.37). AMH was measured in 63 patients (UAE: n = 30; hysterectomy: n = 33). After treatment AMH levels remained significantly decreased during the entire follow-up period only in the UAE group compared to the expected AMH decrease due to ageing. No differences were observed between the groups.
CONCLUSIONS: This study shows that both UAE and hysterectomy affect ovarian reserve. This results in older women becoming menopausal after the intervention. Therefore, the application of UAE in women who still wish to conceive should only be considered after appropriate counselling.
Key words: anti-Müllerian hormone/hysterectomy/menopause/uterine artery embolization/ovarian reserve
Submitted on December 20, 2006; resubmitted on March 21, 2007; accepted on April 2, 2007.
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