MyomectomyPatients often ask about uterine artery embolization as an alternative to surgical removal of fibroids. Like many procedures that arise in different specialties, in this case, radiology, uterine artery embolization was proposed years ago to “treat” symptoms of fibroids without knowledge or experience in gynecology. It was quickly shown not to be indicated in fertility patients and often caused significant diminished ovarian reserve. Despite this, radiologists and some gynecologists continue to recommend these procedures in patients who are seeking or hoping to have pregnancies in the future.

Newer ideas include probes to cryo (freeze) and destroy or heat to destroy fibroids. Our long experience with fibroids has told us that these procedures despite the strong push to utilize them, have fallen far short of the best treatment: surgical myomectomy.

In the many cases in which we have operated on to treat the problem after these procedures have failed, the findings are relatively disturbing. The tissues are barely alive with minimal blood flow and the tissues are soft, unlike healthy living tissue. The patients with large fibroids are left with large fibroids that are partially alive for years.

In my mind, this has to produce a chronic inflammatory response that is not good for overall health or quality of life. As with any inflammatory disease, generally, patients feel bad and may be at risk for advanced vascular disease, etc. This is certainly just an opinion and not proven, but a clear observation. I urge everyone to be cautious about these procedures and seek second opinions to discuss all the ramifications. If these options are to be used in a 45-year-old, who is strongly opposed to surgery and just wants to control bleeding, this might be reasonable. Unfortunately, these patients are less common in the fibroid patient population.

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Michael D. Fox, MD
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists