Anti-Mullerian hormone before and after uterine artery embolisation in reproductive-age women seeking treatment for symptomatic fibroids

Abstract

Background. Uterine fibroids are the most common of the benign  gynaecological tumours, the definitive traditional treatment for which is either myomectomy or hysterectomy. Uterine artery embolisation (UAE) offers an alternative non-invasive option for treatment. There remain concerns as to the effects of UAE on ovarian reserve in women desirous of preserving ovarian function.

Objectives. To determine the effect of UAE on ovarian reserve, as assessed by anti-Mullerian hormone (AMH) measured before and after embolisation, and to assess the trend in serum AMH in the medium term, up to 12 months post UAE.

Methods. A cohort study between October 2012 and May 2015 recruited 40 women with symptomatic uterine fibroids. Serum AMH was measured prior to embolisation and post embolisation, at 2 weeks, 6 months and 12 months. Using descriptive statistics and bivariate analysis, pre-embolisation and post-embolisation AMH concentrations were compared. P<0.05 was considered statistically significant.

Results. The median participant age was 38.5 years (range 31 - 45). Of the women recruited, 47.5% (19) were nulliparous, and 72.5% (29 women) of the total desired a pregnancy in the future. The median (standard deviation) AMH immediately prior to embolisation was 1.3 ng/mL (1.53), and post embolisation at 2 weeks, 0.9 ng/mL (1.98); at 6 months, 2.2 ng/mL (2.63); and 12 months, 3.5 ng/mL (1.54) (p= 0.96).

Conclusion. In the short to medium term, UAE for treatment of  symptomatic fibroids was not found to be detrimental to ovarian reserve. There is a need for longer-term studies evaluating its effects on fecundity, considering that most women in the present study had a strong desire to maintain their fertility.