Impact on fertility according to treatment: analysis of French national medical database on uterine fibroid management (Myomectomy versus Embolization)

Eur J Obstet Gynecol Reprod Biol. 2026 Jun 21;324:115269. doi: 10.1016/j.ejogrb.2026.115269. Online ahead of print.

ABSTRACT

OBJECTIVE: To review French practices for the management of symptomatic leiomyomas and compare uterine artery embolization and surgical myomectomy on pregnancy rates and obstetrical outcomes.

METHODS: A French retrospective cohort study who include all consecutive patients from a national database with a diagnosis of uterine leiomyoma who underwent either embolization of the uterine arteries or myomectomies from 2012 to 2021. First, a descriptive analysis was performed, followed by comparative analysis using matching based on age and year of procedure (embolization versus myomectomy) to compare pregnancy rates and obstetric outcomes after each procedure.

RESULTS: There were 8,573 uterine artery embolization's and 58,680 myomectomies reported. After matching, we obtained two groups comprising 8,547 patients with pregnancy rate after embolization of 2.1% versus 4.9% after myomectomy (p < 0.001). Patients in the embolization group had less recourse to in in-vitro fertilization (9.7% vs 29.8% p = 0.04). There was no difference in the rate of miscarriage and abnormality of placental location. In patients who achieved pregnancy after procedure, there was no difference in mean birth weight (3,088 g vs 3,097 g, p = 0.55) and mean gestational age at birth (38.3 SA vs 38.1 SA p = 0.21).

CONCLUSION: The share between embolization and myomectomy in France has remained broadly stable over the last decade, with a lower proportion of embolization that continues to be offered, mainly to women over 40. In this sense, added to the fact that women in the myomectomy group had more recourse to medically assisted reproduction, we observed more pregnancies reported after myomectomy than embolization. Nevertheless, no difference in term of obstetrical complications between the two procedures was shown, providing additional reassuring data to the existing literature, that could make embolization as an alternative for patients of childbearing age with polyfibromatous uteri in treatment failure with high surgical risk.

PMID:42419195 | DOI:10.1016/j.ejogrb.2026.115269