“Human reproduction is an inefficient process. On average, only one in five meetings of sperm and egg result in a fertilized egg with pregnancy potential. So therefore normal is abnormal.”
This was a quote that Dr. Howard W. Jones gave during a recent interview. And he should know, he started the first in vitro fertilization clinic, with his wife Dr. Georgeanna Seegar, giving “life” to the first test-tube baby. Today Dr. Jones is 99 years old, but he is still a learned-force in the field of infertility, involved in everything from the “mechanics” to the ethics of reproductive assistance.
Having a fibroid (or many) makes the possibility of conceiving even MORE of an “abnormal normal!!” With a fibroid, many women are unable to “hold” a pregnancy, or the fibroid can start growing after conception, which can result in a miscarriage.
In the past, the gold standard for women who have a uterine fibroid and wish to conceive was a myomectomy. This is a surgical procedure that cuts and removes the offending fibroid from the uterus. It is painful and has possible complications associated with it. Recently, however, there have been studies that show the efficacy of uterine fibroid embolization (UFE) and focused ultrasound (FUS) as to being equal to myomectomy with the rates of fertility outcome. Here are the results:
UFE: 743 women treated with UFE had a fertility rate of 58% (myomectomy has a 57% rate)
Most of these women opted for UFE as a fertility treatment after the failure of a myomectomy, or in vitro fertilization failed, or the only other option suggested was hysterectomy. Of the 743 patients who received the UFE treatment, 74 women wished to conceive and had been unable to prior to UFE. Of the 74 women, 43 became pregnant, with conception-time ranging from 2 to 22 months. At this moment, there have been 36 completed pregnancies and 7 women are still pregnant.
“Most of the pregnancies after UFE had good outcomes with few complications. The complication rate of the pregnancies was expected to be higher than the general population because these were high-risk patients who had already undergone fertility treatments and were unable to conceive. However, the percentage of miscarriages (11.1 percent), pre-term delivery (10 percent) and low birth weight (13.3 percent) was the same as the general population. These results are surprising because other studies have favored surgical myomectomy over UFE for women who want to conceive. In the future, UFE will probably be one of the first-line treatment options even for women who wish to conceive and are unable to because of the presence of uterine fibroids.” This was stated by Dr. Pisco, an interventional radiologist, conducting and over-seeing this study.
FUS: The objective of this study was to report all pregnancies that occurred after focused ultrasound (FUS) treatment, the conservative (non-invasive) option for treating clinically significant uterine fibroids. There were/are 13 sites in seven countries that are culling and reporting this information. Fifty-one reproductive-age women with uterine fibroids were treated with (FUS). The outcome: 54 pregnancies occurred with conception occurring within a mean time of 8 months after treatment. Live birth occurred in 41% of the pregnancies and of those, 64% delivered vaginally. Eleven women are still pregnant and all is well. The doctors and record-receivers have concluded that pregnancy expectations after FUS look encouraging, and these preliminary stats are showing a high rate of delivered and ongoing pregnancies after FUS.
Definitely, getting pregnant is the “abnormal normal” (as Dr. Jones so aptly stated), even with everything being status-quo, but throw a ferocious fibroid into the mix and conception is more difficult. With this new information regarding UFE and FUS, at least there are more options, other than in vitro or myomectomy, to assist women in their “abnormal normal” ability to conceive a child.