Options For Treating Fibroids
My wife promptly consulted a new gynecologist, who conducted two imaging tests to better determine the size and location of ClaraТs fibroids, and to determine if any blocked her fallopian tubes.

If the fibroid is very large, a hysterectomy may be necessary, however, other options are sufficient in most cases.

Because of the relatively УsmallФ size of the fibroids (which can grow larger than a melon, and weigh up to 20 pounds), and because ClaraТs fallopian tubes were unobstructed, her gynecologist suggested hormonal therapy to prevent ClaraТs body from producing estrogen. Cutting estrogen supply often makes fibroids shrink. Conversely, low estrogen also produces, among other things:

  • Hot flashes
  • Lower sex drive
  • Vaginal dryness
  • Loss of bone mineral
  • A possible increased risk of coronary artery disease
  • Depression

When Clara and I rejected hormone therapy, her gynecologist mentioned myomectomy as a possible option. Myomectomy is the most common fibroid treatment procedure for women who wish to preserve their fertility. Essentially a Уfibroidectomy, a myomectomy is the removal of fibroids, which leaves a woman’s uterus intact. However, myomectomies also can:
Cause a loss of blood, and a need for transfusion
Scar the uterus, which lowers the chances of getting pregnant
Cause about 50% of all patients to lose their uterus during the procedure

For Clara and me, a 50/50 chance of a myomectomy turning into a hysterectomy was far too risky. Indeed, her gynecologist considered myomectomy only a last resort, and recommended that Clara and I forego treatment altogether and try to conceive. But because levels of estrogen, which make fibroids grow, increase during pregnancy, Clara and I looked into a procedure not recommended by most gynecologists.

Uterine Artery Embolization
Used for decades to control bleeding after C-section or childbirth, uterine artery embolization to treat fibroids was first performed in 1991 in Paris by gynecologist Jacques-Henri Ravina, and became available in U.S. hospitals by the mid 1990s. Since then, more than 10,000 UAE procedures have been performed worldwide.а Results have included a greater than 90% success rate, with an average 55% reduction in fibroid volume three months after the procedure, and an 80% reduction after one year.

When Clara and I read an article quoting a gynecologist who performs UAE saying, Уif I were a woman who wanted to become pregnant, IТd consider UAE as my first alternative, we dug for more information. Another article indicated that of about 21 reported pregnancies following the procedure, only one was unsuccessful, a loss due to reasons unrelated to UAE.

We then discovered interventional radiologist Dr. Robert L. Worthington-Kirsch, who has performed more UAEs than anyone in the world, and who in an article speculated that researchers would eventually find that fertility after UAE is about the same as after myomectomy. In January 2000, Clara and I visited Dr. Kirsch at Roxborough Memorial Hospital in Philadelphia. Our first question for the doctor was:

Why Happens During UAE?
Uterine artery embolization is a minimally invasive hospital procedure, which usually last from 1 to 1- hours.а Some doctors who perform UAE send their patients home the same day.а Dr. KirschТs patients stay overnight. In the operating room:
Patients are given a local anesthesia
A small incision (less than – of an inch) is made in the groin
Guided by x-ray, the doctor threads a catheter (about the diameter of spaghetti) through the femoral artery and into the uterine artery
Tiny particles of polyvinyl alcohol (PVA), about the size of grains of sand, are injected near the uterus where blood flow carries them into the left and right uterine arteries, partially blocking blood from reaching the fibroid(s)
The body reacts with blood clotting, minor inflammation and scarring, which completes the blockage
With blood supply cut off, the fibroid(s) gradually shrink
Patients experience significantly painful cramps for 6 to 10 hours after the operation
Most patients return to work in 1 to 2 weeks

After UAE: What About Fertility?
After careful consideration, Clara and I opted for UAE. On May 10, 2001, she underwent the procedure, performed by Dr. Kirsch in Philadelphia. Clara returned to work one week later.а Within a month, all of her problems due to fibroids had greatly diminished or disappeared. After three months, Clara was practically symptom free.

In a recent study by the French team who pioneered UAE 10 years ago, 9 women who underwent UAE had 12 pregnancies, and none had regrowth of their fibroids during pregnancy. Because the uterus has so many vessels to supply it with blood, UAE does not harm uterine tissue. However, the number of women who have become pregnant after UAE remains small, and a Уfertility rateФ for uterine artery embolization has yet to be officially determined.

Our fingers crossed, Clara and I remain optimistic!

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