Key facts

  • Pregnancy after either UAE (also called UFE) or myomectomy has been reported1.
  • Limited randomized data suggest discussing myomectomy first when future pregnancy is the primary goal1. The FEMME trial was not powered for pregnancy2.
  • UAE is also associated with a higher risk of miscarriage in some analyses3.
  • Guidelines describe UAE fertility effects as incompletely understood. Shared decision-making with an OB-GYN and a fertility subspecialist is recommended4,5.
  • Submucosal or cavity-distorting myomas (FIGO types 0–2) are most often discussed in relation to bleeding and pregnancy loss4,5.
  • Talk with your doctor before you decide. This information does not replace personal medical advice.

What the evidence says about pregnancy after UFE

Pregnancy after either uterine artery embolization (UAE, also called UFE) or myomectomy has been reported. Limited randomized data suggest discussing myomectomy first when future pregnancy is the primary goal1. The FEMME trial was not powered for pregnancy2. A Cochrane overview of uterine artery embolization for symptomatic uterine fibroids is available as of the 2014 review6.

Why this matters: A wish for pregnancy changes the questions, and the randomized evidence on pregnancy is limited. Ask how that limit applies to you before you choose. For how the procedures differ aside from pregnancy, see UFE vs myomectomy.

Why guidelines are cautious

Guidelines describe UAE fertility effects as incompletely understood. Shared decision-making with an OB-GYN and a fertility subspecialist is recommended4,5.

Questions to ask

  • Which clinician should lead the fertility part of this decision: my OB-GYN, a fertility subspecialist, or both?
  • How should I read a study that was not powered for pregnancy?
  • What is still unknown about UAE and a future pregnancy in my situation?

Pregnancy outcomes reported after UFE

UAE is also associated with a higher risk of miscarriage in some analyses3. Ask your clinicians how that finding applies to you. Ask your clinicians about placenta problems and cesarean birth after UAE.

Questions to ask

  • How do you talk about miscarriage risk after UAE?
  • Which pregnancy outcomes should I ask about besides miscarriage, such as the placenta and delivery?
  • Who follows a pregnancy after UAE?

Pregnancy after myomectomy

Pregnancy after myomectomy has been reported. Limited randomized data suggest discussing myomectomy first when future pregnancy is the primary goal1. Ask your own clinicians how that finding fits you. If embolization is still part of the visit, bring questions to ask before UFE. If hysterectomy is also on the list, see UFE vs hysterectomy for questions to take to that specialist. Other fibroid guides are collected in the fibroid article library.

How long to wait is a question for your team

There is no single waiting time after UFE or myomectomy that fits everyone. Ask your OB-GYN, and a fertility subspecialist if future pregnancy is the primary goal, how long they advise you to wait.

Questions to ask

  • How long do you suggest I wait before trying to conceive after the treatment we are discussing?
  • Does the way a myomectomy is done change that wait for me?
  • What follow-up should happen before I try?

Cesarean birth and uterine scar questions

Whether you need a cesarean birth after myomectomy depends on your situation. A uterine scar, if you have one, is a question for your obstetrician.

Questions to ask

  • If I have a scar on the uterus, how does that affect plans for labor and birth?
  • Will I need a C-section, or is that decided later in pregnancy?
  • Who should answer this: my OB-GYN, or the surgeon who would do the myomectomy?

Do fibroids themselves affect fertility?

Submucosal or cavity-distorting fibroids, also called myomas (FIGO types 0–2), are most often discussed in relation to bleeding and pregnancy loss4,5. Ask what your own report says about location. The fibroid MRI report guide explains words that often appear on ultrasound and MRI reports.

Questions to ask

  • Do any of my fibroids distort the cavity, and are they FIGO types 0–2?
  • How does that location change the conversation about bleeding and pregnancy loss?
  • Do I need another imaging test before we talk about treatment?

Ovarian reserve and age

Ask your clinicians whether age or ovarian reserve belongs in your decision.

Questions to ask

  • How should my age change the questions I ask about UAE and myomectomy?
  • Do you want any ovarian-reserve testing before we decide?
  • Should a fertility subspecialist join this visit?

Questions to ask each specialist

Shared decision-making with an OB-GYN and a fertility subspecialist is recommended4,5. An interventional radiologist can explain UAE. Talk with your doctor before you decide.

Questions to ask an OB-GYN

  • If future pregnancy is my primary goal, should we discuss myomectomy before UAE?
  • How do fibroid size and location, including any fibroid that distorts the cavity, change that conversation?
  • Which symptoms should make me call the same day?

Questions to ask a fertility subspecialist

  • How should we weigh UAE when its effects on fertility are incompletely understood?
  • What would you want to know about my age and ovarian reserve before I choose?
  • Who should be in the conversation: you, my OB-GYN, and an interventional radiologist?

Questions to ask an interventional radiologist

  • What do the studies you use say about pregnancy after UAE, including miscarriage?
  • The FEMME trial was not powered for pregnancy. How should I read that limit?
  • What follow-up would you want if I hope to become pregnant later?

Common questions

Can I get pregnant after UFE?

Pregnancy after either uterine artery embolization (UAE, also called UFE) or myomectomy has been reported. Limited randomized data suggest discussing myomectomy first when future pregnancy is the primary goal1. The FEMME trial was not powered for pregnancy2. UAE is also associated with a higher risk of miscarriage in some analyses3. Talk with your doctor before you decide.

How long after UFE or myomectomy should I wait to try?

There is no single waiting time that fits everyone. Ask your OB-GYN, and a fertility subspecialist if future pregnancy is the primary goal, how long to wait in your situation. Talk with your doctor before you decide.

Will I need a C-section after myomectomy?

Whether you need a cesarean birth after myomectomy depends on your situation. Ask your obstetrician how a uterine scar, if you have one, affects delivery. Talk with your doctor before you decide.

Does UFE cause infertility?

Guidelines describe UAE fertility effects as incompletely understood4,5. Pregnancy after UAE has been reported, and UAE is also associated with a higher risk of miscarriage in some analyses3. Shared decision-making with an OB-GYN and a fertility subspecialist is recommended. Talk with your doctor before you decide.

Should I see a fertility specialist first?

Shared decision-making with an OB-GYN and a fertility subspecialist is recommended when UAE and future pregnancy are part of the conversation4,5. Limited randomized data suggest discussing myomectomy first when future pregnancy is the primary goal1. Talk with your doctor before you decide.

Talk with your doctor before you decide. This information does not replace personal medical advice. Read the medical disclaimer.

Sources

  1. Mara 2008, UAE compared with myomectomy, midterm clinical and reproductive results (PMID 17943348) ↩︎
  2. FEMME trial; not powered for pregnancy (PMID 32726530) ↩︎
  3. Homer and Saridogan 2010, UAE and a higher risk of miscarriage (PMID 19361799) ↩︎
  4. Symptomatic uterine leiomyomas, 2021 guideline (PMID 34011888) ↩︎
  5. Removal of myomas to improve fertility and reduce miscarriage, 2017 guideline (PMID 28865538) ↩︎
  6. Cochrane overview of uterine artery embolization for symptomatic uterine fibroids, as of the 2014 review (PMID 25541260) ↩︎