Search

Objective: To assess the reproductive outcomes after laparoscopic uterine artery occlusion (LUAO) and uterine artery embolization (UAE) in women with symptomatic fibroids., Design: Prospective, clinical multicentric study., Setting: Endoscopic center in the department of obstetrics and gynecology at a hospital in the Czech Republic., Patient(s): Thirty-eight pregnant women after LUAO and 20 pregnant women after UAE., Intervention(s): Laparoscopic uterine artery occlusion and UAE., Main Outcome Measure(s): Pregnancy, abortion, preterm delivery, and live-birth rates., Result(s): Pregnancies after uterine embolization had a statistically significantly higher rate for spontaneous abortion (56%) than did pregnancies after surgical uterine artery occlusion (10.5%). The risk of malpresentation (20%) and the rate for cesarean section (80%) after UAE similarly were higher than was the risk after laparoscopic occlusion; however, these differences were not statistically significant. Also, there were no significant differences between the groups in preterm deliveries (15.3% in the LUAO group vs. 20% in the UAE group)., Conclusion(s): Pregnancies of women who were treated with uterine embolization were at significantly increased risk for spontaneous abortion when compared with pregnancies of women treated with LUAO.

Aim: Uterine artery embolization for fibroids is a controversial issue for women with incomplete reproductive plans. Ovarian failure and uterine infection are the most dreaded complications of this procedure. The purpose of the present study was to assess the types and the frequency of intrauterine abnormalities and the histological features of the endometrium after embolization., Methods: Uterine artery embolization was performed on 51 women (average age 34.5 years) with intramural fibroid/s larger than 4 cm. Hysteroscopy and endometrial biopsy was performed from 3 to 9 months later in the luteal phase of the cycle., Results: Despite all women having no major symptoms prior to hysteroscopy, only 19 (37%) had completely normal hysteroscopic findings. There was intrauterine protrusion of fibroid/s in 19 cases (37%), yellowish coloration of the endometrium in 14 (28%), intrauterine or cervical adhesions in seven (14%), and communication between the myoma and the uterine cavity in five cases (10%). A normal, functional endometrium was histologically verified in 44 women of 49 (90%) who could be evaluated. Regressive changes (necrosis or hyalinization) of leiomyoma or of indefinite origin were found in 17 patients and embolization particles in five, including one patient with microspheres inside the endometrial vessel. No case of Asherman syndrome or endometrial atrophy was observed., Conclusion: The frequency of abnormal hysteroscopic findings after embolization is surprisingly high. The clinical significance, reversibility, and impact on fertility of abnormal hysteroscopic findings after embolization remain unclear. Regardless, hysteroscopy should be strongly recommended to all patients after uterine fibroid embolization, prior to conception.

The objective of this study was to test whether silymarin induces changes indicative of estrogenic effects in gonadal organs of ovariectomized (OVX) rats. Silymarin was administered in two experimental groups of OVX rats (n = 7 + 7) for 30 days at the doses of 25 or 50 mg per animal per day. OVX rats (n = 7) receiving 5 µg of 17b-estradiol (E2) for the last three days before killing and untreated OVX rats (n = 7) were used as the positive and the negative controls, respectively. Uterine and blood samples were collected immediately after killing. Compared with the negative controls, total and normalized uterine weights were significantly higher in the two experimental groups (P < 0.01 and P < 0.05, respectively). Uterotrophic effects of silymarin were also evident from increased heights of the luminal epithelium (P < 0.01) and the endometrium (P < 0.05). The response was dose-independent within the tested range. The strongest uterine response was observed in the OVX rats treated with E2. A highly significant decrease in mean density of estrogen receptor (ERa) immunostaining in the luminal and the glandular endometrial epithelia (P < 0.01) and a stronger ERa immunostaining in stromal cells were observed in the two experimental and the positive control groups. The activities of alkaline and acid phosphatases were significantly increased in the luminal (P < 0.05) and the glandular (P < 0.01) epithelia only in the rats treated with E2. Both silymarin and E2 induced an increase in thyroid hormone concentrations in blood serum. The rises of free T3 and T4 were significant (P < 0.05) in the group receiving 50 mg of silymarin per day. Hepatic oxidative metabolism of steroids was assumed to be another target of the action of silymarin. The mitochondrial cytochrome P450-dependent testosterone hydroxylase activity and the cytochrome P4501A-dependent 7-ethoxyresorufin O-deethylase activity were significantly increased (P < 0.05) in the group receiving 50 mg of silymarin per day and in the E2-treated control group, respectively. However, the modulations of the CYP enzymes played only a minor role in the overall estrogenic effect of silymarin. Histological and functional alterations in the OVX rats treated orally with silymarin for 30 days were consistent with those seen in E2-treated rats and were indicative of estrogenic effects of silymarin.