title: Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve.
abstract: OBJECTIVE
  To compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive-aged women with uterine artery embolization (UAE) versus laparoscopic myomectomy (LM), using sensitive measures including antral follicle count (AFC) and serum anti-Müllerian hormone (AMH).
  
  
  METHODS
  We undertook a retrospective cohort pilot study to evaluate the utility and feasibility of carrying out a larger prospective trial. Thirteen women were evaluated in this study, including eight in the UAE group and five in the LM group. They were identified from a larger group of 125 women who had undergone LM and 200 women who had undergone UAE at a participating institution at least 12 months previously; of these, 32 who had UAE and 27 who had LM were of reproductive age and eligible to participate. Participants had an assessment of ovarian reserve including measurements of serum AMH, estradiol, and FSH, and ultrasound assessment of AFC and ovarian volume.
  
  
  RESULTS
  Median serum AMH levels were significantly lower in women who had undergone UAE at least 12 months previously than in women who had undergone LM (0.78 ng/mL [range 0.67 to 1.28] vs. 2.17 ng/mL [range 1.17 to 2.38], P = 0.01). Median AFC per ovary was also significantly lower in women who had UAE than in those who had LM (3.5 [range 2 to 7] vs. 7 [range 6 to 11], P = 0.03). Median levels of FSH and E2 and of ovarian volume were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Reproductive-aged women who have undergone treatment of fibroids with UAE may have lower ovarian reserve over the long term (> 12 months) than women with fibroids treated with LM. This could have an adverse impact on future response to fertility treatment and/or fecundity. This finding may inform the choice of minimally invasive treatment for fibroids in reproductive-aged women who have not completed childbearing. It suggests that further study in this area is warranted before the application of UAE is expanded to young reproductive-aged women.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Arthur
authors.affiliation: Department of Medical Imaging, University of Toronto, Toronto ON; Division of Vascular and Interventional Radiology, Department of Medical Imaging, Mount Sinai Hospital, Toronto ON.
authors.forename: John
authors.initials: J
authors.lastname: Kachura
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto ON.
authors.forename: Grace
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
authors.forename: Crystal
authors.initials: C
authors.lastname: Chan
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON.
authors.forename: Heather
authors.initials: H
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000628:therapy*; D009215:Myometrium / Q000601:surgery*; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D010053:Ovary / Q000000981:diagnostic imaging; D010865:Pilot Projects; D012189:Retrospective Studies; D014463:Ultrasonography; D055357:Uterine Artery Embolization; D055815:Young Adult
chemical_list: D054304:Anti-Mullerian Hormone
keywords: AMH; antral follicle count; fibroid; laparoscopic myomectomy; myoma; ovarian reserve; uterine artery embolization