Effects Of Uterine Artery Embolization On Ovarian Function

Objective:To observe the effect of uterine artery embolization on menstruation,repregnancy,pregnancy outcome and ovarian reserve function in patients with cesarean scar pregnancy.Methods:1.From January 2010 to June 2017,200 cases of patients diagnosed with cesarean scar pregnancy in Tianjin hospital(Tianhe hospital)and admitted for treatment were selected,including 110 cases of patients who underwent uterine artery embolization +dilatation and curettage,as the observation group.A total of 90 patients who underwent dilatation and curettage were included in the control group.Medical records were reviewed and the menstrual cycle,menstrual period and menstrual volume before pregnancy were recorded in the two groups.Patients were followed up by telephone or outpatient consultation for 3 periods after the operation,and the time of postoperative menstrual recovery,postoperative menstrual cycle,menstrual period and menstrual volume were recorded.Patients in the two groups with the intention of repregnancy were selected and their pregnancy status and pregnancy outcome were followed up 1-3 years after the operation for analysis.The effect of uterine artery embolization on ovarian function was assessed by the outcomes of menstruation and repregnancy.2.Twenty patients diagnosed with cesarean scar pregnancy in Tianjin hospital from June 2017 to June 2018 and admitted for uterine artery embolization + dilatation and curettage were selected as the research group.During the same period,20 patients who were diagnosed as cesarean scar pregnancy in Tianjin hospital and were admitted to the hospital for dilatation and curettage and were matched with age,gestational age,number of pregnancy,birth and cesarean section in the research group were selected as the control group for prospective study.Extraction after admission in patients with venous blood test FSH,E2,AMH levels,vaginal ultrasound measurement of AFC,OV;postoperative follow-up of patients with menstrual recovery time,intravenous blood tests were performed between the first and fourth days of the menstrual cycle on FSH,E2,AMH levels,vaginal ultrasound,AFC,and ovarian volume at the first,third,and sixth day of the postoperative menstrual cycle,respectively.To evaluate the effect of uterine artery embolization on ovarian reserve function by ovarian hormone secretion level and ovarian morphological changes.Results:1.In the observation group,94.5% of the patients recovered to normal menstruation after 1-2 months,and 2.8% of the patients recovered to normal menstruation after 3 months,1.8% of the patients recovered 4-6 months after surgery,and 0.9% developed amenorrhea,which was uterine amenorrhea;In the control group,98.8% of the patients returned to normal menstruation 1-2 months after surgery,and 0.2% of the patients returned to menstruation 3 months after surgery without amenorrhea.2.There was no statistically significant difference between the observation group and the control group in menstrual cycle and menstrual period before pregnancy and after surgery(P > 0.05).In the observation group,there were 10 patients(9.1%)with increased menstrual volume,77 patients(70.0%)with no change,22 patients(20.0%)with decrease,and 1 patient(0.9%)with amenorrhea.In the control group,8 patients(8.9%)had increased menstrual volume,65 patients(72.2%)had no change,17 patients(18.9%)had decreased menstrual volume,and none had amenorrhea.3.Among the patients in the observation group and the control group who wanted to have a second pregnancy,there were 52 patients in the uterine artery embolization + dilatation and curettage group,and 33 patients in the natural pregnancy group(63.5%),including 4 cases of spontaneous abortion(7.7%),12 cases of premature delivery(23.1%),and 17 cases of full-term live birth(32.7%).Among the 44 patients in the dilatation and curettage group,28 patients(63.6%)had natural pregnancy,including 3 patients(6.8%)had spontaneous abortion,11 patients(25.0%)had premature delivery,and 14(31.8%)had full-term live birth.There was no significant difference in pregnancy rate,spontaneous abortion rate,preterm birth rate and full-term live birth rate between the two groups(P > 0.05).4.There were no statistically significant differences in preoperative FSH,E2,AMH,AFC and ovarian volume levels between the study group and the control group(P > 0.05).There was statistically significant difference in AMH between the two groups at the first postoperative menstrual cycle(P < 0.05),but no statistically significant difference at the third and sixth postoperative menstrual cycles(P > 0.05).There was no significant difference in FSH and E2 between the two groups at the 1st,3rd and 6th menstrual cycles after surgery(P > 0.05).In the study group,the postoperative AMH in the 3rd and 6th menstrual cycles was higher than that in the 1st menstrual cycle(P < 0.05),while there was no statistically significant difference between the 3rd and 6th menstrual cycles(P > 0.05).5.There was no significant difference in AFC and ovarian volume between the study group and the control group on the 1st,3rd and 6th menstrual cycles after surgery(P > 0.05).Conclusions:1.Uterine artery embolization had no significant effect on menstruation and the rate of second pregnancy.In this study,we did not observe increased adverse outcomes of uterine artery embolization in patients with second pregnancy.2.Uterine artery embolization affects ovarian reserve function in the short term,but it tends to recover with time.Because of this study has no FSH,E2,AMH,AFC,ovarian volume measurements with the unpregnant subjects younger than 40,whether ovarian reserve function can be restored to the normal level before pregnancy after uterine artery embolization and whether there is any effect on ovarian reserve function in elderly patients need to be further observed in the follow-up study.AMH is more sensitive in indicators reflecting ovarian reserve function.3.Because this study is a single-center study,with a small sample size and a short research time,the conclusions obtained have some limitations,and a multi-center study with a large sample is required.