The impact of uterine artery embolization on ovarian reserve: a systematic reviewand meta-analysis.
INTRODUCTION: In the recent years, uterine artery embolisation (UAE) has been gaining increasing popularity as an effective and minimally invasive treatment for uterine fibroids. However, there has been a growing concern over the risk of unintended embolization of the utero-ovarian circulation leading to reduction of ovarian blood supply with subsequent impairment of ovarian reserve. The purpose of this study was to investigate the impact of UAE on circulating anti-Müllerian hormone (AMH) and other markers of ovarian reserve. MATERIAL AND METHODS: This meta-analysis included all published cohort, cross-sectional and case-control studies a well as randomized trials that investigated the impact of UAE on circulating AMH. Data sources included MEDLINE, EMBASE, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials. gov and the Cochrane Library from January 2000 to June 2019. All identified articles were screened, and articles were selected based on the inclusion and exclusion criteria. AMH and other data were extracted from the eligible articles and entered into RevMan software to calculate the weighted mean difference between pre- and post-embolization values. PROSPERO registration number: CRD42017082615. RESULTS: This review included three cohort and three case-control studies (n=353). The duration of follow up after UAE ranged between three and 12 months. Overall pooled analysis of all studies showed no significant effect of UAE on serum AMH levels (weighted mean difference -0.58 ng/ml; 95% CI -1.5 to 0.36, I2 =95%). Subgroup analysis according to age of participants (under and over 40 years) and according to follow-up duration (3, 6 and 12-month) showed no significant change in post-embolization circulating AMH. Pooled analysis of serum follicle stimulating hormone (FSH) concentrations (four studies, n=248) revealed no statistically significant change after UAE (weighted mean difference 4.32; 95% CI -0.53 to 9.17; I2= 95%). Analysis of two studies (n=62) measuring antral follicle count showed a significant decline at 3-months follow up (weighted mean difference -3.28; 95% CI -5.62 to -0.93; I2 = 94%). CONCLUSIONS: Uterine artery embolization for uterine fibroids does not seem to affect ovarian reserve as measured by serum concentrations of AMH and FSH.