Fertility and Pregnancy Outcomes after Uterine Artery Embolization for Obstetrical Indications: A Single-Center Retrospective Study

Uterine artery embolization (UAE) is an established uterus-sparing intervention for obstetric hemorrhage; its long-term effect on fertility remains debated. We evaluated menstrual recovery, fertility, pregnancy outcomes, and obstetric complications following UAE for obstetrical indications in a single-center retrospective cohort. This was a single-center retrospective study of consecutive women aged 18 to 45 years who underwent UAE for obstetrical indications between June 2018 and March 2024. Exclusion criteria were post-UAE hysterectomy, incomplete records, or loss to follow-up. Reproductive outcomes were ascertained through telephone interview; the fertility population comprised women attempting conception after UAE. Statistical analyses was performed using SPSS version 25.0 and reporting followed the STROBE guidelines. Thirty-eight women (mean age 31.1 ± 5.7 years; mean follow-up 4.5 ± 2.25 years) were included. Indications were postpartum hemorrhage (n = 14, 36.8%; 9 secondary), ectopic/scar pregnancy (13; 34.2%), uterine arteriovenous malformation (n = 6; 15.8%), placenta accreta (n = 3; 7.9%), and invasive mole (n = 2; 5.3%). Bilateral UAE was performed in all patients, most commonly using PVA–Gelfoam (55.2%). Technical and clinical success rates were 100% and 97.4% (37/38), respectively. Menses resumed within 1 year in 88.9% of women attempting pregnancy. Eighteen women (47.4%) attempted conception. Among them, nine (50%) conceived spontaneously, yielding eight live births (7 term, 1 preterm at approximately 34 weeks), and one first-trimester miscarriage; Seven of the eight deliveries were vaginal. The mean time to conception was 15.3 ± 13.4 months. No maternal mortality, fetal demise, or placenta previa occurred. UAE for obstetrical indications was technically successful and uterus-preserving in this single-center cohort. Among women who attempted conception after UAE, spontaneous conception and live birth occurred in a subset of patients. However, the small sample size, absence of a control group, and lack of formal infertility evaluation preclude definitive conclusions regarding the causal effect of UAE on secondary infertility. Larger prospective controlled studies are required.