PhD project:
The endometrial impact of my omectomy and embolization of uterine fibroids - a gene expression and secretomics study
Main supervisor: Pernille Ravn, senior consultant, associate professor, Research Unit of Gynaecology and Obstetrics
Co-supervisors: Ole Mogensen, professor; Peter Humaidan, professor
Background
Treatment of uterine fibroids in young women with a desire to become pregnant should be effective and preserve fertility. Fibroids occur in approximately 30% of women of childbearing age. Research indicates that fibroids have a possible negative impact on female fertility. Currently, women with fibroids and persistent infertility, are offered surgical removal of the fibroids before further fertility treatment. However, when fibroids are large and engage the uterine cavity, removal of the fibroids without affecting the fertility is difficult and sometimes impossible. This has incited development of alternative treatment modalities. One of these options is uterine artery embolization (UAE). Guided by x-ray application of small particles are led into the blood vessels supplying the fibroids. The blood flow is blocked (embolized), which cause the fibroids to wither and shrink. This method is less invasive and is associated with fewer complications and reduced recovery time compared to surgery. It is still not fully proven whether UAE affects female fertility. The main concern relates to the endometriums ability to receive the fertilized egg (implantation) after the procedure. Presently it is believed that the blood flow to the endometrium is affected by both procedures, though relatively more by UAE. Consequently, surgical removal of fibroids in women with a desire to be pregnant, has been considered first choice. Over the last decade, however, both surgical removal and UAE have been developed and refined. It is thus important to re-investigate which of the options is a better choice in terms of fertility.
Purpose
The purpose of this study is to compare surgically removing of fibroids with embolization treatment, in respect to effects on fertility.
Aim
The aim is to show that surgically removing of fibroids and embolization treatment of fibroids are comparable in regards to endometrium damage.
Methods
The women will be examined before and 6 month after the 2 treatments. Women will undergo hysteroscopic examination of the uterus whereby the endometrium are visualilly examined and biopsies are taken. Secret collected from the cervix and uterus will be sent for gene expression analysis. In addition, the women get blood tests to measure hormone production and egg reserve and conducted MR scan.
Results
We expect embolization and surgical removal to be equivalent methods with respect to effects on fertility.