Embolization Provides Options for Infertility & Fibroids
November/December 2006
Physicians consider referring to interventional radiology for diagnosis and treatment.
With a focus on non-invasive diagnosis and treatment, interventional radiologists can provide male patients suffering from varicoceles and female patients suffering from fibroids other treatment options beyond surgery.
Varicocele Embolization
Varicoceles are abnormal dilations of the pampiniform plexus of veins within the scrotum. Approximately 15 percent of all men have them and they are the cause of 40 percent of infertility problems, according to the American Urological Association. Causes range from incompetent or absent valves in the gonadal or spermatic veins leading to an abnormal enlargement of the pampiniform plexus of veins and/or the angle at which the gonadal vein enters the renal vein leading to dilation of the pampiniform plexus. Generally, the left gonadal vein is more susceptible to varicoceles than the right gonadal vein.
“Some patients may experience a dull or aching pain, but many are asymptomatic,” says Scott Trerotola, MD, chief of interventional radiology at the Hospital of the University of Pennsylvania. “Whether it’s causing pain or leading to infertility, we can often eliminate the varicocele with embolization.” In fact, embolization offers a 90 percent success rate for varicocele treatment—the same success rate offered by surgery.
Success rates with regards to fertility are more difficult to measure. “A number of different factors may impact a couple’s ability to become pregnant,” says Dr. Trerotola. “However, if the varicocele is the definite cause of infertility, there’s an excellent chance the patient will become fertile again after the varicocele is removed.” According to the American Urologic Association, semen quality is improved in approximately 60 percent of infertile men undergoing varicocele correction (embolization or surgery).
Typically performed on an outpatient basis, varicocele embolization involves the percutaneous insertion of a catheter into the groin or neck. After radiographic visualization of the incompetent gonadal vein causing the varicocele, stainless steel or platinum coils, balloons or other material are released to create an obstruction in the vein, interrupting retrograde blood flow and reducing pressure in the varicocele.
Following the procedure, patients may notice minor back pain that can be treated with OTC medications. Recovery periods are typically shorter compared to surgical repair. There are no distinct contraindications (except those with anaphylactic reaction to contrast media) and complications are rare; there is a small risk of bruising or bleeding. “Embolization can offer a patient a faster recovery with the same or better outcomes,” says Dr. Trerotola.
Uterine Artery Embolization
For patients suffering from symptomatic uterine fibroids, uterine artery embolization (UAE) may be a treatment option. Although benign, fibroids are a common type of abnormal uterine growth and often result in hysterectomy. They can be accompanied by bothersome symptoms such as menorrhagia and/or pelvic/bulk symptoms.
Performed under moderate sedation, UAE involves threading a catheter from the artery in the leg to the arteries in the pelvis. Particles, typically made of plastic or gelatin-like material, are injected into the arteries and preferentially block blood flow to the fibroids. “We have patients lie flat for four to six hours after the procedure, after which they can ambulate,” says Dr. Trerotola. Patients are hospitalized overnight for management of side effects, which can include mild nausea, vomiting, pain and/or fever.
Penn has one of the largest clinical experiences with UAE in the country. “We have a 90 percent success rate with UAE for menorrhagia,” says Dr. Trerotola. “Women can expect some improvement in their first menstrual cycle following the procedure and progressive improvement thereafter. Bulk symptoms can take longer to subside.”
There are relatively few contraindications to the procedure and minor complications can include blood vessel injury or bruising; major complications are rare, but may include infection or infarction resulting in hysterectomy; and premature menopause. “For these reasons, we generally don’t recommend UAE for women still trying to conceive,” says Dr. Trerotola.
Advances in embolotherapy continue and are used daily by Penn interventional radiologists in many other clinical settings, including cancer therapy and trauma, among others.
For more information about embolization, call PENNHealth at 1-800-789-PENN.
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Referring Physicians: To speak with a Penn physician
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1-800-789-PENN
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