The impact of different surgical treatments for uterine fibroids on ovarian reserve indices

Vysotsky M.М., Kuranov I.I., Nevzorov O.B.

1) A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation, Moscow, Russia; 2) S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia
Objective. To investigate ovarian reserve indices after various organ-sparing operations for uterine fibroids: hysteroresectoscopic (HRS) myomectomy, laparoscopic myomectomy, and uterine artery embolization (UAE).
Subjects and methods. Ninety-two patients were examined; organ-sparing operations, such as laparoscopic and HRS myomectomies and UAE, were performed. All the examinees were divided into 3 groups: 1) 27 women after HRS myomectomy; 2) 42 patients after laparoscopic myomectomy; 3) 23 patients after UAE. A control group consisted of 20 healthy reproductive-aged women.
Results. All surgical interventions lead to a significant decrease in the production of anti-Müllerian hormone (AMH) and estradiol in the presence of elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. HRS myomectomy results in a gradual restoration of ovarian reserve markers overtime at 4-6 months postsurgery. After laparoscopic myomectomy, the changes in the level of ovarian reserve markers were more pronounced and the production of gonadotropic and steroid hormones became normal at month 6 following surgery. After UAE, there was the most pronounced decline in the production of AMH and estradiol and an increase in the levels of LH and FSH; the production of AMH and estradiol significantly increased over time by the 6th postoperative month, but returned to the normal preoperative values only 10 months following surgery.
Conclusion. UAE exerts the greatest impact on ovarian function, after which the changes in the hormonal status and blood flow in the uterus and ovaries remain for 10 months compared with 6 months after HRS and laparoscopic myomectomies.


uterine myoma
hysteroresectoscopic myomectomy
laparoscopic myomectomy
uterine artery embolization
ovarian reserve


  1. Dolmans M.M., Donnez J., Fellah L. Uterine fibroid management: Today and tomorrow. J. Obstet. Gynaecol. Res. 2019; 45(7): 1222-9.
  2. Agdi M., Tulandi T. Endoscopic management of uterine fibroids. Best Pract. Res. Clin. Obstet. Gynaecol. 2008; 22(4): 707-16.
  3. Beyan E., Kanmaz A.G., İnan A.H., Karataşlı V., Tutar S.O., Alan M. et al. Töz E, Sancı M. Evaluation of occult uterine leiomyosarcomas. Ginekol. Pol. 2019; 90(8): 433-7.
  4. Arthur R., Kachura J., Liu G., Chan C., Shapiro H. Laparoscopic myomectomy versus uterine artery embolization: long-term impact on markers of ovarian reserve. J. Obstet. Gynaecol. Can. 2014; 36(3): 240-7.
  5. Practice Committee of the American Society for Reproductive medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil. Steril. 2012; 98(6): 1407-15.
  6. Torre A., Fauconnier A., Kahn V., Limot O., Bussierres L., Pelage J.P. Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur. Radiol. 2017; 27(7): 2850-9.
  7. Alessandri F., Lijoi D., Mistrangelo E., Ferrero S., Ragni N. Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J. Minim. Invasive Gynecol. 2006; 13(2): 92-7.
  8. American College of Obstetricians and Gynacologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet. Gynecol. 2008; 112(2, Pt 1): 387-400.
  9. Mara M.M., Maskova J., Fucikova Z., Kuzel D., Belsan T., Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc. Intervent. Radiol. 2008; 31(1): 73-85.
  10. Moss J., Cooper K., Khaund A., Murray L., Murray G., Wu O. et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 2011; 118(8): 936-44.
  11. van der Kooij S.M., Hehenkamp W.J.K., Volkers N.A., Birnie E., Ankum W.M., Reekers J.A. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am. J. Obstet. Gynecol. 2010; 203(2): 105. e1-13.
  12. Goodwin S.C., Spies J.B., Worthington-Kirsch R., Peterson E., Pron G., Li S. et al. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID registry. Obstet. Gynecol. 2008; 111(1): 22-33.
  13. Ouyang Z., Liu P., Yu Y., Chen C., Song X., Liang B. et al. Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies. Surg. Radiol. Anat. 2012; 34(8): 737-41.
  14. Ahmad A., Qadan L., Hassan N., Najarian K. Uterine artery embolization for treatment of uterine fibroids: Effect on ovarian function in younger women. J. Vasc. Interv. Radiol. 2002; 13(10): 1017-20.
  15. Spies J.B., Roth A.R., Gonsalves S.M., Murphy-Skrzyniarz K.M. Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay. J. Vasc. Interv. Radiol. 2001; 12(4): 437-42.
  16. McLucas B., Danzer H., Wambach C., Lee C. Ovarian reserve following uterine artery embolization in women of reproductive age: a preliminary report. Minim. Invasive Ther. Allied Technol. 2013; 22(1): 45-9.
  17. Hehenkamp W.J.K., Volkers N.A., Broekmans F.J.M., de Jong FH, Themmen A.P.N., Birnie E. et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum. Reprod 2007; 22(7): 1996-2005.
  18. Gupta J.K., Sinha A., Lumsden M.A., Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst. Rev. 2014; (12): CD005073.
  19. Manyonda I.T., Bratby M., Horst J.S., Banu N., Gorti M., Belli A.M. Uterine artery embolization versus myomectomy: Impact on quality of life - results of the FUME (Fibroids of the uterus: Myomectomy versus embolization) trial. Cardiovasc. Intervent. Radiol. 2012; 35(3): 530-6.
  20. Jun F., Yamin L., Xinli X., Zhe L., Min Z., Bo Z., Wenli G. Uterine artery embolization versus surgery for symptomatic uterine fibroids: A randomized controlled trial and a meta-analysis of the literature. Arch. Gynecol. Obstet. 2012; 285(5): 1407-13.
  21. Chrisman H.B., Saker M.B., Ryu R.K., Nemcek A.A. Jr., Gerbie M.V., Milad M.P. et al. The impact of uterine fibroid embolization on resumption of menses and ovarian function. J. Vasc. Interv. Radiol. 2010; 11(6): 699-703.
  22. Panagiotopoulou N., Nethra S., Karavolos S., Ahmad G., Karabis A, Burls A. Uterine-sparing minimally invasive interventions in women with uterine fibroids: A systematic review and indirect treatment comparison meta-analysis. Acta Obstet. Gynecol. Scand. 2014; 93(9): 858-67.

Received 21.11.2019

Accepted 29.11.2019

About the Authors

Maxim M. Vysotskiy, MD, PhD, Professor of the Department of Endoscopic Surgery, The A.I. Yevdokimov Moscow State University of Medicine and Dentistry,
Head of the course «Endoscopic surgery in gynecology». E-mail: 39 Losinoostrovskaja str., Moscow, 107150, Russian Federation.
Ivan I. Kuranov, MD, Gynecologist of the 22nd Gynecological Department, The S.P. Botkin City Clinical Hospital. E-mail:
5 Vtoroi Botkinsky proezd, Moscow, 125284, Russian Federation.
Oleg B. Nevzorov, MD, PhD, Associate Professor of the Department of Obstetrics and Gynecology, The A.I. Yevdokimov Moscow State University of Medicine and Dentistry. E-mail: 39 Losinoostrovskaja str., Moscow, 107150, Russian Federation.

For reference: Vysotsky M.М., Kuranov I.I., Nevzorov O.B. The impact of different surgical treatments for uterine fibroids on ovarian reserve indices.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 5: 132-138 (In Russian). 132-138

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