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INFERTILITY: THE EFFECT OF VARICOCELE AND UTERINE FIBROIDS

Did you know that two potential causes of infertility can be treated by radiologists? Uterine fibroids in women and varicocele in men are both conditions that can lead to difficulty conceiving and are commonly treated by our Mayfair Diagnostics interventional radiologists (IR).

An interventional radiologist (IR) is a doctor who specializes in minimally invasive procedures.

Uterine fibroids are non-cancerous growths in or on the walls of the uterus. They affect women mostly during their reproductive years and are diagnosed in a majority of women during their lifetime. Fibroids may cause symptoms including abnormal menstrual bleeding, anemia, pelvic pain, and decreased fertility.

Varicocele is abnormal enlargement of the veins inside the scrotum caused by leaking valves in the veins of the abdomen and pelvis. Varicocele is also common, effecting 10 -15 % of men, usually arising in puberty and early adulthood. Symptoms of varicocele include pain, scrotal swelling, and decreased sperm count and sperm motility, which in turn can lead to decreased fertility.

HOW ARE THESE CONDITIONS TREATED?

Uterine fibroids can be treated in a variety of ways including drugs, surgery, and by decreasing blood flow to the fibroids (embolization). In some cases, symptoms can be so severe that surgical removal of the uterus (hysterectomy) may be considered.

Varicoceles can be treated by conservative measures, open surgery, or by blocking off abnormal veins causing the varicocele (embolization).

Embolization, performed by an interventional radiologist, is a safe, effective, minimally invasive alternative to surgery for both conditions. In embolization procedures, an IR uses ultrasound and X-ray guidance to painlessly move a small plastic tube through a tiny hole in the skin around the blood vessels of the body to an area of abnormality. After navigating the tube to the site of abnormality, the abnormal blood vessels can be blocked by injecting small metal coils or glue-like liquids through the tube.

For varicocele, the tube would be directed to the abnormal veins draining the enlarged veins in the scrotum. The decrease in back flow from the abnormal, leaky veins decreases the size of the veins in the scrotum and cures the varicocele.

For uterine fibroids, the tube would be directed to the arteries supplying the fibroids. By blocking the blood supply to the fibroids, the fibroids decrease dramatically in size and the symptoms improve or resolve entirely.

WHAT ARE THE BENEFITS OF EMBOLIZATION PROCEDURES?

Embolization procedures have lower risks and complication rates when compared to their surgical alternatives. Because embolization procedures are performed through a tiny hole in the skin, the hospital stay after this procedure is less than 24 hours and complete recovery from the procedure is often within a week.

WHAT ARE THE RISKS OF EMBOLIZATION PROCEDURES?

Varicocele embolization and uterine fibroid embolization have been shown to be safe and effective treatments, but are relatively new compared to traditional surgery. Varicocele embolization was first performed in 1978. Uterine fibroid embolization was first performed in 1994.

Although they are considered low-risk procedures, there are side effects, risks, and potential complications which should be considered.

  • Complications associated with embolization procedures in general include bleeding, infection, and pain.
  • For uterine fibroid embolization, complications can also include passage of the fibroid material from the vagina after the procedure.
  • For uterine fibroid embolization, the fibroids are slowly deprived of blood supply. As a result, it may take up to six months for you to see the full benefit, although you may start to feel some relief much earlier than this.
  • Though fibroid embolization may maintain or improve fertility by avoiding hysterectomy and shrinking fibroids, the procedure of fibroid embolization may also cause a decrease in fertility.

HOW DO I GET AN EMBOLIZATION PROCEDURE?

Mayfair Diagnostics interventional radiologists perform these embolization procedures in-hospital within Calgary. These procedures are covered under the Alberta Health Care Insurance Plan. Out-of-province patients are accepted; you would need to confirm with your provincial health care plan that they will cover the procedure as Alberta Health Services will bill your provincial plan.

If you think you might benefit from one of these procedures, you will need to speak with your family doctor or specialist. Your doctor or specialist will then need to fax a consultation request to Rockyview General Hospital’s Diagnostic Imaging Department at 403-592-4852.

Once the information has been received, our interventional radiology team will review the request and contact you to arrange a consultation to determine if the procedure is appropriate based on your medical history. There may also be imaging required. For example, abdominal magnetic resonance imaging (MRI) may be ordered prior to a uterine artery embolization procedure and a scrotum ultrasound may be needed to diagnose a varicocele prior to varicocele embolization.

For more information, please contact the Mayfair Diagnostics Customer Contact Centre via the following options:


REFERENCES

American Society for Reproductive Medicine (2015) “Fibroids and Fertility.” www.reproductivefacts.org. Accessed March 17, 2022.

Giuliani, E., As-Sanie, S. and Marsh, E.E. (2020) “Epidemiology and management of uterine fibroids.” International Journal of Gynecology & Obstetrics, 149: 3-9. Accessed March 18, 2022.

Halpern, J., et al. (2016) “Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications.” Asian Journal of Andrology. 2016 Mar-Apr; 18(2): 234–238. Accessed March 18, 2022.

Johns Hopkins Medicine (2022) “Varicocele Embolization.” www.hopkinsmedicine.org. Accessed March 18, 2022.

Mayo Clinic Staff (2022) “Varicocele.” www.mayoclinic.org. Accessed March 17, 2022.

RESOLVE: The National Infertility Association (2022) “National Infertility Awareness Week.” www.infertilityawareness.org. Accessed March 17, 2022.

Urology Care Foundation (2022) “What are Varicoceles?” www.urologyhealth.org. Accessed March 18, 2022.

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