Fertility Complications After Uterine Artery Embolization for Postpartum Hemorrhage: A Case of Infertility and Miscarriage Following Stillbirth

TL;DR

A woman who had uterine artery embolization for severe postpartum hemorrhage later faced infertility and miscarriage, possibly due to uterine damage.

Contribution

This case highlights the potential fertility risks of UAE, including endometrial thinning and uterine cavity narrowing.

Findings

UAE can lead to persistent endometrial thinning and uterine cavity narrowing despite regular menstruation.

Infertility and miscarriage may occur after UAE even without intrauterine adhesions or amenorrhea.

ART cycles with frozen-thawed embryos failed due to implantation issues following UAE.

Abstract

Uterine artery embolization (UAE) is widely used as a minimally invasive treatment for postpartum hemorrhage (PPH), with the expectation of preserving fertility. However, its effects on fertility remain unclear. We present the case of a 32-year-old woman who developed secondary infertility after undergoing UAE for severe PPH following a stillbirth at 37 weeks of gestation. Despite the resumption of regular menstruation, the endometrium remained persistently thin, and hysterosalpingography revealed narrowing of the uterine cavity. She underwent assisted reproductive technology (ART), but repeated frozen-thawed embryo transfer (FET) cycles resulted in implantation failure. Although she eventually conceived, she experienced a missed abortion at seven weeks. No specific causes for the miscarriage were identified. This case highlights that even in the absence of intrauterine adhesions or amenorrhea, endometrial thinning and uterine cavity narrowing after UAE can contribute to infertility and miscarriage. UAE should be carefully considered in women desiring future pregnancies, and alternative hemostatic measures should be prioritized when possible. Further research is required to improve UAE techniques and fertility preservation.

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