Uterine artery embolization (UAE) is a great alternative to conservative surgical procedures like hysterectomy with its highly promising results, low recurrence, and considerably shorter hospitalization period.
Uterine artery embolization is a minimally invasive procedure that is performed to stop pelvic bleeding that might be caused by either uterine adenomyosis, uterine fibroids, cancerous tumors, trauma or injuries amongst other conditions. Among these, adenomyosis is a common pathophysiological condition in women of reproductive age that leads to distressing conditions which affect our daily performance and interactions. Although a major chunk of our population of approximately 20% to 80% are affected by this gynecological problem, adenomyosis still remains highly under-recognized and under-researched disease. Therefore, it is important to spread awareness regarding this condition and its treatment plans to help those that are suffering in silence.
Uterine Adenomyosis – Overview
Adenomyosis is an often-misunderstood benign gynecological condition in which the lining of the womb or uterus that should be on the inside invades and get embedded into the muscular wall of the uterus and is primarily seen in women of ages between 30 and 50 years.
Uterine Adenomyosis Symptoms
As all of us act differently in similar situations, women affected by adenomyosis may be completely asymptomatic, which allows the disease to go unnoticed until the case becomes severe. However, on the contrary, a bunch amongst us experience symptoms that vary in severity, making it hard for them to go on about their daily business without any discomfort and difficulty. Since the symptoms of adenomyosis overlap considerably with those of uterine fibroids, people tend to confuse one with each other. Adenomyosis symptoms that are most frequently noticed in the affected women include intense fatigue, menorrhagia (heavy menstrual bleeding), dysmenorrhea, pelvic pain, and irritation in the bladder due to inflammation caused by the shedding of the invasive adenomyosis tissues in the uterus. Other symptoms may include abdominal bloating due to uterus enlargement, dyspareunia (painful intercourse), anemia and iron deficiency due to heavy monthly bleeding, irregular menstruation cycle while some also experience fertility issues.
Uterine Adenomyosis Causes
Being as under-researched as it is contrary to the affected population, the definitive root cause and pathogenesis of adenomyosis is yet to be discovered. Regardless, researchers have pinned down quite a few theories that could be the culprit behind its origin.
Age: Since this condition has been observed commonly in women over 40 years of age, it has might be linked with the aging process.
Surgical Procedures: It’s been seen that women who have had children especially through caesarean delivery or have previously undergone any uterine fibroid surgery or any intrauterine procedure are more at risk of developing uterine adenomyosis.
Invasionof Uterine Cells: Adenomyosis could develop due to the invasion of endometrial cell into the uterine muscular walls due to either an incision made during uterine surgery or during normal physiological conditions.
Inflammation: Inflammation associated with tears and incisions made during normal childbirth.
Fetal origin of extra tissues in the uterine wall that set down before birth and grow during adulthood.
Metaplasia of stem cells in the uterus, which is the differentiation of one type of adult cell into another type.
Adenomyosis Treatment
Earlier to deciding the treatment regime, it is necessary that definitive diagnosis of adenomyosis is performed. This may include physical examination to check for any uterine enlargement and tenderness, along with different imaging techniques like ultrasound and MRI. There are two options for its treatment, medically and procedurally depending on different factors such as your symptoms, severity of the disease and personal preferences. Below are a few treatment plans described that are used frequently to treat adenomyosis symptoms.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to relieve adenomyosis associated pain.
Hormonal Therapy: Hormonal therapies have been suggested to control symptoms such as heavy or pain during by prescribing medicines like levonorgestrel-releasing intrauterine device (a contraceptive method), aromatase inhibitors, Gonadotropin-releasing hormone analogs and estrogen-progestin therapy.
Endometrial Ablation: This is a minimally invasive procedure in which the lining of the uterus is destroyed.
Hysterectomy: If you have surpassed child-bearing age or are ready to undergo surgery that removes the whole uterus to relieve the symptoms once and for all, then hysterectomy is another option.
Uterine Artery Embolization: Also known as uterine fibroid embolization (UFE), is an innovative outpatient procedure that has been established in 1995 as a beneficial treatment option for symptomatic uterine fibroids. Since then, the procedure has been established and is also used for the treatment of adenomyosis through adenomyosis embolization, which has shown favorable outcome.
It is a highly effective and essentially pain-free procedure performed by an interventional radiologist. Local anesthesia at the groin is applied, which may not even sting as prior to giving local anesthesia anesthetic spray is used over the access site.Specialized micron size particles are injected through a tiny tube inserted into the uterine artery that block the blood flow to the adenomyosis affected area. The procedure is guided through real-time fluoroscopy to direct the tube. The micron size particles then aid in shrinking down the invasive muscular growth that is the characteristic of adenomyosis by cutting off the blood supply to the affected area. Soon after embolization, pain (menstrual pain) may be experienced, however it will subside. You could feel the symptoms alleviate after the procedure. Being minimally invasive in nature, risks associated with surgical procedures such as wound infections and post-procedure complications are eliminated.
Uterine Artery Embolization is now available in Pakistan for the first time since 2017, as a 3-D precision guided endovascular treatment in two of its major cities; Karachi and Lahore. The embolization procedure is carried out using an FDA approved devices and medications by Dr. Imtiaz Ahmad, who is a renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up up to 6 months. There are numerous success stories of patients that underwent UAE procedures performed by Dr Imtiaz Ahmed that speak for his expertise in this area without compromising your fertility.
Even with improvements in the medical diagnostic technologies with their high resolution, adenomyosis remains a highly under-recognized and under-researched gynecological disease which affects about 20% to 88% of women of reproductive age. Therefore, it is important to shed light on this condition that many of us live with even without having any diagnosis. It can significantly affect the work and quality of life of those suffering, to the extent where it causes extreme tiredness and also affects daily performance. However, this condition resolves by itself as women reach menopause.
A Brief Overview of Adenomyosis
Adenomyosis is a benign uterine condition characterized by an enlarged uterus. It is a condition in which the endometrium, which is the inner lining of the uterus, grows into the outer muscular wall of the uterus (myometrium). The development of this extra tissue thus causes the uterus to grow in size, leading to abnormal uterine bleeding. Where, adenomyoma of endometrium is a type of adenomyosis are focal benign lesions or growths that blend with the myometrium and is rather difficult to distinguish from fibroid growth.
Adenomyosis and endometriosis are both uterine diseases that affect endometrial tissues that can be confused with one another or coexist in females that have been diagnosed with endometriosis. In both conditions the symptoms overlap considerably however, they are not the same. In endometriosis, the inner lining of the womb (endometrium) grows outside of the uterus and can breach the organs nearby, making it hard to conceive. Whereas in adenomyosis, the endometrium grows inside the uterine muscular wall. Thus, they affect different body parts while sharing a number of symptoms making it unavoidable to confuse them with one another.
What Causes Adenomyosis
Although the etiology and pathogenesis of adenomyosis are largely unknown till date, researchers have pinned down a few theories. It’s been observed commonly in women over 40 years of age, who have had children or undergone any fibroid surgery, are more likely to be suffering from this disease.
Invasion of endometrial cells into the uterine walls. This could be either due to an incision made during uterine surgery or during normal conditions as well.
Inflammation associated with childbirth.
Fetal origin of extra tissues in the uterine wall that set down before birth and grow during adulthood.
Metaplasia (differentiation of one type adult cell into another type) of stem cells in the uterus.
Adenomyosis Associated Symptoms
Adenomyosis symptoms vary from women to women. While some might not feel any symptoms at all, other may have it hard for them to endure. Several main symptoms associated with adenomyosis that include:
Heavy menstrual bleeding
Bloating
Menstrual cramps
Pelvic pain
Dyspareunia (painful sexual intercourse)
Anemia or iron deficiency due to heavy bleeding
Adenomyosis and Cancer
Although adenomyosis is generally considered a benign condition, studies have suggested increased potential of developing uterine cancer such as endometrial and ovarian cancer in such patients due to the risk of malignant development of endometrium. Generally, the symptoms associated with uterine cancer include weight loss, painful intercourse, unusual vaginal discharge, pain in the pelvic region and painful urination.
Adenomyosis Treatment Options
Before treatment, definitive adenomyosis diagnosis is necessary for which your healthcare professional will want to perform a diagnostic evaluation which will include a physical exam and diagnostic imaging test such as an ultrasound or MRI scan to determine uterus enlargement, tenderness to palpation and location of invasive growths respectively.
Your treatment plan will in part depends on your symptoms, disease severity and personal preferences. The available adenomyosis treatment options are discussed briefly, herein:
Medications: You might be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve adenomyosis associated pain. Which are prescribed to be taken one to two days before the beginning of menstrual bleeding and is continued through the first few of the cycle.
Hormone Therapy: Hormonal therapies are suggested to control symptoms such as heavy or pain during by prescribing medicines like levonorgestrel-releasing intrauterine device (a contraceptive method), aromatase inhibitors, Gonadotropin-releasing hormone analogs and estrogen-progesterone treatment.
Endometrial Ablation: In this minimally invasive procedure, lining of the uterus is destroyed. Even though, the procedure does not involve surgery, the process will result in infertility, which is what most women of childbearing age would not prefer.
Uterine Artery Embolization: UAE, today, is the most minimally invasive adenomyosis treatment available, which helps in shrinking down fibroids, adenomyosis or muscular growths. It uses nanoparticles which block the blood flow to the adenomyosis affected area guided through a tiny tube inserted into the femoral artery. This will eventually cut off the blood supply and hence the adenomyosis will shrink as a result.
Hysterectomy: If you have surpassed child-bearing age or are ready to undergo surgery that removes the whole uterus to relieve the symptoms once and for all then this adenomyosis treatment is also an available option for you.
Uterine Artery Embolization, also known as Uterine Artery Embolization, is now available in Pakistan for the first time since 2017, as a 3-D precision guided endovascular treatment in two of its major cities; Karachi and Lahore. The embolization procedure is carried out using an FDA approved drug and performed by Dr. Imtiaz Ahmad, who is a renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up up to 6 months. There are numerous success stories of patients who underwent UAE procedures performed by Dr. Imtiaz Ahmad, which is what speaks for his expertise in this area. The procedure relieves you of your symptoms without compromising your fertility.
When couples decide that it’s time to start a family, often at times, fertility can be a serious impediment for them and the process does not seem as easy as they had initially hoped. What’s more daunting is that it comes with undeniable emotional and psychological ramifications. Therefore, if you think you are suffering from fertility problems, the initial course of action should be to consult your doctor at the earliest, who will likely take your medical history, perform a complete physical check-up and recommend several fertility tests for men to find out what could be the underlying cause of your infertility, which usually is correlated with low-quality sperm production that interferes with conception.
When it comes to fertility, it’s a 50-50 deal: half egg and half sperm. It isn’t a blame game, so it shouldn’t come as a surprise if the complication in getting pregnant is associated with men. If you are stuck in this dilemma, then it’s about time that you empower yourself with the knowledge of alternative options and treatments that you need to get for the outcome you want. In spite of its prevalence, male infertility is often ignored in conversations. In our society, it’s the lack of awareness surrounding male infertility along with a heavy stigma surrounding the topic, that keeps men reluctant from openly talking about their fertility struggles. This drives the situation to the point where couples miss out on having the opportunity of being able to conceive.
Explaining Male Factor Infertility
Male factor infertility is clinically defined as the presence of abnormal semen parameters in the male partner of a couple who is unable to conceive after one year of unprotected intercourse. Therefore, World Health Organization (WHO) male factor infertility is the presence of abnormalities seen in semen analysis.
There is a general division that allows your expert urologist to appropriately workup the underlying cause of infertility. This helps your doctor in choosing a specific course of action for treatment that suits you best. Male factor infertility is in essence associated with suboptimal sperm parameters that can either exist alone or in combination which include deficiencies in sperm formation that result in lower sperm concentration, poor sperm motility, abnormal morphology along with suboptimal delivery or transportation.
Researchers have noticed that the rates of infertility in less industrialized areas are markedly higher that have been associated with the prevalent infectious diseases in those specific regions, which then contribute to a greater proportion of infertility.
Symptoms Associated with Male Infertility
Often there won’t be a particular symptom of for it, apart from the obvious obstructions in trying to get pregnant. Your medical expert will perform a thorough medical and urologic history. That will include your timing of puberty, the duration of infertility, any urologic disorders, spinal cord injury, medical illness, or surgical procedures for the proper diagnosis.
It’s Underlying Causes
Some of the underlying causes of male infertility include:
Disorders relating to sperm production
Structural abnormalities in sperms
Any prior surgical procedures such as vasectomy and hernia repairs
Groin or spinal cord injury
Varicocele
Immunologic disorders
Hormonal disturbances
Environmental factors
Diagnostic Tests for Male Infertility
Your overall sperm quality provides a window to your health. It’s highly impacted by your lifestyle choices such as smoking and alcohol consumption which further deteriorates the condition however, that can be improved by adopting good diet, exercise, and sleep pattern.
To diagnose the culprit behind male infertility, your urologist or male infertility expert will recommend fertility tests that asses the semen which will measure three main factors including your sperm concentration, its morphology and motility. While more sperm count isn’t necessarily better, however, less can be problematic. Similarly, sperm must be of a certain shape to be able to penetrate the egg to fertilize it. Similarly, the sperm’s ability to move is also of great importance during the process of conception.
In many cases, your genetic background can be a factor behind your fertility issues. If your semen analyses show fewer than five million sperm per mL in your semen, DNA testing is recommended, such as karyotyping and Y-chromosome analysis.
Y-Chromosome Microdeletions (YCMD)
Men with very low sperm counts are usually recommended to get tested for Y-chromosome microdeletion fertility test. These may be transmitted to your offspring, which may result in fertility problems in your male progeny.
Y-chromosome is essentially related to male fertility and unfortunately there are cases where portions of the Y-chromosome are missing or simply put deleted. It’s still possible for the patient to produce few healthy sperms if these mutations do not affect your fertility related regions in the chromosome. However, if the portions of your chromosome that are critical in the development of healthy sperm are deleted, then it is a rather bad news and may require extreme medical interventions.
DNA Fragmentation And Male Infertility
Sperm DNA fragmentation is a physical break in either one or both strands of DNA within the sperm. Many studies till date have shown that sperm DNA damage is common in infertile men which may be the contributing factor towards poor reproductive outcomes. It’s been found that despite having normal semen analysis results, a large proportion of men dealing with infertility issues have increased DNA fragmentation. Therefore, fertility tests assessing DNA integrity is yet another method used to assess your fertility potential.
There are many different types of tests for sperm DNA fragmentation, which provide an estimate of the degree of DNA damage present in a semen sample. Most used DNA fragmentation tests include sperm chromatin structure assay (SCSA), deoxynucleotidyl transferase-mediated dUTP nick end labeling assay (TUNEL), the single-cell gel electrophoresis assay (COMET) and sperm chromatin dispersion test (SCD).
Karyotype
Karyotyping is the analysis of all chromosomes of the said subject to see if there are any chromosomal abnormalities, such as extra or missing chromosomes.
Treatment Options for Male Factor Infertility
Depending on the results of your semen analysis, your reproductive urologist will refer you to different treatment options. Some of the treatment options are categorized below:
Medications – a regimen is prescribed to control hormonal imbalances and treat any urogenital infection.
Non-invasive varicocele treatment to correct enlarged incompetent veins around testes.
Intrauterine insemination (IUI) – In this procedure, sperm is placed inside the uterus thus, bypassing the need for sperm transportation and delivery.
In-vitro fertilization (IVF) – In this procedure, fertilization of an egg and sperm is performed in a lab test-tube.
Amongst the most common causes of infertility are varicocele, which is characterized by dilated or enlarged blood vessels around the testicles. It is the result of abnormal closure of the vessels valves which leads to pooling of blood around the testicle, due to which the temperature inside the testicle rises and thus compromises the sperm production.
The non-surgical treatment for varicocele is a complex and challenging procedure which requires high expertise in the said field. So far, the best treatment for varicocele available is the minimally invasive endovascular treatment. Varicocele treatment in Pakistan was introduced by Dr Imtiaz Ahmed, who is an endovascular surgical specialist and an interventional radiologist who treats men suffering from infertility issues that may have little hope left. The technique uses fluoroscopic guidance which helps the catheter to reach the selective abnormal veins draining blood from the testis while using specialized FDA approved devices and medications for the treatment of abnormally enlarged veins(Varicocele)around the testis. The entire treatment is done in single session and patient is discharged on the same day in 1-2 hours after procedure.
Uterine Fibroid Embolization confers additional benefits in addition to qualifying fibroid symptoms. UFE is a minimally invasive treatment option now available in Pakistan.
Researchers have estimated that 70-80% of women of reproductive age are affected by uterine fibroids by the time they reach their 50s. With this being one of the most common female gynecological ailments, one would assume people would be more knowledgeable about the topic. Sadly, that is not the case; there are many women around the world who suffer in silence with fibroids as it slowly gnaws at them, or they are simply unaware of their condition and its treatment options.
A Quick Overview of Fibroids
Leiomyomas, otherwise more commonly known as uterine fibroids, are benign growths of uterine muscles. Being the most prevalent reproductive tumors, chances of its incidence increase as women age. Depending on the lifestyle, environment and genetics of the suffering individual, the size of the tumor and its growth rate varies greatly. Where some women do not experience any symptoms, while others have to go through bothersome symptoms that affect their daily activities and quality of life.
Symptoms That You Should Look Out For
With fibroids, every woman’s experience is different. Keep a watchful eye on yourself and consult a healthcare professional at earliest if you think you’re experiencing any of the following symptoms:
Abdominal discomfort, pelvic pain, or pressure
Bloating in the lower abdomen
Inconsistent or heavy menstrual bleeding
Menstrual bleeding extending a week’s period
Excessive fatigue and weakness
Bladder dysfunction
Frequent urination
Constipation
Treatment Options
If you’re amongst those women whose life has been disturbed and wish to preserve their uterus, then worry not, there are numerous therapeutic options in the market for its treatment. Traditionally, invasive surgical options like myomectomy and hysterectomy have been of primary choice for the management of symptomatic fibroids which involve surgical removal of the fibroid itself and removal of the whole uterus, respectively.
However, in today’s date, minimally invasive outpatient alternatives like uterine artery or fibroid embolization procedures are also available for the patients.
Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization is a low-risk, minimally invasive outpatient procedure performed by an interventional radiologist. UFE is unique in its essence that it shrinks fibroids of various sizes at different locations, whether inside or outside the uterus. The procedure is performed while the patient is under local anesthesia. It involves temporary occlusion of the arteries supplying blood to the uterus by injecting biocompatible particles, which are engineered /programmed to block blood supply only to fibroids while sparing the normal uterine walls, into the blood stream through a catheter at the wrist or groin area, ultimately blocking uterine blood supply to the fibroids. The procedure uses specialized X-ray equipment for real-time tracking of the particles. The forestalling leads to the ischemic infarction of the arteries that were supplying blood to the fibroids. The treatment promises patient compliance and high success rate by coalescing it with other procedures besides UFE. Pain management via intra-arterial infusion of specialized medication and post embolization syndrome management are these critical aspects of the treatment, ensuring an overall success and comfort of the patient. The whole treatment usually takes about an hour. After a few hours of medical surveillance, the patient may go home and resume light daily activities.
There is a high chance that you might experience abdominal pain or pelvic cramps for several days after your UFE surgery, accompanied by low-grade fever. However, it will clear up in a few days, and you’ll be good as new to start afresh again.
Uterine Fibroid Embolization is now available in Pakistan for the first time since 2017, as a 3-D precision guided endovascular treatment in two of its major cities; Karachi and Lahore by Dr. Imtiaz Ahmad, who is a renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up up to 6 months. There are numerous success stories of patients that underwent UFE procedures performed by Dr Imtiaz Ahmed, which speaks for his expertise in this area.
Effects After UFE
After it was first performed in the 1990s, the technique has since advanced and has become a procedure of choice for many women owing to its non-invasive nature. It has a substantially good success rate in treating fibroid.
Following are few positive effects that you may experience after uterine fibroid embolization.
Low Recurrence Rate
Uterine fibroid embolization has success rate of 99% with considerably lower recurrence rate compared to other surgical interventions available.
Post Procedure Weight-Loss
Although weight gain isn’t usually listed amongst the common symptoms of fibroid. However, often times, fibroid can cause weight gain in the abdomen when they grow large. Uterine fibroid can weigh up to several pounds that may even compress other organs. Undergoing UFE can help you shed those extra pounds as the fibroid shrinks after the procedure and there is substantial reduction in abdominal bloating.
Symptomatic Relief
Approximately 90% of the women that underwent uterine fibroid embolization have experienced either complete or significant relief from fibroid related symptoms. In the context of UFE procedure, even post-surgery discomfort is reduced to a minimum. Overall, a quick recovery and UFE success helps improve the quality of life in all the ways fibroid were affecting it.
No Hormonal Disturbances
Hormonal therapies for uterine fibroid usually disturb the normal hormonal balance of the body. UFE overrules this possibility, which leads to downstream of side effects that inevitably affect every-day social interactions as well as activities.
It is crucial to understand that surgery alone cannot promise overarching benefits and complete success unless it is backed by a healthy lifestyle. It is never too late to start living to the fullest.
