Ovarian Reserve after Uterine Artery Embolization in Women with Morbidly Adherent Placenta

Objective: The aim of this study is to assess ovarian reserve in women after preservative cesarean section using uterine artery embolization due to morbidly adherent placenta.

Study Design: A prospective historical study including all women after successful preservative cesarean section delivery with bilateral uterine arteries embolization admitted to a single tertiary care center, since November 2011 until July 2016. Inclusion criteria included gestational age >24 weeks, singleton pregnancy and placenta increta / percreta diagnosed by ultrasound. Exclusion criteria included maternal age > 43 years. Control group included women attending the infertility clinic due to male factor, or single women conceiving via sperm donation, matched by age. Blood samples were collected from all patients on day 2-5 of menstruations for hormonal profile and anti mullarian hormone (AMH) levels.

Results: 59 women underwent preservative cesarean section and uterine artery embolization due to morbidly adherent placenta during the study period. 21 women met inclusion criteria (33.9%) and were matched controls (n=40). Circulating levels of E2 and FSH did not differ significantly between the two groups (p=0.665, p=0.396, respectively). AMH was lower in the study group (median 0.8 IQR 0.44-1.80) compared to the controls (median 2.08 IQR 1.68-3.71),(p=0.001). This finding was consistent in linear multivariate regression analysis where the group of cesarean section using bilateral artery embolization was significantly predictive for the levels of AMH (B=-1.308, p=0.012).

Conclusion: Women post preservative cesarean section using uterine artery embolization due to placenta accrete have lower ovarian reserve compare to controls matched by age.