Robert L. Worthington-Kirsch

Interventional radiologists have become increasingly involved with women’s health issues over the last few decades. This has led to increased participation in the care of patients presenting with symptomatic uterine fibroids, pain due to pelvic congestion syndrome, or infertility due to fallopian tube pathology. In any of these cases, fertility issues become a significant consideration during the course of managing these patients. Fertility issues are important when considering any procedure performed on women of childbearing age, but are especially critical when contemplating procedures treating the genitourinary system. Radiation safety concerns are paramount in this population as outlined in an earlier chapter. However, there also should always be an awareness of what direct effects a particular procedure will have on fertility. This chapter will provide an overview of fertility issues surrounding the treatment of fibroids and fallopian tube interventions.

Before any discussion of the clinical issues surrounding treatment, one has to address the importance of building a team to address these issues. There must be clear and continuous channels of communication between the interventional radiologist and both the primary gynecologist and the reproductive endocrinologist providing care for each patient. This ensures that each patient is provided with a plan for care that is thorough and coherent. In my practice, there is a steady stream of correspondence between all three of these physicians, as well as frequent personal communications by phone and e-mail, regarding each patient.

In addition, it is important for the interventional radiologist to develop a true physician—patient relationship with each patient. All women should be seen for an office consultation before any elective invasive procedure. This allows the interventional radiologist to become familiar with the patient’s medical history and current situation. It also is invaluable for setting a woman at ease regarding a physician who is going to be providing medical care in an area of life (and anatomy) that may have tremendous emotional repercussions. To gain that trust, an open discussion that includes the potential risks as well as the potential benefits of any procedure being considered must be held with the patient. This relationship continues after any procedure because the interventional radiologist is responsible for postprocedure and recovery issues, follow-up, and management of any complications that may occur. The importance of this is that physicians who do not have training in interventional radiology (IR) including the gynecologist, primary care physician, or local emergency room [ER] staff will likely be unfamiliar with issues that arise after IR procedures and therefore may not be able to manage them appropriately.

Fibroid Interventions