Many reasons why a woman is having trouble achieving successful pregnancy : Fibroid Embolization in India

Female Infertility

Because of the intricate and complex nature of the female reproductive tract, there can be many reasons why a woman is having trouble achieving successful pregnancy.  Some of these factors may include: Fibroids Endometriosis Ovarian cysts Polycystic Ovarian Syndrome Pelvic Adhesions Decreased Ovarian Reserve Premature Ovarian Failure Fibroids Uterine fibroids are benign (noncancerous) growths of the muscular wall of the uterus. The growths, which may appear singly or in groups, range from the size of a pea to the size of a grapefruit.  They may either be confined to the uterine wall or grow outward on thin stalks. Fibroids often cause no symptoms, unless they grow large enough to press painfully on other organs or even distort the shape of the abdomen. Fibroids are quite common and typically affect women between ages 30 and 45. Large fibroids may narrow the uterine cavity and lead to miscarriage or infertility. Fibroids can impact fertility if they grow inside of the uterus. They change the environment of the uterus in a way that can interfere with embryo implantation or predispose a woman to have early miscarriages. Fibroids have a tendency to grow during pregnancy and may cause deformity of the arms and legs of the baby if they press on the fetus. If fibroids are found, your doctor will recommend removing them prior to any IVF procedure. Endometriosis Endometriosis is a common disorder that affects the tissue that lines the uterus, causing it to grow outside the uterine cavity.  The tissue becomes attached to reproductive or abdominal organs, and swells with blood during menstruation as if it were still in the uterus. Because this blood is trapped within the tissue and cannot be shed through the vagina, blood blisters form and may develop into cysts, scar tissue, or adhesions (fibrous bands that link together other tissues that are normally separated).  This can be very painful. Endometriosis is a leading cause of infertility and typically impacts women between 25 and 40 years of age. Endometriosis affects the ability for a woman to achieve pregnancy by inducing scar tissue formation that compromises the normal function of the fallopian tubes. Endometriosis cells can also secrete substances that might interfere with the sperm/egg interaction, preventing fertilization.  Women with endometriosis have a high chance of having other hormonal dysfunction conditions, like progesterone deficiency, that can make implantation weak and cause early miscarriages.  Women can be treated medically or surgically:   Medically.  Ovulation can be blocked, or the menstrual cycle can be stopped for four to six months Surgically.  Laparoscopy or laparotomy can be performed to cauterize the endometrial implants to destroy the endometriosis  Ovarian Cysts An ovarian cyst is a fluid-filled sac that forms in the ovary. Ovarian cysts are common and, in the vast majority of cases, they are benign (non-cancerous) in patients younger than 35. Ovarian cysts affect fertility if they interfere with normal ovulation or represent a mechanical obstacle for the fertilization process. Ovarian cysts can be aspirated (collapsing the cyst) under ultrasound guidance through the vagina or by laparoscopy. In either event, the fluid must be sent for cytology (take cell samples for analysis) to rule out any malignancy. Some cysts have a tendency to recur. Therefore, patients can benefit from three to four months of birth control pills after removing the cysts before attempting IVF treatment. Polycystic Ovarian Syndrome Polycystic ovarian syndrome (“PCOS”) is a medical condition characterized by: infrequent menstrual cycles obesity hirsutisum (extra hair on extremities, face, chest, abdomen and back), associated with acne and increase in male hormone levels in the blood dysfunction in the production of the LH and FSH hormones that control ovulation In certain cases, PCOS is associated with other endocrine gland problems like the adrenal gland and thyroid gland. In certain patients, the condition may occur along with hyper insulinism or peripheral resistance to insulin and adult onset diabetes.

Fibroid Embolization 

It is a minimally invasive procedure, which means it requires only a tiny nick in the skin. It is performed while the patient is conscious but sedated - drowsy and feeling no pain. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The interventional radiologist makes a small nick in the skin (less then ¼ of an inch) in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist guide the progress of the procedure using a moving X-ray (fluoroscopy). The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor.

 This cuts off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated. Embolization preparation: A tiny angiographic catheter is inserted through a nick in the skin in to an artery and advanced into uterus. 

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Uterine Fibroids in India - da Vinci Robotic Surgery as a Minimally Invasive Treatment Option for Uterine Fibroids

If you have been diagnosed with uterinefibroids, you should consider all your treatment options and work with your physician to identify the best treatment option for you. The da Vinci® Surgical System is one of the advanced, minimally invasive treatment options, including the use of the da Vinci robot for uterine fibroids.

A new category of surgery, introduced with the development of the da Vinci® System, is being used by an increasing number of surgeons worldwide to treat uterine fibroids. This minimally invasive approach, utilizing the latest in surgical and robotics technologies, is ideal for delicate gynecological surgeries. Using the da Vinci surgery system, your surgeon has a better robotic option to spare surrounding nerves, cause less tissue damage, and overall have a minimally invasive method encouraging a better surgical outcome.

If your doctor recommends surgery to treat uterine fibroids, you may be a candidate for minimally invasive da Vinci Surgery. Doctors are using the most advanced technology available, the da Vinci Surgical System. da Vinci allows the surgeon to operate through a few tiny incisions. Advantages include -

• Less likelihood of negative side effects
• Less pain from surgery
• Less risk of infection
• Less scarring
• Shorter hospital stay

da Vinci is a robotic surgery system in which the surgeon controls a robot through advanced technology. Even with this advanced robotic surgical treatment for uterine fibroids, the surgeon is always in control.

Is da Vinci Robotic Surgery the Best Treatment Option for You? What are the best treatment guidelines for Uterine Fibroids?

Uterine fibroids is a 

complex condition, and you should consult with your primary care physician as well as your specialist to consider your best treatment options. da Vinci is one of the newer robotic techniques and has been very successful, when used appropriately. Ultimately, however, only you and your surgeon can decide if da Vinci is the best minimally invasivetreatment option for you.

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Fibroids can reduce the chances of getting pregnant - Minimally-Invasive Treatment of Fibroids (Uterine Artery Embolization)

Being a woman is hard enough as it is, but when everyday trials are made worse with heavy menstrual bleeding, backaches and general discomfort, the day can seem unending. Excessive bleeding or prolonged periods are a glaring sign that something is wrong in your body, and you need to visit your gynaecologist. One of the most common conditions that causes these symptoms in women over the age of 20 is what doctors call ‘fibroids’, which are basically benign smooth muscle growths in the uterus. They can vary in size, from being as small as a pea to be as big or bigger than a melon.

In most women, a gynaecologist might incidentally notice the presence of fibroids during a routine sonography, since very few experience any noticeable symptoms. 

Most women experience symptoms only when the fibroid grows to such an extent that it presses on the uterus, rectum, bladder or spinal column. Another possible cause for the symptoms could be the fact that when the fibroid outgrows its blood supply and is deprived of nutrition, it begins to die and releases by-products that causes pain and fever. If you notice any of the following symptoms, consult a good gynecologist:

• Prolonged menstrual bleeding that lasts for more than seven days
• Persistent pelvic pain even after menstruation (when the fibroid is pressing on the uterus or the back)
• Frequent urination and difficulty emptying the bladder 
• Constipation (when the fibroid is present at the back of the uterus, exerting pressure on the rectum)
• Back or leg pain (when a fibroid either grows large and presses on the spinal column through the uterus or is formed behind the uterus)

 

Uterine Artery Embolization  or  Uterine Fibroid Embolization  is a minimally invasive technique used for treating symptomatic fibroids. The advent of UAE for treatment of fibroids has been revolutionary as the procedure requires a tiny nick in the skin and virtually does not involve blood loss or need of blood transfusion.  Thus one can anticipate “No surgery and Quick Recovery” with Uterine Artery Embolization.

What does a Uterine Artery Embolization procedure entail?

The Uterine fibroids stimulate blood vessels which increase blood supply to fibroids. The uterine artery embolization procedure entails injecting small particles into the uterine arteries which supply blood to the uterus and fibroids. The injected embolic agents block the vessels which starve fibroids and cause them to shrink and die.

Advantages of Uterine Artery Embolization:

• Minimally invasive procedure with infrequent complications
• Simultaneously treats all fibroids
• Performed under local anesthesia
• Rare chances of recurrence of fibroids after UAE
• Shorter Recovery Period
• Minimal blood loss
• No need for any blood transfusion
• No adhesion formation
• Is emotionally, physically and sexually more advantageous over surgery

UterineArtery Embolization, the non surgical cure for uterine fibroids is now available in India at some of the best hospitals at highly affordable cost. Uterine Artery Embolization is done by some of the best interventional radiologists in India who are specially trained to diagnose and treat conditions using miniature tools while watching their progress on imaging equipment.

The hospitals in India that offer Uterine Artery Embolization in India are well equipped with latest technology and infrastructure which are at par with any other facility in the world. The cost of Uterine Artery Embolization in India is much lesser than its western counterparts. Thus getting Uterine Fibroid Embolization in India is highly advantageous than getting it done in any other western country.

If untreated, fibroids can reduce the chances of getting pregnant. They may cause a distortion of the fallopian tubes leading to lack of ovulation, may block the entry of sperm into the uterus in the case of cervical fibroids and may cause disruptions in the implantation of the fetus in the case of submucosal fibroids.

In case a woman is already pregnant, fibroids can be quite dangerous. Complications during this phase include pain during the first and second trimester of the pregnancy. If a woman experiences multiple miscarriages or is unable to conceive after a year of trying, she should consult her gynecologist immediately.

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Non-Surgical treatment of Uterine Fibroids - MRI-HIFU fibroids Treatment options

Whatare fibroids?

Uterine fibroids (leiomyomas or myomas) are the most common neoplasms of the female pelvis. These benign tumors arise from the smooth muscle cells of the uterus, are generally oval shaped, are often highly vascular, and occur in up to 50% of women of reproductive age. Their size can range from few millimeters to 10 cm or more. Fibroids, particularly when small, may be entirely asymptomatic. Important symptoms include abnormal gynecologic hemorrhage, heavy or painful periods, abdominal discomfort or bloating, painful defecation, backache, urinary frequency or retention, and in some cases, infertility. There may also be pain during intercourse, depending on the location of the fibroid.

Uterine fibroids are often multiple, and if a uterus contains too many leiomyoma to count, it is referred to as “diffuse uterine leiomyomatosis.”

Measures of the clinical success of fibroid treatment are subjective and thus evaluated by the patient in terms of rapid and long-lasting improvement in the symptoms that caused her to seek treatment (decrease in pain, bladder, or bowel symptoms or reduction in vaginal bleeding) along with a minimum of adverse effects from the treatment itself.

MRI-HIFU Fibroids Treatment Options in India

The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.

The search for non-invasive techniques to provide the patient with relief from this otherwise non- threatening illness led to other minimally invasive options like Uterine Artery Embolisation, and Radio- Frequency Ablation which however had limited efficacy, and considerable adverse effects like excruciating post-treatment pain.

MRI guided HIFU or Magnetic Resonance Imaging- guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

The procedure is gaining wide acceptance because of the ease of use, exemplary safety and minimal disruption in the patients' daily routine. This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure. The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term

Advantages of Nonsurgical Fibroid Embolization

On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms.

 Requires only a tiny nick in the skin (No surgical incision of abdomen).

 Recovery is shorter than from hysterectomy or open myomectomy.

All fibroids are treated at once, which is not the case with myomectomy. There has been no observed recurrent growth of treated fibroids in the past 9 years.

 - Uterine fibroid embolization involves virtually no blood loss or risk of blood transfusion.

 - Many women resume light activities in a few days and the majority of women are able to return to normal activities (including exercise) within a week. If the presenting complaint was excess vaginal bleeding, 87-90% of cases experience resolution within 24hours.

Laproscopic Myomectomy (Keyhole, Minimally Invasive procedure to remove fibroids)

Whatare Uterine Fibroids?

Fibroids are Tumors that arise within the muscle of the uterus forming round masses. Some women have single fibroids as large as a football, others have multiple (up to 20 or more) which vary in size from a peanut to golf balls and larger. Fibroids are named according to their position in relation to the uterine muscle and cavity. 1) Intramural fibroids are located within the wall of the uterus and are the most common type; unless large, they may be asymptomatic. It may cause heavy bleeding with clots. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity. 2) Subserosal fibroids are located on surface of the uterus and can become very large. They can cause pressure over bladder and rectum producing urgent urination and constipation with back pain. 3) Submucosal fibroids are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesion in this location may lead to bleeding and infertility. 4) Cervical fibroids are located in the wall of the cervix (neck of the uterus.

What Problems do Fibroids Cause?

1) No Symptoms : most fibroids up to the size of an orange (12 weeks pregnancy) cause any symptoms. Their mere presence is not a reason to treat them.

2) Submucus : They protrude into the uterine cavity and cause menstrual cramps, heavy periods, infertility and repeated miscarriages. The diagnosis is often missed as the uterus is not enlarged and unnecessary hysterectomies have been performed for these. The diagnosis is made by hysterosonography or hysteroscopy.

3) Intramural : These fibroids are within the muscle of the uterus and can be very large. Because they enlarge the cavity of the uterus they can also cause heavy periods. The most common problem is PRESSURE symptoms on the bladder and rectum.

4) Subserous : These are external to the uterine muscle and are connected by a thin stalk. They are the least likely to be symptomatic and rarely need removal. TORSION (twisting) is a very rare complication.

5) Degeneration : Rarely there is liquifaction and bleeding within the center causing pain and fever. Infection may also occur. The most common occurrence is during pregnancy. Treatment is never surgery but conservative with fluids, pain medication and antibiotics.

Laproscopic(Minimally Invasive) Fibroids Treatment - Uterine Fibroids Surgery at WorldClass Hospitals in India

1) Fibroids shrink at the menopause to 50% of their size but never go away.

2) GnRh agonists e.g. Lupron, Synarel, Busarelin are medications given by injection or nasal spray that create a temporary menopause allowing shrinkage.

3) However on stopping medication the fibroid regrows to its original size.

4) Therefore long term treatment is not indicated as these drugs cause severe menopausal symptoms and osteoporosis.

5) They are used for 1-3 months before surgery to reduce the blood loss of surgery.

Surgical Treatment : 1) The treatment for removing the fibroids from the uterine muscle is known as MYOMECTOMY. 2) It is a specialized operation where the uterus is preserved for future fertility and only fibroids are removed. 3) This operation is traditionally done through a LAPAROTOMY via a 'bikini' or 'up and down' incision. 4) When the fibroids are less than 5 and less than 18 weeks size LAPAROSCOPIC myomectomy can be performed. Laproscopic Myomectomy (Keyhole, Minimally Invasive procedure to remove fibroids) Myomectomy is the most suitable surgery option for women who have fibroids but wish to retain their uterus. Laproscopic Myomectomy : The advantage of this is that patients can go home the same or next day and be back to work in 1-2 weeks. We use laser, harmonic scalpel, knife or electro surgery to remove the fibroids. The skill of the surgeon is paramount to results. Minilap Myomectomy : This is another technique pioneered at our center where large multiple (up to 24 weeks) can be removed through a 2-inch bikini incision. Patients can go home the next day after surgery. Hysteroscopic Myomectomy : Submucus fibroids are removed by inserting a hysteroscope (small camera passed through the Vagina) and an electrical loop is used to remove the protruding part. This is rapid and effective surgery without the need of laparoscopy. Estrogen is used after surgery to promote uterine lining re growth. Total Laparoscopic Hysterectomy : When the family is complete and patient has a symptomatic fibroid, the whole Uterus is removed via only four small holes in the tummy using laparoscopic technique.

Laproscopic Myomectomy has many Advantages over the abdominal (open) approach :- ·  Minimal Pain ·  Minimal Blood Loss ·  Early Post Operative Recovery ·  No Scar ·  Faster Recovery ·  A shorter hospital stay ·  Decreased Adhesion formation ·  Better chances of post surgery pregnancy

Non-Surgical Treatment for Uterine Fibroids

Fibroids are growths enclosed in capsules in the wall of your womb. They don't spread to other parts of your body, except in very rare circumstances.

 Fibroids are very common – around one in two women will be affected at some point in their lives. However, most don't ever get any symptoms. You may have only one fibroid or you may have many fibroids of different sizes. Fibroids can range from being very small to around the size of a basketball.

Uterine fibroids or myomas are the most common tumours to affect women, and are present in up to 40% of women in the reproductive age group. Not all of these women are symptomatic, and they usually do not require any treatment for these fibroids. Occasionally, the fibroids can cause pain, heavy menstrual as well as inter-menstrual bleeding, and pressure effects such as frequency of urination due to the size of the fibroid. In a small number of cases, fibroids can be a cause of infertility.

Fibroids are traditionally known to grow very slowly throughout the reproductive life of a woman, and they exhibit a growth spurt during pregnancy. After menopause, a fibroid typically begins regressing in size, and at this stage, fibroids rarely need to be treated.

Attempts at symptomatic relief through medications have largely been unsuccessful, leaving the patient suffering from fibroids no option other than surgery.

The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.

The search for non-invasive techniques to provide the patient with relief from this otherwise non- threatening illness led to other minimally invasive options like Uterine Artery Embolisation, and Radio- Frequency Ablation which however had limited efficacy, and considerable adverse effects like excruciating post-treatment pain.

How can Fibroids be treated in a non invasivemanner?

MRI guided HIFU or Magnetic Resonance Imaging- guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

As fibroids are almost always benign, with a neglible percentage (0.07% of operated patients - Parker W, Berek J, Fu YS., Obstetrics and Gynecology 1994; 83:414-8) showing the presence of a sarcoma (malignancy),fibroids only require treatment for the alleviation of symptoms due to the fibroid.

 

How MRI does guided HIFU work?

The MRI acquires high resolution 3-D images of the fibroid and surrounding structures. These images are used for accurate planning and mapping of the treatment. During treatment, the HIFU transducer focuses the ultrasound beam into the fibroid as per the planned areas (cells) and heats the tissue up to 65 degree Celsius, coagulating it. This is called sonication.

Sonalleve MRI guided HIFU ensures patient safety by having a number of safety mechanisms built into the system. All of these ensure that apart from the tissue being targeted, no other organ or tissue is affected by the treatment.

During treatment, the MRI plays an important role by monitoring temperatures within the treatment areas as well as in the surrounding tissues. The recorded temperatures are then superimposed in the form of colour coded maps on the 3-D images that are being used for the treatment monitoring.

The real-time feedback loop ensures that adequate heating takes place, treating every bit of tissue that has been targeted and volumetric ablation (a Philips proprietary technology) helps treat larger volumes efficiently and quickly.

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Major Effects of Fibroids on Women's Fertility – Fibroids Treatment in India

Fibroids are common benign tumors of uterine origin that may develop as variably sized solitary tumors or as aggregated clusters. They occur predominantly in premenopausal women, and their growth appears to be hormone (estradiol, progesterone) dependent. They may grow towards the uterine cavity (submucous) or towards the abdominal cavity (subserosal), or they may be located within the uterine wall (intramural). Fibroids may be asymptomatic or could be associated with a variety of complaints. Symptoms, such as menometrorrhagia, pressure, urinary frequency, constipation, and pain, are associated with size, number, and location of the fibroids.

Fibroids are very common – around one in two women will be affected at some point in their lives. However, most don't ever get any symptoms. You may have only one fibroid or you may have many fibroids of different sizes. Fibroids can range from being very small to around the size of a basketball.

Fibroids are named according to where they are found in your womb.

·         Intramural fibroids grow within the muscular wall of your womb.

·         Subserous fibroids grow from the outside wall of your womb into your pelvic cavity. They can become very large.

·         Submucosal fibroids grow from the inner wall of your womb into the space inside your womb.

·         Pedunculated fibroids grow from the outside of your womb. These fibroids are almost free of the wall of your womb and are only attached by a narrow stalk.

It has long been suspected that fibroids that distort the uterine cavity are associated with infertility and miscarriages. The association between fibroids and reproductive failure (infertility, pregnancy loss) has been studied by several groups. The majority of these studies are affected by the same problems: small sample size, no or inappropriate controls, and a retrospective design. The use of a meta-analysis may remedy the shortcomings of individual studies. In addition, few studies have addressed the benefits of treatment in a well-designed manner. To further complicate the issue, several treatment options -- medical, surgical, radiologic -- are available, but their effects would need to be assessed separately.

This analysis is based on the results of 23 studies and is an update of a previous review  Fibroids in general, regardless of location, were associated with a 15% reduction in pregnancy rates, a 30% reduction in live birth rates, and a 67% increase in miscarriage rates when compared with controls without fibroids. The effect was especially pronounced when submucous fibroids were analyzed (64% reduction in pregnancy rates, 69% reduction in live birth rates, and 67% increase in miscarriage rate). The effect of intramural fibroids was significant but less pronounced (22% decrease in live birth rates, 89% increase in miscarriage rates). Subserous fibroids did not affect pregnancy rates or pregnancy outcome. The analysis did not demonstrate a consistent effect on pregnancy rates and outcomes.

Myomectomy was associated with improved pregnancy outcome when submucosal myomas were evaluated. The pregnancy rate was significantly higher after myomectomy when compared with women with fibroids left in place. On the basis of a small number of cases, the removal of intramural fibroids was not associated with improved pregnancy outcome.

Although fibroids are one of the most common benign tumors that affect reproductive-age women, studies are few and have been poorly designed to assess their effect on reproduction. A cause-and-effect relationship seems obvious between submucosal fibroids and reproductive failure. This association is supported by this current review as well. In these cases, myomectomy does improve outcome. The association between intramural fibroids and lower pregnancy rates seems to be supported as well, but the effect of treatment is not obvious. In these cases, treatment needs to be individualized on the basis of the outcome of previous pregnancies, the number of previous surgeries, comorbidities, and the number and size of fibroids when treatment is offered. In the future, studies will have to evaluate the benefits of treatment of intramural myomas.

Fibroid Embolization 

It is a minimally invasive procedure, which means it requires only a tiny nick in the skin. It is performed while the patient is conscious but sedated - drowsy and feeling no pain. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The interventional radiologist makes a small nick in the skin (less then ¼ of an inch) in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist guide the progress of the procedure using a moving X-ray (fluoroscopy). The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor.

 This cuts off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated. Embolization preparation: A tiny angiographic catheter is inserted through a nick in the skin in to an artery and advanced into uterus. 

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