Abstract Study question In women with unexplained infertility, does tubal flushing with oil-based contrast during HSG early in the fertility work-up reduce time to ongoing pregnancy? Summary answer In women with unexplained infertility, tubal flushing with oil-based contrast during HSG early in the fertility work-up does not reduce time to pregnancy. What is known already In couples with unexplained infertility, tubal flushing with oil-based contrast during HSG is known to increase live births and reduce time to pregnancy compared to HSG with water-based contrast. It is unknown whether tubal flushing with oil-based contrast incorporated early in the fertility work-up will have this effect as compared to 6 months later in the fertility work-up. Study design, size, duration Between August 2019 and May 2023, we performed a multicenter, randomized trial in 15 Dutch hospitals. After informed consent, participating women were randomized to immediate HSG (oil-based contrast) or HSG delayed by six months. This allowed us to assess the effect of tubal flushing versus no tubal flushing over a 6-month period, as well as time to conception after immediate versus delayed flushing over a period of 12 months. We aimed to recruit 554 participants. Participants/materials, setting, methods We included ovulatory infertile women (18-39 years), who were advised expectant management based on a favorable prognosis for natural conception (Hunault prediction-model). The study has two primary endpoints, time to conception leading to live births (I) within 6 months, and (II) over a 12-month period. Here we report on conception within 6 months leading to ongoing pregnancy. Live birth data will be available at the 2024 ESHRE meeting. Analyses were done according to intention-to-treat principle. Main results and the role of chance Between August 2019 and May 2023, we randomized 577 women (287 allocated to the immediate HSG and 290 allocated to the delayed HSG group). Mean (±sd) female age was 30.0±3.6 years and median duration of infertility was 17.0 months. In the immediate HSG group, 239 women had an HSG after a median duration of 0.7 months after randomization, while in the delayed group 83 women had an HSG within 6 months (median time to HSG: 5.2 months after randomization). Conception leading to ongoing pregnancy within 6 months occurred in 90 women (32.5%) in the immediate HSG group and 91 women (33.2%) in the delayed HSG group (HR: 0.96; 95% CI: 0.72-1.29). Conception leading to any pregnancy within 6 months occurred in 119 women (43.0%) in the immediate HSG group and 104 women (38%) in the delayed HSG group (HR: 1.16; 95% CI: 0.89-1.51). The median time to conception leading to ongoing pregnancy was 2.4 months in the immediate HSG group and also 2.4 months in in the delayed HSG group. Limitations, reasons for caution This study was limited to women with unexplained infertility with favorable natural conception chances (>30%). In this abstract, we only report time to ongoing pregnancy and not time to pregnancy leading to live birth. Data on conception leading to live births will be available at the 2024 ESHRE meeting. Wider implications of the findings In women with unexplained infertility and a favorable prognosis to conceive, early tubal flushing with oil-based contrast during HSG does not increase live birth rates nor reduce time to pregnancy within six months as compared to tubal flushing delayed by six months. Trial registration number EU clinical Trials Register, no: 2018-004153-25 AND Clinicaltrials.gov, ID: NCT05608590

In women with unexplained infertility, tubal flushing with oil-based contrast during hysterosalpingography leads to significantly more live births as compared to tubal flushing with water-based contrast during hysterosalpingography. However, it is unknown whether incorporating tubal flushing with oil-based contrast in the initial fertility work-up results to a reduced time to conception leading to live birth when compared to delayed tubal flushing that is performed six months after the initial fertility work-up. We also aim to evaluate the effectiveness of tubal flushing with oil-based contrast during hysterosalpingography versus no tubal flushing in the first six months of the study. This study will be an investigator-initiated, open-label, international, multicenter, randomized controlled trial with a planned economic analysis alongside the study. Infertile women between 18 and 39 years of age, who have an ovulatory cycle, who are at low risk for tubal pathology and have been advised expectant management for at least six months (based on the Hunault prediction score) will be included in this study. Eligible women will be randomly allocated (1:1) to immediate tubal flushing (intervention) versus delayed tubal flushing (control group) by using web-based block randomization stratified per study center. The primary outcome is time to conception leading to live birth with conception within twelve months after randomization. We assess the cumulative conception rate at six and twelve months as two co-primary outcomes. Secondary outcomes include ongoing pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, number of complications, procedural pain score and cost-effectiveness. To demonstrate or refute a shorter time to pregnancy of three months with a power of 90

Pelvic venous congestion syndrome (PVCS) is a common, but underdiagnosed, cause of chronic pelvic pain (CPP) in women. PVCS occurs usually, but not exclusively, in multiparous women. It is characterized by chronic pelvic pain of more than six months duration with no evidence of inflammatory disease. The patients present to general practitioners, gynaecologists, vascular specialists, pain specialists, gastroenterologists and psychiatrists. Pain of variable intensity occurs at any time but is worse in the pre-menstrual period, and is exacerbated by walking, standing, and fatigue. Post coital ache, dysmenorrhea, dyspareunia, bladder irritability and rectal discomfort are also common. Under-diagnosis of this condition can lead to anxiety and depression. A multidisciplinary approach in the investigation and management of these women is vital. Non-invasive imaging (US, CT, MRI) are essential in the diagnosis and exclusion of other conditions that cause CPP as well in the definitive diagnosis of PVCS. Trans-catheter venography remains the gold standard modality for the definitive diagnosis and is undertaken as an immediate precursor to ovarian vein embolization (OVE). Conservative, medical and surgical management strategies have been reported but have been superseded by OVE, which has a reported technical success rates of 96–100%, low complication rates and long-term symptomatic relief in between 70–90% of cases. The condition, described in this paper as PVCS, is referred to by a wide variety of other terms in the literature, a cause of confusion. There is a significant body of literature describing the syndrome and the excellent outcomes following OVE however the lack of prospective, multicentre randomized controlled trials for both investigation and management of PVCS is a significant barrier to the complete acceptance of both the existence, investigation and management of the condition.

Category: Gynaecological radiology

Impaired tubal patency accounts for up to 35% of cases of subfertility and infertility. Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy) represents a first-line test in evaluating fallopian tube patency. Despite the association of HSG with ionizing radiation, HSG is a reference standard in assessing fallopian tube patency and tubal conditions such as tubal occlusion, salpingitis isthmica nodosa, and hydrosalpinx. HSG is widely available and utilizes either a water-soluble contrast medium (WSCM) or an oil-soluble contrast medium (OSCM). Compared with WSCM, HSG with OSCM results in a higher incidence of non-in vitro fertilization pregnancies and, therefore, may be preferred in women younger than 38 years with unexplained subfertility. HSG may also be helpful in assessment after sterilization or before fallopian tube recanalization. US-based tubal tests are free of ionizing radiation and include HyCoSy, with either air-saline or microbubble US contrast material, and hysterosalpingo-foam sonography (HyFoSy), a tubal patency test that utilizes a gel foam. A comprehensive US infertility evaluation of the pelvis and fallopian tubes can be achieved in one setting by adding coronal three-dimensional imaging of the uterus, saline infusion sonohysterography, and HyCoSy or HyFoSy to routine pelvic US. MR HSG and virtual CT HSG also depict tubal patency and uterine and adnexal pathologic conditions and may be considered in select patients. While laparoscopic chromopertubation remains the standard for tubal patency evaluation, its disadvantages are its invasiveness and cost. Knowledge of the different fallopian tube tests and radiologic appearance of normal and abnormal fallopian tubes results in fewer pitfalls, accurate interpretation, and optimal patient care. Online supplemental material is available for this article. ©RSNA, 2021.

The role of imaging in subfertility is well established but is changing. In addition to traditional fertility assessments, there is an emerging role for the radiologist. The role of imaging in fertility-restoring procedures in benign disease and congenital malformations is evolving, and there is a growing need for accurate identification of young candidates suitable for fertility-preserving surgery in the oncologic setting. To facilitate this developing role, knowledge of the key imaging modalities used and potential therapeutic applications is important for accurate diagnosis and interpretation by the radiologist. ©RSNA, 2017.

The advent of assisted reproduction techniques such as in vitro fertilisation (IVF) has led to a significant increase in the demand for hysterosalpingography (HSG), a fluoroscopic imaging procedure involving the introduction of iodinated water-soluble contrast medium into the female genital tract to delineate the endo-cervical canal, uterine cavity, fallopian tubes and pattern of intraperitoneal spill. NICE guidance for the investigation of subfertility and a common perception is that HSG is primarily recommended for the detection of tubal disease. Performed correctly it is also invaluable in detecting and monitoring uterine pathology. The technique was first described in 1910 by Rindfleish using a bismuth solution; by the early 1920s the oily contrast medium lipiodol was being used when, amazingly, one of the indications for the technique was to diagnose pregnancy. By the 1990s water soluble contrast media had largely replaced lipiodol for HSGs. Current indications for the procedure are numerous (table 1). HSG typically forms part of subfertility investigations that also include an ultrasound, hormonal profiles and semen analysis. Other imaging modalities are usually supplementary (such as MRI) but can be helpful to further delineate abnormalities detected at HSG. It is important to appreciate that findings considered abnormal at HSG may or may not be of significance in regards to the patient’s symptoms and subsequent management. This article will focus on factors that influence the interpretation of hysterosalpingograms. A comprehensive description of the technique, contraindications and complications can be found elsewhere. A crucial factor upon which an accurate interpretation can be made is image quality; achieving the highest possible image quality is dependent on numerous other factors including clinical background, patient anxiety, imaging sequence, procedure, technique and the experience of the radiographer and operator (table 2). The paper or electronic request form for HSG should provide the patient’s gynaecological and obstetric history, other significant medical history and results of investigations to date. Past history affects the conduct and interpretation of the study. For example, previous uterine instrumentation should alert the radiologist to the possibility of uterine scar tissue, Asherman’s syndrome. A history of ectopic pregnancy increases the index of suspicion for tubal pathology such as salpingitis isthmica nodosa (SIN). An empathetic, calm environment is essential; women who have researched HSGs on the internet or had a poor smear experience will be anxious. Anxiety predisposes to pain which in turn can cause vaginismus or tubal spasm and an erroneous diagnosis of tubal occlusion. A simple preprocedural checklist allows the operator to confirm all relevant information, establish rapport, provide a full explanation of the procedure, record the result of the pregnancy test and any drugs given and obtain written informed consent. Confirmation of demographic details, date of last menstrual period together with the outcome of any previous pregnancy, ie live birth, miscarriage, termination or ectopic, is essential. We recommend performing a urine pregnancy test in all women as well as ascertaining no intercourse in that menstrual cycle – positive tests can occur in women who have experienced apparently cyclical bleeding in an early pregnancy. History of post-partum complications should be sought, eg manual removal of placenta or post-partum haemorrhage; pelvic inflammatory disease, which may indicate tubal disease; previous pelvic or abdominal surgery such as myomectomy, tubal surgery, C-section or evacuation retained products of conception, which can all affect interpretation. Ideally the procedure is undertaken and supervised by experienced staff with an interest in gynaecology. The procedure must be conducted gently and slowly, as a rushed speculum insertion or forceful contrast medium injection will cause unnecessary pain and diminish image quality. A wide range of catheters must be available, because the external cervical os may range in size from pinpoint to large and patulous. A 5Fr balloon inflated gently in the upper cervical canal is our catheter of choice. Once the catheter is in place the pelvic cavity is examined fluoroscopically and a control image acquired if any radio-opaque lesions are observed. Infusing contrast gently, a minimum of four image exposures, early filling AP, RAO, LAO and AP to show spill, are acquired supplemented by frame grabs as desired. Frame grab, fluoroscopic images alone are insufficient for accurate image interpretation. A low dose programme must be used and screening kept to a minimum. Women will frequently voice concerns about dose to the ovaries and question the operator regarding potential harm to future pregnancies. The national diagnostic reference level (DRL) for HSG is 2Gycm2; 9 our local DRL for HSG is 0.7Gycm2. It is essential to obtain a true en-face view of the uterine cavity (figure 1); views that only show a foreshortened view down the long axis of the uterus are non-diagnostic. Oblique images are essential (figures 2a-b) and can be obtained using a C-arm, patient rotation or a combination of both. Air bubbles can be distinguished from polyps by use of patient rotation, and it should be noted that small air bubbles can lodge at the cornu and mimic cornual occlusion. If a balloon catheter is used and is inflated in the lower uterine segment a view following deflation (figures 2c-d) must be obtained to avoid missing lower uterine segment pathology. The range of uterine and /or tubal abnormalities that can be identified are shown in tables 3 and 4.

Purpose: To assess the frequency and demonstrate the range of potentially clinically significant abnormalities in women with a history of Caesarian section (C-section) undergoing HSG for investigation of secondary infertility or prior to assisted conception.

Purpose: Asherman's syndrome, uterine synechiae or intrauterine adhesion (IUA), occurs following endometrial insult e.g. evacuation of retained products of conception (ERCP), surgical termination of pregnancy (STOP), diagnostic dilatation and curettage (D&C), myomectomy, uterine artery embolization (UAE) and infection. The presentation illustrates the diversity of appearances as demonstrated by hysterosalpingography (HSG) and magnetic resonance imaging (MRI).

OBJECTIVES:The aim of this study was to describe our experience of imaging following hysteroscopic sterilisation with the Essure (Conceptus Inc., Mountain View, San Carlos, CA) microinsert, and to underline the importance of a carefully performed follow-up hysterosalpingogram (HSG) in the management of these patients.METHODS:18 women underwent the procedure and all returned for follow-up HSG. A standard HSG technique was used and views were acquired to establish microinsert position and tubal occlusion.RESULTS:In 16 of the 18 women, adequate microinsert positioning and bilateral tubal occlusion was present. In one woman, a unilateral microinsert occluded the fallopian tube, whereas the other fallopian tube was ligated with a clip. The final patient underwent two studies; both showed well-positioned microinserts but unilateral free spill from the right fallopian tube. There are no reported pregnancies thus far.CONCLUSION:Essure sterilisation coils have a unique appearance when radiographed and are an effective means of permanently occluding the fallopian tubes. HSG is a rapid and safe method of confirming satisfactory placement and tubal occlusion. Non-HSG imaging techniques are suboptimal at detecting patent fallopian tubes and expose patients to the risk of an unwanted and potentially complicated pregnancy.

Angiodysplasia is a condition of unknown aetiology in which microvascular abnormalities are found in the mucosa and submucosa of the bowel wall. The lesions are found predominantly in the caecum and right side of the colon and are frequently associated with either intermittent acute or continuous chronic intestinal blood loss. There is no family history and no recognized association with vascular abnormalities of the skin or other organs. The lesions of angiodysplasia which are small (less than 5mm) and usually multiple are diagnosed by selective visceral angiography and/or colonoscopy but cannot be detected on barium enema or by the naked eye at laparotomy. Localization by the histopathologist is greatly facilitated by special injection techniques demonstrating the blood vessels of resected colonic specimens prior to fixation and section. The lesions are thought to represent a distinct benign pathological entity characterized in their early stage by dilated tortuous submucosal veins. In the more advanced stages there is further dilatation of the submucosal veins and venules and capillaries.' These characteristic features of right colonic vascular ectasias correspond to the definition given by Gentry et al.2 of telangectasias, i.e. dilatation of pre-existing vascular structures. Galdabini in 19743 first used the term 'angiodysplasia' to describe the pathological abnormality found in a patient who presented with what is now recognized as a characteristic history' and the angiographic features of the condition defined above. There are two main clinical problems related to angiodysplasia; firstly, the fact that true prevalence of the condition in the general population is unknown and secondly the difficulty in detecting the disorder in patients with gastrointestinal bleeding of uncertain origin and, having made the diagnosis of angiodysplasia, establishing that it is the cause of the blood loss.

Fertility 2008 BFS Summer College 2008 OC1: Do patients receiving donor sperm need evaluation of their uterine cavity and fallopian tubes? Tulay Karasu, Ben Lavender, Anne Hemingway, Geoffrey Trew, & Stuart Lavery IVF Unit, Hammersmith Hospital, London, United Kingdom, and Imaging, Imperial College Healthcare, London, United Kingdom Introduction. In cases of infertility requiring the use of donor sperm, there is a debate about whether investigations for uterine and tubal pathology are routinely necessary, and if so which is the investigation of choice. We wanted to find out whether assessment of the uterine cavity and fallopian tubes with hysterosalpingogram (HSG) detects a significant amount of pathology which could affect treatment outcome. Material & Methods. This is a retrospective study in a London teaching hospital-assisted conception programme looking into the investigations of women prior to their treatment with Donor sperm. In the time period from January 2003 to November 2007, 162 women underwent assisted conception (IUI/IVF) Donor treatment in our unit. The patients were identified from the embryology database and data were collected from their case notes. Results. One hundred and forty-nine women (92%) had an HSG performed before starting their treatment. The HSG was normal in 92 women (56.8%) and showed abnormalities in 57 women (35.2%). Uterine pathology only was detected in 31 women (20.8%) and tubal pathology only was described in six patients (4%). Nineteen patients (12.8%) had uterine as well as tubal pathology on HSG examination. HSG was abandoned in one patient due to technical difficulties. Seventeen women (11.9%) underwent laparoscopic surgery, and 10 of these women had confirmed tubal pathology (7% in total), mainly hydrosalpinx. Hysteroscopy was performed in 35 women (24.5%) with 25 women showing uterine abnormalities (17.5% in total). The main findings were polyps in the uterine cavity. Conclusions. 17.5% of the patients had confirmed uterine abnormalities and 7% of the women demonstrated tubal pathology. The findings of the HSG did influence further management such as the decision to perform surgery or to proceed with IUI or IVF. We therefore believe that evaluation of the uterine cavity and tubes is justified in women before treatment with Donor sperm, and in our own practice we use the HSG. OC2: Correlation between number of eggs predicted and actual eggs collected during IVF/ICSI stimulated cycles: a prospective observational pilot study Koli Chandra Reddy, Arianna D’angelo, Grace Jose, Bebbie Jefferies, Lorraine Goucher, & Janet Evans IVF Wales University Hospital of Wales, Cardiff, United Kingdom Background. It is always difficult to predict accurately the number of eggs to collect during an ART cycle only looking at the follicular size and numbers on transvaginal scan on the day of hCG injection. The accurate prediction is extremely important for patients’ expectation and for the laboratory to prepare the culture dishes for the day of the egg collection. The aim is to assess the correlation between number and size of follicles reported by the scan and actual number of oocytes collected. Material & Method. Prospective observational data collection between December 2007 and February 2008 (6 weeks) at the IVF Wales Unit, University Hospital of Wales, Cardiff. On the day of the oocyte retrieval, patients’ details including demographic factors, stimulation regime, size and number of the follicles on day 11, and when appropriate, day 14 of monitoring were collected. The number of oocytes was predicted on the basis of follicular mean size of 16 mm around the time of the trigger injection. The actual number of eggs was collected on the day of the procedure for each patient. Any difficulties encountered during the procedure (i.e. high ovaries) were noted. Statistical analysis performed using Microsoft Excel software. Results. Twenty-six (26) women data were collected. Mean age was 34 years (25–42), mean BMI was 26 (19–40), 92.4% were nonsmokers, 65.3% were primary subfertile, 65.3% had no previous ART, 23% were PCO, 19.2% had endometriosis, 80.8% used urinary hMG. According to the number of follicles plotted during the scan, 57.6% had good response (6–14 follicles 16 mm), 30.7% had poor response (56 follicles 16 mm) and 11.5% had hyper response (415 follicles 16 mm). On day of hCG injection, 35 follicles were between 12 and 13 mm, 47 follicles were between 14 and 15 mm and 151 were 16 mm (total 233). The total number of eggs predicted was 231, and the actual total number of eggs collected was 217. 69.3% of the procedures were not difficult. Conclusions. The mean follicular size measured by ultrasound on the day of hCG of 12 mm over-estimates the number of eggs collected by 7.3% (þ16 eggs). However, considering only 14 mm on same day underestimates by 8.7% (719 eggs). This can be useful when counselling the patients and for the laboratory organization before the egg collection. OC3: Effect of pituitary desensitization on the early growing follicular cohort estimated using Anti-Mullerian Hormone Kannamannadiar Jayaprakasan, Bruce Campbell, James Hopkisson, Jeanette Clewes, Ian Johnson, & Nick Raine-Fenning NURTURE, School of Human Development, University of Nottingham, Nottingham, United Kingdom Background. Although the decrease in FSH secondary to shortterm administration of GnRH agonist during IVF does not affect the number of ultrasonographically detected antral follicles, its effect on the early growing follicle population, not evident on even highresolution ultrasound, is not known. The objective of this study was to evaluate the effect of pituitary desensitization on the early growing Human Fertility, August 2008; 11(S1): 3–13 ISSN 1464-7273 print/ISSN 1742-8149 online British Fertility Society DOI: 10.1080/14647270802336171 follicle population through assessment of serum anti-Mullerian Hormone (AMH) concentration. Other markers of ovarian reserve, basal FSH, LH, oestradiol, Inhibin-B and three-dimensional ultrasound ovarian parameters have also been assessed for comparison. Methods. One-hundred and two subjects aged5 40 years with FSH levels512 IU/l underwent venepuncture and transvaginal ultrasound in the early follicular phase of the menstrual cycle and after 14 days of downregulation using GnRH agonists. Serum levels of AMH and other markers of ovarian reserve measured during the early follicular phase and those measured following down-regulation were compared using a paired students’ t-test for normally distributed or Wilcoxon signed rank test and skewed data, respectively. The study was approved by the National Health Service research ethics committee, and written consent was obtained prior to the enrolment of each subject. Results. Although mean (+SD) AMH levels increased significantly (P5 0.01) by about 28% (1.3+ 0.7–1.6+0.9 ng/ml), there was a significant decline (P50.01) of about 40–50% in levels of Inhibin-B (47.9+26.5 to 15.0+16.0 pg/ml), FSH (7.1+1.9 to 4.2+1.5 IU/l), LH (5.3+3.0 to 2.6+ 1.6 IU/l) and oestradiol (156.5+ 66.3 to 64.3+45.3 pmol/l). Down-regulation treatment was also associated with a decrease (P50.01) in mean ovarian volume (6.5+ 2.0 to 5.6+ 2.2 cm) and in ovarian blood flow indices (vascularisation index: 7.5+ 4.3 to 6.1+5.0; flow index: 36.3+4.7 to 34.1+7.9 and vascular flow index: 2.9+ 1.8 to 2.3+1.8), but no difference was seen in the antral follicle count (14.9+ 4.4 to 14.6+ 6.0). Conclusion. Pituitary desensitization results in a significant increase in AMH levels, which implies that either the secretion of AMH by early growing follicles is enhanced or that the size of this follicle cohort is increased. The number of antral follicles visualised on ultrasound in the early follicular phase and at down-regulation appears unchanged suggesting any effect is restricted to the smaller ‘selectable’ follicles. OC4: Endometrial expression of follistatin and inhibin/ activin in women with implantation failure after IVF Alka Prakash, Elizabeth M. Tuckerman, Susan Laird, Bolarinde Ola, Tin C. Li, & William L. Ledger Addenbrookes Hospital, Cambridge, United Kingdom, Biomedical Research Unit, Sheffield, United Kingdom, BRMC, Sheffield Hallam University, Sheffield, United Kingdom, Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, United Kingdom, and Royal Hallamshire Hospital, Sheffield, United Kingdom Introduction. The aim of the study was to assess the expression of beta A and beta B subunit of inhibin/activin molecule and follistatin in the endometrium of women with history of implantation failure after IVF and compare it with a fertile control group. Methods. This was a case–control study. Eleven women with history of implantation failure were recruited from the implantation failure clinic whereas seven women with history of proven fertility were recruited as a control group. All women had daily measurements of luteinising hormone (LH) until an LH surge was identified. An endometrial biopsy sample was then taken at day LHþ 7. The tissue obtained was dated using Noyes criteria and immunocytochemistry using the ABC method was performed on paraffin embedded sections to assess expression of beta A subunit, beta B subunit and follistatin molecule expression in the endometrium. Results. There was a trend for lower beta A stromal score in women with implantation failure although this was not statistically significant. The mean H score for glandular epithelial follistatin expression was significantly lower in women with repeated IVF failure as compared with the control group (P1⁄40.03). Conclusion. The reduced expression of follistatin in the endometrial glandular compartment in women with implantation failure did not translate into increased activin expression from the endometrium. It may be hypothesized that other factors regulate the activin follistatin pathway than currently known, and follistatin appears to play a key ro

Fertility 2008 Abstracts from the British Fertility Society Summer College, Liverpool, September 2–5, 2008

Uterine artery embolization has been shown to be an effective treatment in controlling symptomatic uterine fibroids. Reports suggest that significant complications associated with the procedure are rare. However, data pertaining to preservation of fertility after embolization are scarce, and some authors do not advocate this procedure for women considering future pregnancy. We present a case of a post-embolization uterine cavity abnormality which was repaired surgically, followed by successful pregnancy outcome.