LAUSR

To the Editor, I read the paper by Sheikh et al. [1] regarding the angiographic detection of utero-ovarian anastomosis (UOA) and influence on ovarian function after uterine artery embolization (UAE) with great interest. The study found that UOA is more common than previously expected and patients with type Ib and type III anastomoses carry the risk of ovarian failure after UAE. Protective coiling seems to be an adequate strategy for avoiding ovarian failure in those types of anastomoses. However, as far as we know, this conclusion still needs to be testified. The rate of UOA that can be displayed in this study was 97%, which is much higher than previous reports. In fact, many corpse studies have confirmed that UOA is 100% present [2, 3]. But unlike cadaveric studies, UOA is also affected by a variety of factors such as hemodynamics and contrast agent injection pressure during uterine angiography in vivo, which is the main reason for the large difference in UOA display rates in various studies. Although the classification of Razavi et al. seems reasonable, the value of practical applications is limited. First, the classification is influenced by the subjective factors of the observer. Second, the injection pressure of contrast agent may directly affect the results of typing. Furthermore, the pressure at which the contrast agent and the embolic agent are injected is quite different, and the UOA type when the embolic agent is injected is not necessarily the same as the type when the contrast agent is injected. In fact, since the report of Razavi et al., reports on the application of UOA in UAE are rare [4]. The use of follicle-stimulating hormone (FSH) as an indicator of ovarian failure in the study is debatable. Although many previous studies have used FSH as an indicator of the impact of UAE on ovarian function, some studies have subsequently confirmed that the value of FSH is very limited or even inaccurate [5]. First, the secretion of FSH is pulsed, which results in a large fluctuation in serum concentration. Second, the secretion of FSH is closely related to the menstrual cycle. If the timing of blood draw is not strictly controlled, the comparability between results is very poor. Unfortunately, the FSH detection time was not described in this study. At present, two of the most recognized diagnostic criteria for premature ovarian failure in the world are that the amenorrhea time is greater than 6 months and twice blood FSH of more than 1-month interval is greater than 40 mIU/mL [6]. Therefore, ignoring the description of menstrual conditions, merely a single FSH greater than 27 mIU/mL in 3 months after UAE is not sufficient to diagnose ovarian failure. Moreover, only 3 months of follow-up after UAE was too short, because an anti-Mullerian hormone (AMH) based study found that UAE induced ovarian function impairment still had some recovery at 12 months after surgery [7]. The same as other studies, age is still considered to be a main risk factor for ovarian failure after UAE. Although there was no statistically significant difference in age between the two subgroups in the study (39 y vs. 42.24 y), it was obviously that the age of the subgroup without coiling was much closer to 45 years. Moreover, the & Zhen-bo OuYang [email protected]