Background: Uterine fibroids are highly prevalent benign tumors in premenopausal women. While hysterectomy is definitive, uterine-sparing treatments such as uterine fibroid embolization (UFE) and myomectomy are preferred for women desiring future fertility. A primary concern with UFE is the potential for non-target embolization of the ovarian vasculature, which may compromise ovarian reserve.

Objective: This study aimed to compare the impact of UFE versus laparoscopic myomectomy on ovarian reserve, as measured by serum Anti-Mullerian Hormone (AMH) levels, over a 12-month period.

Method: A simulated retrospective cohort study was conducted using synthesized academic training data of 240 premenopausal women (aged 25-45 years) with symptomatic fibroids. Patients were stratified into a UFE group (n=120) and a laparoscopic myomectomy group (n=120). Serum AMH levels were assessed at baseline, 6 months, and 12 months post-procedure.

Results: Both groups experienced a decline in AMH levels at 6 months, but the decline was significantly more pronounced in the UFE group (mean decrease of 22.4% versus 8.1%, p<0.001). At 12 months, the myomectomy group showed recovery to near baseline levels, whereas the UFE group exhibited a sustained, though partially recovered, reduction (mean decrease of 15.2% from baseline, p=0.002).