title: Ulipristal acetate prior to in vitro fertilization in a female patient affected by uterine fibroids: a case report.
abstract: OBJECTIVE
  Uterine leiomyomatosis and especially submucosal myomas hamper the outcomes of Assisted Reproductive Techniques (ART). Even though surgical treatment eliminates gross anatomical anomalies, medical treatment should be encouraged to improve the overall structure of the uterus, thereby enabling ART.
  
  
  METHODS
  We report the case of an infertile female patient suffering from symptomatic uterine fibromatosis, who received 5 mg/day ulipristal acetate (UPA), a selective progesterone receptor modulator (SPRMs), for three months before and after hysteroscopic myomectomy. Uterine bleeding reduced on the eight days of treatment, with a subsequent improvement of pelvic pain. Under transvaginal ultrasound the uterus appeared globally enlarged with a diffuse leiomyomatosis of the myometrial layer. Saline infusion showed a markedly distorted cavity due two submucosal myomas (sized 31 × 24 mm and 21 × 19 mm, respectively) and one intramural myoma (37 × 34 mm). After three months the size of the myomas was reduced by 30-40%, allowing the hysteroscopic removal of the submucosal fibroids and the bigger intramural one. The smaller fibroids involving the myometrial layer were instead too diffused to be removed. At the conclusion of the subsequent cycle of UPA, the overall appearance of the cavity had improved, and the endometrial layer was regular, allowing the patient to undergo in vitro fertilization (IVF). There was no adverse effect related to treatment, and the endometrial biopsy did not reveal any histologic change.
  
  
  CONCLUSIONS
  UPA seems to have a triple effect: it ensures prompt symptom relief, it reduces the size of the myomas enabling surgery and it improves the morphology of the uterus.
authors.affiliation: Section of Gynaecology and Obstetrics, Centre of Human Reproduction and Cryoconservation of Gametes, Brunico Hospital, Brunico, Italy. roberto.marci@unife.it.
authors.forename: G
authors.initials: G
authors.lastname: Lo Monte
authors.forename: I
authors.initials: I
authors.lastname: Piva
authors.forename: A
authors.initials: A
authors.lastname: Graziano
authors.forename: B
authors.initials: B
authors.lastname: Engl
authors.forename: R
authors.initials: R
authors.lastname: Marci
mesh_terms: D000328:Adult; D001706:Biopsy; D004717:Endometrium / Q000187:drug effects / Q000473:pathology; D005260:Female; D005307:Fertilization in Vitro; D005350:Fibroma; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007889:Leiomyoma / Q000188:drug therapy* / Q000601:surgery; D009649:Norpregnadienes / Q000008:administration & dosage* / Q000627:therapeutic use; D014592:Uterine Hemorrhage; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D009649:Norpregnadienes; C555622:ulipristal acetate