Fertility and ulipristal acetate – case report of two spontaneous pregnancies following a three-month treatment cycle

Abstract

Introduction: Ulipristal acetate (UPA) – an oral selective progesterone receptor modulator – is a new alternative in the management of symptomatic fibroids – its safety and effectiveness have been demonstrated in several studies. Nevertheless, there is few evidence regarding its use in the subgroup of women who experience fertility issues and desire to conceive. The authors report a case of a 39-years-old woman referred due to abnormal uterine bleeding and anemia. She already had been pregnant in her twenties, with no complications, and was trying to have a second child. She was treated for 3 months with UPA, at a daily dose of 5 mg, per os, following a ressectoscopic myomectomy. After 5 months, she conceived spontaneously – the pregnancy was uneventful and she delivered a healthy child, at term, by cesarean section. During the follow-up visits to her gynecologist, she had no fibroid related complaints, and 23 months after the C-section, a new (unplanned) pregnancy was clinically confirmed – there were no complications and the patient recently gave birth to other healthy child, again by cesarean. Conclusion: This case supports the idea that UPA may be effective in patients who have symptomatic fibroids but still desire to conceive and thus want to avoid surgery. Even tough larger studies on the subject are required, UPA may, in a near future, play a role in the management of fibroids in the infertility context.