Abstract
BackgroundThe presence of submucous fibroids strongly impacts on IVF results, therefore, these patients should be considered for surgical or medical treatment. The aim of this study was to assess the role of Ulipristal acetate (UPA), a selective progesterone receptor modulator, in restoring uterine cavity deformation due to submucous fibroids, in infertile patients attempting an IVF treatment. The secondary study outcome was to evaluate the impact of preconception UPA treatment on rate of biochemical pregnancy, ongoing pregnancy, and live birth compared to a control group without fibroids.MethodsInfertile patients with submucosal fibroid (Type 1 and Type 2 according to FIGO classification) were enrolled in the study as fibroids group and received 1 to 3 treatment cycles of UPA, according to their response, as reflected by fibroid volume reduction and restoration of normal uterine cavity. Patients in control group were randomly selected from a general IVF cohort by a ratio of 2:1 with fibroids group, matched by age, BMI, type and cause of infertility and antral follicle count. The impact of UPA on fibroids volume reduction was evaluated. IVF outcome was compared between groups.ResultsTwenty-six patients underwent UPA treatment revealed a mean volume reduction of their fibroids of 41%. A total of 15 (57.6%) biochemical pregnancy were obtained, resulting in 13 (50%) ongoing pregnancy and 9 (34.6%) healthy babies were already delivered. Similar results were obtained in control group.ConclusionRestoration of normal uterine cavity by UPA treatment prior to IVF treatment avoids surgery and establishes a pregnancy rate comparable to a control group without fibroids.
Highlights
The presence of submucous fibroids strongly impacts on In vitro fertilization (IVF) results, these patients should be considered for surgical or medical treatment
Prompted by the aforementioned information we aimed to evaluate the efficacy of Ulipristal acetate (UPA) in avoiding surgery and restoring uterine cavity deformation due to submucous fibroids, in infertile patients attempting an IVF treatment
The inclusion criteria in the fibroids group were: age between 20 and 38 years; regular menstrual cycles of 25–35 days; basal Follicle-stimulating hormone (FSH) less than 12 IU/L; total antral follicle count of 10–25 follicles; infertility resulting from tubal factors; unexplained infertility; presence of both ovaries; IVF cycle followed by fresh embryo transfer
Summary
The presence of submucous fibroids strongly impacts on IVF results, these patients should be considered for surgical or medical treatment. The aim of this study was to assess the role of Ulipristal acetate (UPA), a selective progesterone receptor modulator, in restoring uterine cavity deformation due to submucous fibroids, in infertile patients attempting an IVF treatment. Fibroids, are the most common form of benign uterine tumors occurring in 20–40% of women of reproductive age [1]. They are hormonesensitive, smooth-muscle tumors with a wide heterogeneity in composition, size and number [2]. Other symptoms include pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, dyspareunia and obstetrics complications [2]
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