Post-IVF pregnancy after treatment With Ulipristal Acetate for uterine myomas: a case report.
Federico Cirillo (IT), Valentina Canevisio (IT), Giulia Mulazzani (IT), Elena Zannoni (IT), Luca Cafaro (IT), Paolo Levi Setti (IT)
[Cirillo] Humanitas Research Hospital, [Canevisio] Humanitas Research Hospital, [Mulazzani] Humanitas Research Hospital, [Zannoni] Humanitas Research Hospital, [Cafaro] Humanitas Research Hospital, [Levi Setti] Humanitas Research Hospital
Context In recent years, Ulipristal Acetate (UA), Esmya, has become one of the main drugs in the treatment of uterine fibroids; it has been demonstrated to control symptoms associated with myomas, to reduce their volume and successfully maintain these effects for months after treatment completion (1). Esmya has a hepatic metabolism: its use is forbidden in case of severe liver disease while a close clinical monitoring is recommended with mild liver impairment. Few data are available on the effects of Esmya in terms of pregnancy. Objectives Our case report underlines the efficacy and safety of Esmya in the management of myomas with a specific focus on fertility issues. Methods Case report Patient 36-year-old woman with a history of chronic HCV infection without liver insufficiency, primary idiopathic infertility and 3 posterior myomas of around 2 cm in diameter; over the period 2012-2015 she performed 4 intrauterine inseminations and 4 IVF cycles, with negative outcome. Intervention In 2015, her known myomas significantly grew (3, 4 and 5 cm in diameter respectively) so the patient underwent a 3-month-long therapy with Esmya to reduce the volume before myomectomy. The drug was approved as safe by the hepatologist and no alterations in liver enzymes were reported during treatment. 2 months after therapy completion, a significant reduction in the volume of the myomas was obtained (in particular, the biggest one displayed a >50% volume reduction) and the patient decided not to undergo the planned myomectomy. She soon after transferred a cryopreserved blastocyst and got pregnant. The pregnancy is now at 23 weeks. Results This pregnancy, after a non-routine use of UA without the usual subsequent myomectomy, demonstrates the positive effect Emsya can have in terms of fertility improvement.