Commentary on the article “Pre-treatment with ulipristal acetate before ICSI procedure: a case report” published in Menopause Review 6/2013 (Przeglad Menopauzalny 2013; 6: 496-500)

Failure to become and remain pregnant after IVF depends on multiple factors including but not limited to the ability of the uterus to implant embryo and to carry a pregnancy to term. One of the factors which adversely affect fertility is the presence of uterine fibroids [1]. The closer the fibroids are to the uterine cavity, the greater their effect is on female fertility [2]. Reproduction is adversely affected mainly by intramural fibroids, which modulate endometrium and also by submucosal fibroids [2]. In patients with uterine fibroids, the course of pregnancy is often complicated. These are high-risk pregnancies as they may end in miscarriage, premature delivery or intrauterine death [3-5]. The factors predisposing to uterine fibroids include age, African ancestry, obesity and nulliparity. Although studies performed to date have extended our knowledge on fibroid pathology, their etiology has not been fully elucidated. There is a need for further research on predisposing factors and for prevention of uterine fibroids in women. Minimizing invasive treatment becomes the most advisable option, which has been recommended during the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research [6]. Currently, treatment with ulipristal acetate seems the most promising non-invasive treatment option [7-10].
The commented article presents the case of a 35-year-old patient who in June 2012 came to the Non-Public Health Care Unit ‘Ovum Reproduction and Andrology’ in Lublin to continue the treatment of infertility. Before stimulation for the intracytoplasmic sperm injection (ICSI) procedure, an attempt was made to reduce the fibroid volume with 3-month treatment with Esmya 5 mg 1 × 1 given for 84 days. Ultrasound performed after discontinuation of Esmya treatment showed the previously detected intramural fibroid located in the posterior wall, which was found to have a diameter of 1.08 cm, illustrating a reduction from the pre-treatment size and the fibroid located in the front wall of the uterus previously detected by ultrasound was no longer visible.
The next sonographic scan in the 20th week of pregnancy showed normal anatomical structure of the fetus, no fibroid growth in the posterior uterine wall and absence of new fibroids. Between the 24th and 29th weeks of pregnancy, the patient complained of pain in the lower abdomen and periodic uterine contractions. The cervical length and fibroid size were monitored...


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