Management of women with uterine fibroids in reproductive center: retrospective analysis of clinical and reproductive outcomes.

Abstract

BACKGROUND\nUterine fibroids are the most common benign tumor in women. According to literature, submucosal myomas have a negative effect on reproductive outcomes in women undergoing assisted reproductive techniques (ART) but there are fewer data concerning intramural fibroids. During last years, Ulipristal acetate (UPA) 5 mg was widely used as medical option of fibroid s treatment, but from 2020, the Pharmacovigilance Risk Assessment Committee (PRAC) has revoked the marketing authorisation after some cases of liver toxiciy.\n\n\nMETHODS\nIn this observational, retrospective study we collected data from a sample of 23 women affected by symptomatic uterine fibroids (from Type 1 to Type 7 according FIGO classification) followed in our center for assisted reproduction from 2016-2019. All patients received 5 mg/day UPA for three months, followed by two months of wash-out therapy. A group of 13 women treated with UPA, with intramural fibroid not distorting the uterine cavity, after wash-out therapy, affected by tubal or idiopathic factors of infertility too, underwent ART. We also evaluated a control group of women, not affected by fibroids, randomly selected from a general group of our ART patients, similar by age, BMI, and cause of infertility only idiopathic or tubal factors. We evaluated the impact of UPA on reduction of fibroid volume, symptomatology and distortion of the cavity in all the women treated, and the IVF (In Vitro Fertilization) outcome between the fibroid group of women affected by intramural fibroids who underwent ART, and the control group.\n\n\nRESULTS\nIn all the women treated with UPA the overall median fibroid volume pre-treatment was 45.168±35.360 mm3, that decreased to a mean value of 22.592±22.116 mm3 post one cycle of UPA, with an overall mean decrease of -22.586 mm3 (of 49%) statistically significant (p=0.00001). After treatment, the distortion of the uterine cavity reduced in high percentage of cases: 85,71% (type 1-2), χ squared difference in respect to the value pre-treatment of 0,3941, and 86.96% of patients subjectively referred an improvement in the symptomatology. In the group of 13 women that undergone ART, after one IVF cycle for each patient, we obtained 61% of positivity of dosage of beta human chorionic gonadotropin (hCG) after UPA treatment, and we obtained a similar value in the control group.\n\n\nCONCLUSIONS\nIn our little sample we have observed that UPA represented a valid non-invasive medical treatment strategy for fibroids in women candidate for (IVF, not only in women affected by submucosal, but also by intramural fibroids not distorting uterine cavity. After a single, three months course of treatment, we obtained good results in terms of reduction of fibroid s volume and improvement of symptomatology, without side effects, preparing a more favorable environment for ART.