OBJECTIVE: Uterine leiomy-omatosis and especially submucosal myomas hamper the outcomes of Assisted Reproductive Techniques (ART). Even though surgical treatment eliminates gross anatomical anomalies, medical treatment should be encouraged to improve the overall structure of the uterus, thereby enabling ART. CASE PRESENTATION: We report the case of an infertile female patient suffering from symptomatic uterine fibromatosis, who received 5 mg/day ulipristal acetate (UPA), a selective

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... e receptor modulator (SPRMs), for three months before and after hysteroscopic myomec-tomy. Uterine bleeding reduced on the eight days of treatment, with a subsequent improvement of pelvic pain. Under transvaginal ultrasound the uterus appeared globally enlarged with a diffuse leiomyomatosis of the myometrial layer. Saline infusion showed a markedly distorted cavity due two submucosal myomas (sized 31 × 24 mm and 21 × 19 mm, respectively) and one intramural my-oma (37 × 34 mm). After three months the size of the myomas was reduced by 30-40%, allowing the hysteroscopic removal of the submucosal fi-broids and the bigger intramural one. The smaller fibroids involving the myometrial layer were instead too diffused to be removed. At the conclusion of the subsequent cycle of UPA, the overall appearance of the cavity had improved, and the endometrial layer was regular, allowing the patient to undergo in vitro fertilization (IVF). There was no adverse effect related to treatment, and the endometrial biopsy did not reveal any histo-logic change. CONCLUSIONS: UPA seems to have a triple effect: it ensures prompt symptom relief, it reduces the size of the myomas enabling surgery and it improves the morphology of the uterus. Abbreviations ART = Assisted Reproductive Techniques; GnRH ago-nist (GnRH-a); UPA = Ulipristal Acetate; SPRM = selective progesterone receptor modulator; IVF = In Vitro Fertilization; TVUS = Transvaginal sonography; MRI = Magnetic resonance; HyCoSy = Hysterosono-constrast sonography; PAECs = PRM-associated endometrial changes.