Does ulipristal acetate emergency contraception (ella®) interfere with implantation?
Emergency contraception
Endometrial effect
Implantation
Ulipristal acetate
Journal
Contraception
ISSN: 1879-0518
Titre abrégé: Contraception
Pays: United States
ID NLM: 0234361
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
14
03
2019
revised:
15
07
2019
accepted:
18
07
2019
pubmed:
28
7
2019
medline:
2
10
2020
entrez:
28
7
2019
Statut:
ppublish
Résumé
Ulipristal acetate (UPA) 30 mg (ella®, HRA-Pharma, Paris, France) acts as an emergency contraceptive (EC) by delaying ovulation. Because it is a selective progesterone receptor modulator, an additional effect on interfering with implantation has been suggested. This review discusses the evidence for, and against, an anti-implantation effect of UPA-EC. Primary research on the effect of UPA, at a relevant dose, on endometrium, implantation, efficacy and pregnancy outcome. UPA-EC does not appear to have a direct effect on the embryo. Changes in endometrial histology are small and not consistent, varying among studies. While UPA-EC affects the profile of gene expression in human endometrium, the findings vary between studies, and it is not clear that these changes affect endometrial receptivity or prevent implantation. UPA at pharmacological concentrations does not appear to have any inhibitory effect on embryo attachment in in vitro systems of human endometrium. UPA-EC is not more effective at preventing pregnancy than chance alone if used after ovulation and does not increase miscarriage rates. An anti-implantation effect of UPA is highly unlikely at the dose used for EC. Maintaining the warning on the FDA-approved label that "it may also work by preventing implantation to the uterus" might deter some women from using EC, leaving them no option to prevent unwanted pregnancy after unprotected sexual intercourse.
Sections du résumé
BACKGROUND
Ulipristal acetate (UPA) 30 mg (ella®, HRA-Pharma, Paris, France) acts as an emergency contraceptive (EC) by delaying ovulation. Because it is a selective progesterone receptor modulator, an additional effect on interfering with implantation has been suggested.
OBJECTIVE
This review discusses the evidence for, and against, an anti-implantation effect of UPA-EC.
SOURCES OF EVIDENCE
Primary research on the effect of UPA, at a relevant dose, on endometrium, implantation, efficacy and pregnancy outcome.
RESULTS
UPA-EC does not appear to have a direct effect on the embryo. Changes in endometrial histology are small and not consistent, varying among studies. While UPA-EC affects the profile of gene expression in human endometrium, the findings vary between studies, and it is not clear that these changes affect endometrial receptivity or prevent implantation. UPA at pharmacological concentrations does not appear to have any inhibitory effect on embryo attachment in in vitro systems of human endometrium. UPA-EC is not more effective at preventing pregnancy than chance alone if used after ovulation and does not increase miscarriage rates.
CONCLUSIONS
An anti-implantation effect of UPA is highly unlikely at the dose used for EC. Maintaining the warning on the FDA-approved label that "it may also work by preventing implantation to the uterus" might deter some women from using EC, leaving them no option to prevent unwanted pregnancy after unprotected sexual intercourse.
Identifiants
pubmed: 31351035
pii: S0010-7824(19)30368-3
doi: 10.1016/j.contraception.2019.07.140
pii:
doi:
Substances chimiques
Contraceptives, Postcoital
0
Norpregnadienes
0
ulipristal acetate
YF7V70N02B
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
386-390Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.