Pulsatile gonadotropin-releasing hormone: clinical applications of a physiologic paradigm.

Gonadotropin-releasing hormone (GnRH) is a fundamental driver of human reproduction. A pulsatile pattern of GnRH secretion is essential to achieve pituitary stimulation, gonadotropin secretion, and normal gonadal function. Pulsatile GnRH administration is used to treat anovulation and male hypogonadotropic hypogonadism.

A randomized, controlled, first-in-patient trial of choriogonadotropin beta added to follitropin delta in women undergoing ovarian stimulation in a long GnRH agonist protocol.

Study Question: Does addition of choriogonadotropin beta (recombinant CG beta) to follitropin delta increase the number of good-quality blastocysts following ovarian stimulation in a long GnRH agonist protocol?

Summary Answer: At the doses investigated, the addition of CG beta reduced the number of intermediate follicles and related down-stream parameters including the number of oocytes and blastocysts.

What Is Known Already: CG beta is a novel recombinant hCG (rhCG) molecule expressed by a human cell line (PER.C6®) and has a different glycosylation profile compared to urinary hCG or rhCG derived from a Chinese Hamster Ovary (CHO) cell line.

Are commercial warming kits interchangeable for vitrified human blastocysts? Further evidence for the adoption of a Universal Warming protocol.

Purpose: To study whether a new combination of different warming kits is clinically effective for vitrified human blastocysts.

Methods: This is a longitudinal cohort study analysing two hundred fifty-five blastocysts warming cycles performed between January and October 2018. Embryos were vitrified using only one brand of ready-to-use kits (Kitazato), whereas the warming procedure was performed with three of the most widely used vitrification/warming kits (Kitazato, Sage and Irvine) after patient stratification for oocyte source.

Clinical roles and applications of progesterone in reproductive medicine: an overview.

The physiologic and clinical value of progesterone is undisputed and a cornerstone of human reproduction. Better understanding of the exact dynamics and effects of endogenous progesterone secretion, as well as its therapeutic actions, is critical to ensure optimal clinical results in artificial reproduction technology, and to enhance chances of successfully completing pregnancy. Novel progesterone-based drugs and administration regimens will provide clinicians with greater options to make the management and treatment of infertile couples less burdensome and more successful.

Rapid warming increases survival of slow-frozen sibling oocytes: a step towards a single warming procedure irrespective of the freezing protocol?

Nowadays, human oocytes/embryos are cryopreserved via slow freezing or vitrification. The aim of this study was to evaluate a rapid warming protocol for slow-frozen human oocytes based on the standard warming procedure for vitrification. This was a prospective study on 216 sibling oocytes randomized for either conventional rapid thawing or rapid warming with vitrification warming solution.

Sperm selection: effect on sperm DNA quality.

The selection of spermatozoa without DNA fragmentation and chromosomal diseases prior to assisted reproductive techniques helps to optimize the outcome of the treatment; in particular, sperm selection prior to in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is crucial. In fact, although ICSI has been successfully and safely applied worldwide for almost 20 years, at the present time we have no real knowledge regarding the hypothetical long-term side effects on ICSI adults, given the increased likelihood of spermatozoa with defective nuclear content fertilizing oocytes.In the case of DNA damage, the basal sperm DNA fragmentation rate can be significantly reduced by some sperm processing procedures that improve the percentage of spermatozoa with normal chromatin structure by filtering out DNA-damaged spermatozoa.

A reliable procedure for decontamination before thawing of human specimens cryostored in liquid nitrogen: three washes with sterile liquid nitrogen (SLN2).

Objective: To report a washing procedure, to be performed as frozen specimens are taken out of cryobanks, to minimize the risk of hypothetical culture contamination during thawing.

Design: Basic research.

Setting: Private assisted reproduction center.

The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan.

Background: Septate uterus seems to be strongly associated with an adverse pregnancy outcome. However, the possible relationship between septate uterus and miscarriage has only been retrospectively ascertained. The aim of our study was to describe the reproductive outcome in women with incidental diagnosis of malformed uterus at first trimester scan.

Comparison of two ready-to-use systems designed for sperm-hyaluronic acid binding selection before intracytoplasmic sperm injection: PICSI vs. Sperm Slow: a prospective, randomized trial.

Objective: To compare, in a strict, randomized way, the efficiency of two ready-to-use systems for hyaluronic acid (HA)-intracytoplasmic sperm injection (ICSI): an HA culture dish (PICSI Sperm Selection Device) and a viscous medium containing HA (Sperm Slow).

Design: Prospective, randomized study.

Setting: Medical center.

Efficiency of hyaluronic acid (HA) sperm selection.

Purpose: Hyaluronic Acid (HA) has a role as "physiologic selector" for spermatozoa prior to intracytoplasmic sperm injection (ICSI). The objective of this study is to analyze the results achievable by the introduction of a routine HA-ICSI programme.

Methods: We retrospectively observed 293 couples treated with HA-ICSI versus 86 couples treated with conventional PVP-ICSI (historical control group).

Sterilization of liquid nitrogen with ultraviolet irradiation for safe vitrification of human oocytes or embryos.

Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontamination of liquid nitrogen (LN2).

Design: Basic research.

Setting: Private assisted reproduction center.

"Physiologic ICSI": hyaluronic acid (HA) favors selection of spermatozoa without DNA fragmentation and with normal nucleus, resulting in improvement of embryo quality.

Objective: To evaluate the role of hyaluronic acid (HA) for sperm selection before intracytoplasmic sperm injection (ICSI).

Design: Three prospective studies.

Setting: Private assisted reproduction center in Italy.

Blastocyst formation, pregnancy, and birth derived from human oocytes cryopreserved for 5 years.

Objective: To report a live birth after the transfer of a single blastocyst derived from a human oocyte cryopreserved for 5 years.

Design: Case report.

Setting: Private assisted reproduction center.

Efficacy of low-dose human chorionic gonadotropin alone to complete controlled ovarian stimulation.

Objective: To prove that low-dose hCG alone can be clinically used to replace FSH-containing gonadotropins to complete controlled ovarian hyperstimulation (COH).

Design: Controlled, prospective, randomized study.

Setting: Academic center.

Novel concepts of human chorionic gonadotropin: reproductive system interactions and potential in the management of infertility.

Objective: To extensively review the scientific literature on the potential sites of hCG action and the role of this hormone on reproductive processes not necessarily related to the classic hCG functions of supporting early pregnancy.

Design: Review of the international scientific literature and the authors' personal research experience in this area.

Result(s): The LH/hCG receptor has an almost ubiquitous distribution in reproductive organs, thus suggesting that the actions of hCG might be more extensive than previously thought.

Efficacy of octreotide-LAR in dieting women with abdominal obesity and polycystic ovary syndrome.

Context: Somatostatin reduces LH, GH, and insulin, and somatostatin receptors are present at the ovarian level; somatostatin analogs are thus potential candidates for treatment of the polycystic ovary syndrome (PCOS).

Objective: The purpose of this study was to evaluate the effect of octreotide-LAR, a long-acting somatostatin analog, in anovulatory abdominal obese women with PCOS.

Design: A single-blind, placebo-controlled study was performed, lasting for 7 months.