The actual impact of SARS-CoV-2/COVID-19 pandemic on IVF activity: a survey across Italian ART centers.

Purpose: Since the end of February 2020, SARS-CoV-2 dramatically spread in Italy. To ensure that most of National Health System (NHS) resources were employed to control the pandemic, non-urgent medical procedures (including IVF) were suspended in March 2020. Here, we aimed at assessing the impact of the restrictive measures on Italian IVF activity.

Fertility counseling in women with hereditary cancer syndromes.

Hereditary cancer syndromes are a heterogeneous group of genetic conditions that are associated with an increased risk of developing cancer during lifespan. In affected women, parenthood may be accompanied by concerns for the offspring, considering the common autosomal dominant inheritance. Moreover, fertility preservation to prevent the detrimental effects of cancer treatments differs compared to other clinical contexts.

Characterization of microRNA in the follicular fluid of patients undergoing assisted reproductive technology.

Female fertility plays a decisive role in the reproduction of mammals, with related issues that include oocyte or embryo quality, establishment of pregnancy, and the physiology of the tissues that contribute to reproduction and metabolic disorders associated with reproductive failure. Although reproductive failure may be attributed to various factors in different species, female infertility is largely controlled by a number of molecular signals that can be regulated in a cycle- and tissue-dependent manner.

Single port entry - are there any advantages?

Minimal-invasive, single-port laparoscopic surgery is a recent innovation that may improve surgical outcomes. In this chapter, we review published research on single-port surgery in gynaecology, and the different surgical instruments available. Challenges, advantages, indications and potential future rules of this new approach are also discussed.

Hysteroscopic findings in women with menorrhagia.

Study Objective: To describe the hysteroscopic findings in patients complaining of menorrhagia to establish any significant association between menorrhagia and benign/malignant intrauterine disorders.

Design: Prospective cohort study (Canadian Task Force classification II).

Setting: University La Sapienza, Rome, Italy.

A multicenter, double-blind, randomized, placebo-controlled study to assess whether antibiotic administration should be recommended during office operative hysteroscopy.

We did a double-blind, randomized, placebo-controlled study to assess the incidence of infectious complications and the protective effect of antibiotic administration during operative hysteroscopic procedures in an office setting. A total of 1046 consecutively enrolled women with intrauterine lesions were randomly allocated to the reference group (523 patients administered with 1 g of cefazolin intramuscularly) and the study group (523 patients administered with 10 mL of isotonic sodium chloride solution), and treated in office setting by operative hysteroscopy for endometrial polypectomy, uterine septa, submucosal myomas, and intrauterine adhesions. The primary outcome measure was the computation of difference between groups in postsurgical infectious complications occurring in the 5 days after the procedures.

Three-step model course to teach intracorporeal laparoscopic suturing.

Background: Laparoscopy requires a set of skills such as intracorporeal stitching and knotting. The aim of this study is to present an effective specialized training course for the laparoscopic suturing technique.

Materials And Methods: We designed a specialized 5-day training course for laparoscopic suturing skills with theoretical and practical sessions on inanimate pelvic training.

Feasibility and complications in bipolar resectoscopy: preliminary experience.

Objective: To evaluate whether the new bipolar resectoscope (BR) 22 Fr (Karl Storz) represents a reliable improvement in operative hysteroscopy and to compare the new device to the 26 Fr BR (Karl Storz).

Material And Methods: A prospective observational study. From June 2010 through May 2011, 158 consecutive patients treated with bipolar resectoscope 22 Fr and 26 Fr for endocavitary pathologies were registered.

The practicability and surgeons' subjective experiences with vaginal danazol before an operative hysteroscopy.

This randomized, double blind, placebo-controlled study compared the usefulness of danazol 400mg vaginally versus 600mg orally in women as a preoperative preparation for hysteroscopic surgery. Ninety-one fertile women were randomly allocated to Group A (46 patients received 400mg of danazol placed into the posterior vaginal fornix and three oral tablets of commercially available folic acid as a placebo), and Group B [45 women treated with 600mg of danazol orally (200mg three times daily) and two vaginal tablets of Lactobacillus rhamnosus as a placebo]. The patients underwent an operative hysteroscopy, transvaginal sonography, blood tests, and a histological assay.

Are you good enough for your patients? The European certification model in laparoscopic surgery.

Quality control, training and education in gynaecological surgery are challenged and urgent measures are emerging. The implementation of a structured and validated program for training and quality control seems the most urgent measurement to be taken. The European Academy of Gynaecological Surgery has made a first attempt to do so.

Low-dose spinal anesthesia with hyperbaric bupivacaine with intrathecal fentanyl for operative hysteroscopy: a case series study.

Study Objective: To estimate the efficacy and tolerability of low dose spinal anesthesia during operative hysteroscopy in a group of patients with high surgical risks.

Design: Case series study (Canadian Task Force Classification II-2).

Setting: Tertiary centers for women health care.

Clinical outcomes associated with surgical treatment of endometrioma coupled with resection of the posterior broad ligament.

Objective: To evaluate clinical outcomes associated with the resection of both endometrioma and posterior broad ligament (PBL) among women with PBL adhesion associated with endometrioma.

Methods: Between January 2007 and December 2009 at the Villanova Hospital, Florence, Italy, a prospective trial was conducted on 99 consecutive patients with unilateral or bilateral endometrioma who underwent laparoscopic ovarian cystectomy by a stripping technique and homolateral PBL resection where PBL adhesion was associated with endometrioma. The prevalence of PBL adhesion and endometriosis, the association between PBL endometriosis and pain, and the recurrence of endometrioma and pain were evaluated.

Cytoplasmic expression of estrogen receptor beta (ERβ) predicts poor clinical outcome in advanced serous ovarian cancer.

Objective: In this study we investigated the prognostic value of estrogen receptor α (ERα), ERβ and progesterone receptor (PR) expression in 58 untreated advanced serous ovarian cancer patients. The study also included 12 macroscopically and histopathologically normal ovaries.

Materials And Methods: Protein expression was evaluated by immunohistochemistry, and antibody staining detected in both the nuclear and cytoplasmic compartments was taken into account.

Single-port access laparoscopic assisted vaginal hysterectomy in a case of uterine ventrofixation using a new reusable device.

Vaginal hysterectomy may at times prove difficult and require laparoscopic assistance to ensure safety of operations. This article reports a case in which single port laparoscopic assistance enabled vaginal hysterectomy in a patient with severe uterine ventrofixation. The use of an innovative device and tips to be applied are described.

Single access laparoscopy for adnexal pathologies using a novel reusable port and curved instruments.

Objective: To present our initial experience using single access laparoscopic surgery for the treatment of benign adnexal pathologies.

Methods: Sixteen patients with benign adnexal pathologies underwent salpingoophorectomy (n=9), ovarian cyst enucleation (n=5), or salpingectomy (n=2) using a laparoendoscopic single site approach with a new multiport reusable trocar and flexible and curved-as well as standard-laparoscopic instruments.

Results: Conversion to a multi-access standard laparoscopic technique was not required in any patient and no intraoperative complications were observed.

Minilaparotomy in spinal anaesthesia: a surgical choice in treatment of benign gynaecologic disease.

Purpose: Minilaparotomic access in spinal anaesthesia represents an example of mininvasive surgery and could be a valid cost-benefit alternative in the surgical treatment of benign gynaecologic diseases.

Methods: The study is a randomized study. We analyzed a consecutive series of 80 patients treated for benign gynaecological diseases with spinal (group A) or with general anaesthesia (group B).

Intracytoplasmic sperm injection and pregnancy with decapitated sperm.

Objective: To perform intracytoplasmic sperm injection (ICSI) in couples with primary infertility owing to sperm defects causing total immotility.

Design: Case report.

Setting: Couple Sterility Center, University of Siena.

Correlation between oocyte preincubation time and pregnancy rate after intracytoplasmic sperm injection.

Background And Aim: Both nuclear and cytoplasmic maturation of oocytes have to be completed in a coordinated manner to ensure optimal conditions for fertilization. This is well known for in vitro fertilization, but is debated for intracytoplasmic sperm injection (ICSI). It has been reported that preincubation of oocytes prior to ICSI is associated with improved maturation of oocytes, fertilization and embryo quality.

ICSI for treatment of human immunodeficiency virus and hepatitis C virus-serodiscordant couples with infected male partner.

Background: Assisted reproductive technology with semen washing can offer a significant reduction in risk of sexual and vertical transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) in serodiscordant couples with infected male partner.

Methods: Among couples coming to our centre for reproductive problems from January 2001 to December 2003, we selected 43 couples with seropositive male and seronegative female: 25 couples with HIV-seropositive males, 10 couples with HIV/hepatitis C virus (HCV)-seropositive males and eight couples with HCV-seropositive males. Sperm samples were washed and used for ICSI.

Salpingoscopic and laparoscopic investigations in relation to fertility outcome.

Study Objective: To evaluate the correlation between salpingoscopic and laparoscopic findings and their relation to reproductive outcomes.

Design: Prospective study (Canadian Task Force classification II-2).

Setting: University-affiliated hospital.

Clomiphene citrate increases insulin-like growth factor binding protein-1 and reduces insulin-like growth factor-I without correcting insulin resistance associated with polycystic ovarian syndrome.

The induction of ovulation by clomiphene could be the result of interaction of the drug at various levels: hypothalamus, pituitary and ovary. It was demonstrated that administration of clomiphene to women with polycystic ovarian syndrome (PCOS) is accompanied by a reduction in plasma concentrations of insulin-like growth factor-I (IGF-I). IGF-I seems to have an overall negative effect on normal folliculogenesis and ovulation.

Hysteroscopic metroplasty.

Study Objective: To evaluate 10 years' experience with hysteroscopic treatment of septate uterus in Italy.

Design: Multicenter retrospective study conducted from January 1988 to March 1997 (Canadian Task Force classification II-2).

Setting: Twelve Italian centers for minimally invasive therapy.

Risks of Virus Transmission During Diagnostic Hysteroscopy.

The high frequency of asymptomatic carriers of viral infections represents a major risk for transmission. Viral agents can be transmitted through blood or biologic fluids during diagnostic hysteroscopy. Routine disinfection methods to clean hysteroscopes cannot be considered adequate to prevent transmission.