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Background: The effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain. Objectives: To evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta-analysis (CRD42022379700). Search strategy: Electronic databases were searched until November 15, 2022. Selection criteria: Studies evaluating the effects of FIGO type 3 myomas on IVF outcome. Data collection and analysis: Pooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I2 . Sources of heterogeneity were explored with sensitivity and subgroup analyses. Main results: In total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55-3.01, I2 = 0%, P

Resveratrol display's positive effects on follicle growth and development in preclinical studies while there is scantly information from clinical trials. The aim of this study was to evaluate the biological and clinical impact of a resveratrol-based multivitamin supplement on intracytoplasmatic sperm injection (ICSI) cycles.A randomized, single-center controlled trial conducted at the University Center of Assisted Reproductive Technologies involving 101 women infertile women undergoing ICSI cycles was conducted. A pretreatment with a daily resveratrol based nutraceutical was administered to the Study Group; Control Group received folic acid. The primary outcomes were the number of developed mature follicles (16 mm), total oocytes and MII oocytes recovered, the fertilization rate and the number of cleavage embryos/blastocysts obtained. Secondary endpoints were the duration and dosage of gonadotropins, the number of embryos for transfer, implantation, biochemical, clinical pregnancy rates, live birth and miscarriage rates.A significantly higher number of oocytes and MII oocytes were retrieved in the Study Group than in Control Group (A 3 months period of dietary supplementation with a resveratrol-based multivitamin nutraceutical leads to better biological effects on ICSI cycles.ClinicalTrials.gov registration identifier: NCT04386499.

Objective To study the biological effects of resveratrol on the growth, electrophysiology, and mitochondrial function of human granulosa cells (h-GCs). Design Preclinical study. Setting Electrophysiology laboratory and in vitro fertilization unit. Patient(s) This study included h-GCs from seven infertile women undergoing assisted reproductive techniques. Intervention(s) Human ovarian Granulosa Cell Tumor (GCT) cell line COV434 and h-GCs obtained after oocyte retrieval were cultured in the absence or presence of resveratrol. Main Outcome Measure(s) Granulosa cells were evaluated for cell viability and mitochondrial activity. Electrophysiological recordings and evaluation of potassium current (IKur) and Ca2+ concentration were also performed. Result(s) Resveratrol induced mitochondrial activity in a bell-shaped, dose-effect-dependent manner. Specifically, resveratrol treatment (3 μM, 48 hours) increased ATP production and cell viability and promoted the induction of cellular differentiation. These biological changes were associated with mitochondrial biogenesis. Electrophysiological recordings showed that resveratrol reduced the functional expression of an ultra rapid activating, slow inactivating, delayed rectifier potassium current (IKur) that is associated with a plasma membrane depolarization and that promotes an increase in intracellular Ca2+. Conclusion(s) The effects of resveratrol on potassium current and mitochondrial biogenesis in h-GCs could explain the beneficial effects of this polyphenol on the physiology of the female reproductive system. These findings suggest there are therapeutic implications of resveratrol in a clinical setting.

Puerperium is a period of great vulnerability for the woman, associated with intense physical and emotional changes. Maternity blues (MB), also known as baby blues, postnatal blues, or post-partum blues, include low mood and mild, transient, self-limited depressive symptoms, which can be developed in the first days after delivery. However, the correct identification of this condition is difficult because a shared definition and well-established diagnostic tools are not still available. A great heterogenicity has been reported worldwide regarding MB prevalence. Studies described an overall prevalence of 39%, ranging from 13.7% to 76%, according to the cultural and geographical contexts. MB is a well-established risk factor for shifting to more severe post-partum mood disorders, such as post-partum depression and postpartum psychosis. Several risk factors and pathophysiological mechanisms which could provide the foundation of MB have been the object of investigations, but only poor evidence and speculations are available until now. Taking into account its non-negligible prevalence after childbirth, making an early diagnosis of MB is important to provide adequate and prompt support to the mother, which may contribute to avoiding evolutions toward more serious post-partum disorders. In this paper, we aimed to offer an overview of the knowledge available of MB in terms of definitions, diagnosis tools, pathophysiological mechanisms, and all major clinical aspects. Clinicians should know MB and be aware of its potential evolutions in order to offer the most timely and effective evidence-based care.

On December 2019, a new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) was isolated and identified in Wuhan (China) [...]

The present study investigates the impact of the Coronavirus diseases 2019 (Covid-19) pandemic on the subjective experience of pregnant women, as well as the impact of the pandemic on this population in terms of psychopathological correlates.Pregnant women referring to the Section of Obstetrics and Gynecology of the General Hospital of Perugia, Italy, were recruited from 125 women were included in the study. Among these, 18 (72%) reported that the Covid-19 pandemic negatively impacted their experience of pregnancy. Were detected an average Pre-DM total score of 7.28±4.33 and an average state anxiety scale value of 35.56±9.21 and an average trait anxiety scale value of 34.04±7.44 at the STAI-Y. A global severity index1 at SCL-90 was detected in 8.3% of the sample.The identification of antepartum distress and the early treatment of perinatal psychopathology represent a priority during the Covid-19 pandemic era.

Purpose Fasting blood homocysteine is increased in PCOS women and is involved in several of its co-morbidities including cardiovascular disease and infertility. Corrective interventions based on the administration of supra-physiologic doses of folic acid work to a low extent. We aimed to test an alternative approach. Methods This was a prospective, randomized, parallel group, open label, controlled versus no treatment clinical study. PCOS women aged > 18, free from systemic diseases and from pharmacological treatments were randomized with a 2:1 ratio for treatment with activated micronutrients in support to the carbon cycle (Impryl, Parthenogen, Switzerland—n = 22) or no treatment (n = 10) and followed-up for 3 months. Fasting blood homocysteine, AMH, testosterone, SHBGs, and the resulting FTI were tested before and at the end of the follow-up. Results The mean baseline fasting blood homocysteine was above the normal limit of 12 μMol/L and inversely correlated with SHBG. AMH was also increased, whereas testosterone, SHBG, and FTI were within the normal limit. The treatment achieved a significant reduction of homocysteine, that did not change in the control group, independently of the starting value. The treatment also caused an increase of AMH and a decrease of SHBGs only in the subgroup with a normal homocysteine at baseline. Conclusions In PCOS ladies, blood homocysteine is increased and inversely correlated with the SHBGs. Physiologic amounts of activated micronutrients in support to the carbon cycle achieve a reduction virtually in all exposed patients. Whether this is of clinical benefit remains to be established.

To identify risk factors for maternity blues (MB) and to evaluate the impact of obstetric factors on MB prevalence.194 mothers have completed the Edinburgh Postnatal Depression Scale (EPDS) 2 days after delivery. Bivariate and multivariate logistic regression models were used to identify the predictors of MB.57 women (29.4%) were positive at screening. Comparing the two groups, no statistically significant difference was found in age (This study showed that a lower education level and a previous PPD resulted to be important risk factors for MB development, while natural delivery was revealed as a protective factor. These results could be used to develop a better and more accurate prevention program after delivery.

Prematurity and intra-uterine growth restriction (IUGR) are risk factors for long-term poor neurodevelopmental outcomes and are associated with reductions in regional brain volumes. In this study, the aim was to determine the possible role of 3-D ultrasonography (3-DUS) volumes of whole brain, thalamus, frontal cortex and cerebellum, measured at postnatal days 30–40, as early predictors of long-term risk for neurobehavioral disorders. To this purpose, a heterogeneous population of full-term, preterm, IUGR and preterm IUGR (pre-IUGR) born individuals (n = 334), characterized by gestational age and birth weight in the ranges 24–41 wk and 860–4000 g, respectively, was followed from postnatal days 30–40 to the second year of life. At enrollment, brain volumes were measured using 3-DUS, whereas neurodevelopment was assessed at 2 y using the Griffiths III test. Cerebral volumes were strictly and significantly lower in infants characterized by a negative outcome and had excellent diagnostic accuracy. The 3-DUS volume of whole brain, thalamus, frontal cortex or cerebellum may be an early predictor of neonates at major risk for neurobehavioral disorders in later life.

Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF) are crucial for the peripheral and central nervous system development, respectively, and differential brain and blood levels in Intra Uterine Growth Restriction (IUGR) and prematurity have been found. As reduced growth of brain regions, measured at 30-40 days of postnatal period, has been demonstrated in preterm and IUGR neonates who showed impaired neuro-development at two years of age, in this study, the levels of NGF and BDNF were evaluated in the urine samples of 30-40 day-old subjects who were full-term, preterm and IUGR and showed a normal or an abnormal neuro-development at follow up after two years. Neurotrophins were measured concurrently with volumes of whole brain, thalamus, frontal cortex and cerebellum. Values were then correlated with later neuro-developmental outcome. Biochemical parameters and cerebral volumes were assessed using colorimetric ELISA kits and three-dimensional ultra-sonography (3DUS), respectively. Neuro-development was estimated using the Griffiths-II test. Urinary NGF and brain volumes significantly correlated and were lower in preterm and IUGR subjects characterized by poor neuro-development. No differences were seen in the case of BDNF. The present investigation demonstrates, for the first time, the strong and direct association of NGF with brain growth at the initial phase of the postnatal period and with neuro-developmental outcome in later life. Remarkably, urinary NGF may be suggested as an early prognostic indicator of high long-term risk of motor and cognitive impairment in IUGR and preterm neonates.

The oocyte retrieval theater is only a small part of a larger structure that is the center of assisted reproduction.

Pregnancy has been reported to be associated with an increased risk of ischemic stroke, and stroke occurring during pregnancy is one of the leading causes of maternal death.1 Kuklina et al2 reported that the rate of any stroke among antenatal hospitalizations increased by 47% (from 0.15 to 0.22 per 1000 deliveries) and among postpartum hospitalizations by 83% (from 0.12 to 0.22 per 1000 deliveries) when comparing the period 1994–1995 to 2006–2007. The American Heart Association Stroke Guidelines for Women have been published recently,3 which deal with risk factors unique to women, including reproductive factors, and those factors that are more common in women, including migraine, obesity, metabolic syndrome, and atrial fibrillation. However, the lifelong management of hormonal issues in women who have had stroke was not fully addressed regarding the following: future pregnancies, type of delivery, labor induction, and secondary prevention during future pregnancy and lactation. This consensus provides multidisciplinary approaches compiled by stroke neurologists, gynecologists, and endocrinologists, based on a thorough review of current literature through computerized searches up until July 26, 2016. Literature on pregnancy, secondary stroke prevention, labor induction, hormonal contraceptive therapy, ovarian stimulation, and hormone replacement therapy was reviewed. The panel collected relevant articles using computerized searches of medical literature up until July 26, 2016. The search strategy was designed to identify studies on pregnancy, delivery, labor induction, breast-feeding, ovarian stimulation, hormonal contraceptive therapy, hormone replacement therapy, and their stroke risks. The included studies were identified from the Medline/PubMed database, EMBASE, and the Cochrane Database. Additional papers were identified from reference lists of retrieved articles, abstract lists of recent scientific meetings, and Internet-based sources (http://www.tctmd.com, http://www.cxvascular.com; Figure). Figure. Flow chart of the research strategy. A list of treatment recommendations, including evaluations of evidence strength, is provided in Table 1. View this table: Table 1. Recommendations …

Fetal exposure to gestational diabetes mellitus (GDM) seems to stimulate a negative impact on the kidneys. Renal volumes and urinary biomarkers of renal function and tubular impairment and injury were evaluated in 30&ndash, 40-day old newborns of GDM mothers (n = 139) who needed insulin therapy during pregnancy. We found that neonates of mothers who maintained strict control over normoglycemia (n = 65) during pregnancy and fulfilled the other criteria of the GDM management program showed no differences compared to control (n = 55). Conversely, those (n&nbsp, =&nbsp, 74), whose mothers did not maintain glycemic control and were not compliant to the management program, exhibited significantly lower levels of renal volumes and higher activity of N-acetyl-&beta, D-glucosaminidase and cathepsin B. Differences due to maternal pre-gestational and gestational body mass index (BMI) as well as to maternal weight gain were demonstrated. Our findings indicate that a multidisciplinary approach, which involves an appropriate management of GDM, prevents the negative effects of GDM on the kidneys at 30&ndash, 40 days of postnatal age, indicating the fundamental role of glycemic control, as well as of an adequate range of maternal weight gain. Total renal volume, cortical volume, and urinary activity of N-acetyl-&beta, D-glucosaminidase and cathepsin B may be suggested as indicators for the early recognition of GDM neonates at long-term risk of hypertension and kidney disease.

Uterine rupture is an uncommon but potentially life-threatening obstetrical emergency, occurring in 1 on 1200 to 1 on 5000 deliveries. It is more frequent in developing countries and in low-resource area. Rupture of the uterus in women without a history of cesarean section is rare, with a reported incidence of 0.02%. Incidence of uterine rupture is affected by the level of medical care and the presence of scar in the uterus. While asymptomatic uterine dehiscence rarely results in adverse fetal outcome, the complete uterine rupture with extrusion of the placenta or the fetus in the abdomen can be catastrophic. Generally, uterine rupture refers to a complete separation of all uterine layers, including the uterine serosa. It threatens the life of both the mother and fetus, with devastating maternal complications, including need for blood transfusion, intra-abdominal hemorrhage, and peripartum hysterectomy. Maternal mortality is 0.44%, and it resulted from hemorrhage, shock, sepsis, disseminated intravascular coagulation, pulmonary embolism, ileus paralyticus, peritonitis, and renal failure.

The aim of this study was to assess women preference about pain and duration of labour applying a standardized questionnaire.A prospective multicentre large cohort study was carried out in two different University Hospitals. A standardized questionnaire was proposed before active labour and the day after delivery in order to investigate whether women preferred low pain intensity for a longer labour duration or greater pain intensity for a shorter labour duration. The studied population was divided and analysed in two groups according to Epidural Analgesia (EA) administration. A multivariable linear regression analysis was performed to assess which variables were able to influence the opinion about the pain perception after birth.EA group showed an increased risk of episiotomy (p = 0.004), of longer duration of labour (Stage I, p 0.001; Stage II, p = 0.002) and of oxytocin augmentation (P = 0.030). No statistical differences were found about the route of delivery between the two groups. Rates of pre-labour scores significantly differed from rates of post labour scores (p 0.001). In the multivariable linear regression analysis, pre-labour score was directly related to post-labour score (p = 0.013). The EA was indirectly related to higher pain levels for a longer duration preference (p = 0.001), whereas oxytocic infusion in labour was directly related with preference for higher pain for a shorter duration (p = 0.011).Patients' preferences about labour are focused on both pain relief and labour duration. The standardized questionnaire could be a useful tool to screen patients eligible for EA.

Aims: To investigate sodium hyaluronate (SH) efficacy in the treatment of pregnancy rhinitis. Methods: A single-center, prospective, open-label, 2 parallel-group study was carried out. Pregnant women affected by pregnancy rhinitis were randomly assigned to 1 of 2 groups: Group A was treated with SH, while Group B did not receive any treatment. Pregnancy rhinitis symptoms and quality of life (QOL) during pregnancy were investigated by administering a questionnaire and carrying out an otorhinolaryngoiatric visit. Results: A significant reduction in the intensity of headache, snoring and insomnia in the Group A compared to the Group B were demonstrated. In the Group A, a significant lower presence of amount of secretions (Group A 0.88, 95% CI 0.57–1.18 vs. Group B 2.00, 95% CI 1.69–2.31, p < 0.001), turbinate hypertrophy (Group A 1.70, 95% CI 1.46–1.94 vs. Group B 2.53, 95% CI 2.29–2.77, p < 0.001), and mucosal congestion/hyperemia (Group A 1.41, 95% CI 1.14–1.68 vs. Group B 2.26, 95% CI 1.99–2.53, p < 0.001) was observed. No adverse events were reported in patients treated with SH. Conclusions: SH is a safe and effective therapeutic alternative for the treatment of pregnancy rhinitis symptoms, improving patients’ QOL.

Study Objective To assess the safety and efficacy of cold loop hysteroscopic myomectomy in a large series of cases. Design Retrospective study (Canadian Task Force Classification III). Setting Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. Patients A total of 1215 patients with 1 or more G1-G2 submucous myomas. Intervention Cold loop hysteroscopic myomectomy. Measurement and Main Results A total of 1690 myomas were removed. A minimum of 1 to a maximum of 5 fibroids for each surgical procedure were totally removed. Out of 1215 patients, 1017 (83.7%) were treated with a single surgical procedure. Twelve intraoperative complications occurred (0.84%). No cases of uterine perforation with the thermal loop or clinical intravasation syndrome were reported. Conclusion Cold loop hysteroscopic myomectomy seems to represent a safe and effective procedure for the removal of submucous myomas with intramural development, while at the same time respecting the anatomic and functional integrity of the myometrium. The use of a cold loop in resectoscopic myomectomy is associated with a low rate of minor intraoperative complications and an absence of major complications. This could be of primary relevance with a view to fertility and future pregnancies.

Hydroxyl radical (.OH) is highly reactive, and therefore very short-lived. Finding new means to accurately detect .OH, and testing the ability of known .OH scavengers to neutralize them in human biological fluids would leverage our ability to more effectively counter oxidative (.OH) stress-mediated damage in human diseases. To achieve this, we pursued the evaluation of secondary products resulting from .OH attack, using a detection system based on Fenton reaction-mediated D-phenylalanine (D-Phe) hydroxylation. This reaction in turn generates o-tyrosine (o-tyr), m-tyrosine (m-tyr) and p-tyrosine (p-tyr). Here, these isomers were separated by HPLC, equipped with fluorescence detectors due to the natural fluorescence of these hydrotyrosines. By extension, we found that, adding radical scavengers competed with D-Phe on .OH attack, thus allowing to determine the .OH quenching capacity of a given compound expressed as inhibition ratio percent (IR%). Using a kinetic approach, we then tested the .OH scavenging capacity (OHSC) of well-known antioxidant molecules. In a test tube, N,N'-dimethylthiourea (DMTU) was the most efficient scavenger as compared to Trolox and N-Acethyl-L-cysteine, with NAC being the less effective. OHSC assay was then applied to biological fluid samples as seminal plasma, human serum from normal subjects and patients undergoing hemodialysis (HD), colostrum and human breast milk from mothers that received daily doses of 30g of chocolate (70% cocoa) during pregnancy. We found that a daily administration of dark chocolate during pregnancy almost doubled OHSC levels in breast milk (1.88 ± 0.12 times, p < 0.01). Furthermore, HD treatment determined a significant reduction of serum OHSC concentration (54.63 ± 2.82%, p < 0.001). Our results provide evidence that Fenton reaction-mediated D-Phe hydroxylation is a suitable method for routine and non-invasive evaluation of .OH detection and its scavenging in human biological fluids.

Study Objective To evaluate the intraoperative effects of gonadotropin-releasing hormone (GnRH) analogue pretreatment in patients undergoing cold loop hysteroscopic myomectomy. Design Randomized controlled trial (Canadian Task Force classification I). Setting Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. Patients A total of 99 patients were randomized and subsequently allocated to the GnRH analogue group or to the nonpharmacologic treatment control group. Fifteen patients were lost after allocation, and 42 patients per group underwent hysteroscopic myomectomy. Interventions Cold loop hysteroscopic myomectomy. Measurements and Main Results The control group accomplished the treatment in a 1-step procedure more frequently than the GnRH analogue group (92.85% and 73.8% of cases, respectively; p = .040). The completion of the treatment was more unlikely in case of G2 myomas (p = .006), whereas no differences were recorded for G1 and G0 myomas. The multivariate analysis showed a significant correlation between the multiple-step treatment and the use of GnRH analogue (odds ratio, 5.365; 95% confidence interval [CI], 1.018–28.284; p = .048), grading (odds ratio, 4.503; 95% CI, 1.049–19.329; p = .043), and size of myomas (odds ratio, 1.128; 95% CI, 1.026–1.239; p = .013). Conclusions Preoperative GnRH analogue administration did not facilitate the completion of cold loop hysteroscopic myomectomy in a single surgical procedure in G2 myomas and was correlated with a longer duration of the surgery. No significant benefits were found for G0 and G1 myomas. ( ClinicalTrials.gov : NCT01873378 .)

Myomas, also called leiomyomas or fibroids, are benign, monoclonal tumors of the smooth muscle cells of the myometrium, widely considered as the most common of the female reproductive tract. Myomas can be responsible for pelvic pain, abnormal uterine bleeding, and infertility. Although more than 50% of fibroids are asymptomatic, the submucous myomas are associated with the most severe symptomatology. The advent of endoscopy in the gynecologic surgery revolutionized the treatment of submucous myomas, introducing a viable uterine-sparing alternative to hysterectomy. In the last four decades, several techniques have been described to perform hysteroscopic myomectomy. The hysteroscopic myomectomy should be a simple, well-tolerated and effective procedure. The cold loop technique, preferably accomplished in only one surgical procedure, seems to be the best option in the treatment of submucous myomas. Such technique, conceived in 1995, for the first time allowed to overcome the limits represented by the classical slicing technique and still today ensures a safe and effective myometrial sparing treatment of submucous myomas.

Both in diagnostic and operative setting, the cervical canal is the way that surgeon has to take in order to access the uterine cavity. In the beginning, due to its anatomical characteristics, crossing the cervix represented the first problem that the pioneers of hysteroscopy had to face to reach the uterine cavity. In the last few decades hysteroscopy has developed in terms of technology and execution technique. Nevertheless, resistant cervix and pain, often related to it, still remain the most common causes of failure to complete the procedure in diagnostic and operative hysteroscopy. Several pathologies may affect the cervical canal, creating the condition for a resistant cervix. Nevertheless, behind a consistent number of resistant cervixes there is the lack of an adequate study of the cervical canal during diagnostic hysteroscopy, the poor knowledge of the pathologies that can be encountered and procedures incorrectly performed. The knowledge of characteristics and pathology of cervical canal as well as the hysteroscopic techniques conceived to solve such hindrances could help the surgeon to easily overcome a resistant cervix.

Foetal magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of foetal abnormalities. Over the years, we have successfully applied bi-parametric MRI (bp-MRI) to the following obstetric conditions: (1) neurologic vascular diseases; (2) assessment of lung parenchyma maturation; (3) renal pathologies, such as polycystic kidney, suspected renal infarction, unilateral or bilateral renal agenesis; (4) placental pathologies, as twin-twin transfusion syndrome or placenta accreta; (5) benignant and malignant congenital tumours or cysts of the liver, such as haemangioendothelioma, hepatoblastoma or metastatic neuroblastoma, of the kidney (e.g. mesoblastic nephroma) and of the retroperitoneum, such as teratoma. The information derived from bp-MRI, and concerned with water motions in different tissues, improved the morphologic details provided by conventional foetal MRI. It has the potential to increase the value of MRI in the assessment of a wide range of foetal pathologies, particularly in renal diseases, allowing an adequate management decision and therapy.

Objective To evaluate whether a correlation exists between the pain perceived during diagnostic anesthesia-free hysteroscopy and the characteristics of the cervical canal. Study design Prospective observational pilot study of 255 women undergoing diagnostic hysteroscopy. Data analysis included characteristics of the patient and the cervical canal, and the pain experience during the procedure, assessed by visual analog score (VAS). A multiple logistic regression was then carried out in order to exclude confounding factors. Results The degree of pain during hysteroscopy was equal to a median VAS score of 2 (range 0–10). Bivariate analysis between patients with VAS > 3 and patients with VAS ≤ 3 demonstrated a significant correlation between pain and the presence of synechiae in the cervical canal ( P = 0.022), the patient's age ( P = 0.003) and parity ( P = 0.001). Multivariate analysis revealed that the presence of cervical synechiae ( P = 0.0001) [OR = 4.99 (95% CI 2.13–11.70)] and parity ( P = 0.014) [OR = 0.42 (95% CI 0.21–0.83)] were significantly correlated with pain. There was no significant correlation with the different angles of the cervical canal. Conclusion Cervical synechiae appear as a major factor influencing pain during hysteroscopy. While parity acts as a protective factor, the angle of the cervical canal does not seem to play an important role for pain during diagnostic hysteroscopy.

Diffuse uterine leiomyomatosis (DUL) is a rare clinical entity with important reproductive consequences. To date, only four pregnancies have been reported after hysteroscopic myomectomy. Here we describe the case of a 28-year-old infertile woman with diffuse uterine leiomyomatosis, who presented infertility and metrorrhagia lasting for 2 years. A countless number of subserous, intramural and submucous myomas were ultrasonographically revealed. Diagnostic hysteroscopy described a uterine cavity completely subverted by the presence of myomas. A two-step 'cold loop' hysteroscopic myomectomy was performed following the technique previously described. One month after the treatment, there were no submucous myomas. A regular uterine cavity free of synechiae was endoscopically confirmed. After the treatment, the patient carried to term three consecutive, uneventful pregnancies. This is the first report of repeated successful pregnancies following the 'cold loop' hysteroscopic technique in DUL. We believe that 'cold loop' resectoscopic myomectomy may provide new advantageous perspectives for women with DUL seeking pregnancy.

Aim To determine the risk of cesarean delivery after induction of labor with prostaglandins and to establish if this is influenced by a single indication of induction of labor or any intrinsic characteristic of the woman or labor. Material and methods A retrospective cohort study was carried out. Three hundred and twenty-four pregnant women who underwent pharmacological induction of labor with prostaglandins were divided into nine groups through indication of labor induction. Statistical analysis was assessed with the Kolmogorov-Smirnov test to assess the normal distribution of variables, Kruskal-Wallis test for comparisons of non-parametric continuous variables, univariate analysis to compare cesarean delivery rates and multivariate logistic regression. Results The risk of cesarean section was significantly higher only in prolonged pregnancy (OR = 1.98; 95% CI: 1.18-3.34). Elective induction was associated with the lowest risk of cesarean section (OR = 0.46; 95% CI: 0.26-0.81). Maternal age and was directly related (OR = 1.087; 95% CI: 1.016-1.164), while parity (OR = 0.123; 95% CI: 0.051-0.332), Bishop score (OR = 0.703; 95% CI: 0.571-0.884), and duration of labor (OR = 0.995; 95% CI: 0.993-0.998) were inversely correlated with cesarean delivery. Conclusion Cesarean delivery rate is not significantly influenced by any indication of induction of labor with prostaglandins, except for prolonged pregnancy. Elective induction is associated with the lowest risk of cesarean section. Increasing maternal age, low parity, low Bishop score and low duration of labor are at higher risk of cesarean section.

Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. It has been proposed and extensively used in the treatment of different gynecological pathologies as well as in assisted reproductive technologies and in the maintenance of pregnancy. Called “the pregnancy hormone”, natural progesterone is essential before pregnancy and has a crucial role in its maintenance based on different mechanisms such as: modulation of maternal immune response and suppression of inflammatory response (the presence of progesterone and its interaction with progesterone receptors at the decidua level appears to play a major role in the maternal defense strategy), reduction of uterine contractility (adequate progesterone concentrations in myometrium are able to counteract prostaglandin stimulatory activity as well as oxytocin), improvement of utero-placental circulation and luteal phase support (it has been demonstrated that progesterone may promote the invasion of extravillous trophoblasts to the decidua by inhibiting apoptosis of extravillous trophoblasts). Once the therapeutic need of progesterone is established, the key factor is the decision of the best route to administer the hormone and the optimal dosage determination. Progesterone can be administered by many different routes, but the most utilized are oral, the vaginal and intramuscular administration. The main uses of progesterone are represented by: threatened miscarriage, recurrent miscarriage and preterm birth (in the prevention strategy, as a tocolytic agent and also in the maintenance of uterine quiescence).

The aim of this study is to investigate if advance maternal age is an independent risk factor for cesarean section in women induced with prostaglandins. Only patients with a single indication for induction of labor were considered.A matched retrospective cohort study was conducted. A study group of 112 women aged 35 or older was enrolled. The control group included 216 women aged 34 or younger. Multivariate logistical regression models were fitted for the prediction of the cesarean section.There were no statistically significant differences in characteristics of the patients in the study and control groups. However, a higher prevalence of nulliparous women was found in control group (p = 0.002). The indications of labor induction were homogeneous in the two groups. No significant differences were found in the route of delivery. The median time of labor was significantly shorter in the study group (p = 0.002), and the birth weight and the placental weight were significantly lower in the study group. Advanced maternal age and newborn weight were directly related, whereas time of labor, Bishop score and parity were inversely related to a higher cesarean rate.When single indication of induction of labor with prostaglandins is considered, advanced maternal age represents a significant independent risk factor for cesarean delivery.

The study aimed to analyze the pregnancy outcome of women aged 40 years or more.A matched retrospective cohort study comparing women aged 40 years or more with a control group aged 20 to 30 years is described. Multivariate logistic regression models were fitted for the prediction of preterm birth and cesarean delivery.Pregnancy-induced hypertension, preeclampsia and placenta previa were similar in both groups, but a higher rate of gestational diabetes was found in elderly patients (odds ratio [OR] 3.820, 95% confidence interval [CI] = 1.400-10.400; p0.0001). Preterm delivery was significantly more frequent in elderly women (OR 1.847, 95% CI = 1.123-3.037; p = 0.020). Gestational diabetes and pregnancy-induced hypertension were strongly associated with preterm delivery and advanced maternal age was not an independent risk factor for preterm delivery. The cesarean delivery rate was significantly higher in the study group (OR 3.234, 95% CI = 2.266-4.617; p0.0001). The variables most influencing the cesarean delivery rate were maternal age, analgesia, parity, premature rupture of the membranes and gestational hypertension. No significant differences were detected in neonatal birth weight and Apgar score.Patients aged 40 years or more have been demonstrated to carry a favorable pregnancy and neonatal outcome, similar to younger patients. The risk of cesarean delivery was higher in patients with advanced maternal age, in nulliparous and in women with a previous cesarean section. The risk of preterm delivery was not related to age but it was strongly associated with gestational diabetes and pregnancy-induced hypertension.

Assisted Reproductive Technologies (ART) have created a number of relevant economic implications. Results deriving from cost-effectiveness studies have had some important medical and social consequences. The costs of ART are specific to the healthcare system in each of the countries were the procedure is performed, reflecting the varying degrees of public and private responsibility for purchasing healthcare and total healthcare expenditure. The analysis of different cost components per treatment cycle demonstrates that the hormonal stimulation stage is the most expensive part of IVF/ICSI cycles. The use of a more costly preparation could be justified only in case of a significantly higher live birth rate. Currently, human gonadotrophins seem to be more cost-effective than recombinant preparations.

The diabetes epidemic is sweeping the globe. In 2011, 366 million people worldwide had diabetes; by 2030, that number is projected to almost double. More than eight million women in the United States have pregestational diabetes mellitus, and it is observed in 1 % of all pregnancies [1]. Studies suggest that the prevalence of diabetes among women of childbearing age is increasing in the United States [2]. Many of these women are undiagnosed until pregnancy.

A 28-year-old woman was seen in the outpatient clinic with 9-month history of heavy periods. She was anaemic and iron supplementation was reported. A transvaginal ultrasound scan showed a single 56...

A substantial body of research on mammalian gametogenesis and human reproduction has recently investigated the effect of myo-inositol (MyoIns) on oocyte and sperm cell quality, due to its possible application to medically assisted reproduction. With a growing number of both clinical and basic research papers, the meaning of several observations now needs to be interpreted under a solid and rigorous physiological framework. The 2013 Florence International Consensus Conference on Myo- and D-chiro-inositol in obstetrics and gynecology has answered a number of research questions concerning the use of the two stereoisomers in assisted reproductive technologies. Available clinical trials and studies on the physiological and pharmacological effects of these molecules have been surveyed. Specifically, the physiological involvement of MyoIns in oocyte maturation and sperm cell functions has been discussed, providing an answer to the following questions: (1) Are inositols physiologically involved in oocyte maturation? (2) Are inositols involved in the physiology of spermatozoa function? (3) Is treatment with inositols helpful within assisted reproduction technology cycles? (4) Are there any differences in clinical efficacy between MyoIns and D-chiro-inositol? The conclusions of this Conference, drawn depending on expert panel opinions and shared with all the participants, are summarized in this review paper.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in woman of reproductive age. Although extensive studies have been performed in past decades to investigate the pathobiological mechanisms underlying the unset of this disease, its etiology remains unknown. Progesterone is a hormone of paramount importance in ovulation, implantation and luteal phase support. Low levels of progesterone have been found in the early luteal phase in PCOS patients. Granulosa cells from polycystic ovaries show an altered progesterone production. Moreover, the lack of cyclical exposure to progesterone may have a role in the development of the gonadotropin and androgen abnormalities found in PCOS patients. Ovulation failure and progesterone deficiency may facilitate the hypothalamic-pituitary abnormalities causing the associated disordered luteinizing hormone secretion in PCOS. Progesterone may be administered to PCOS patients in the following cases: to induce withdrawal bleeding, to suppress secretion of luteinizing hormone, in ovulation induction in clomiphene citrate-resistant patients and in luteal phase support in assisted reproduction. We discuss the pharmacologic characteristics of the different routes of progesterone administration with reference to these diverse indications, the therapeutic objectives and patient compliance.

Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, and since 1935 it has been synthesised and is now available commercially, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is the way in which the hormone is administered, with parenteral use proving the best way to obtain optimal plasma levels. Another concern is the paucity of randomised controlled trials and the different dosages and populations studied. As a result, the therapeutic application of progesterone in pregnancy is restricted to the prevention and treatment of threatened miscarriage, recurrent miscarriage and preterm birth. Progesterone is efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high risk pregnant women using high-dosage prophylactic progesterone.

Objective A new fertility assessment after a B-Lynch suture without a concomitant uterine devascularization is proposed. Case Report The case of a 37-year-old woman who experienced postpartum hemorrhage due to uterine atony during cesarean delivery of the previous pregnancy is reported. A B-Lynch brace suturing technique, not associated to any other hemostatic surgical procedure, was carried out. One year later and after an uncomplicated pregnancy of 39 weeks, the patient delivered a healthy infant by an elective cesarean section. Only omental adhesions were found on the anterior surface of the uterus as a consequence of the previous B-Lynch suture. Conclusion The B-Lynch hemostatic surgical procedure, alone, does not seem to have a negative impact on fertility. Additional clinical evidences in a greater case-series of patients are needed to assess the value of the method for fertility preservation.

Objective To compare the effectiveness of IM P and IM P plus oral phytoestrogens for luteal phase support in patients undergoing IVF-ET cycles. Design Prospective, controlled, randomized trial. Setting University Hospital, Perugia, Italy. Patient(s) Two hundred thirteen infertile patients undergoing IVF-ET were included in the study. The inclusion criteria were use of a GnRH agonist for pituitary down-regulation and age Intervention(s) Patients were assigned to receive either IM P (50 mg daily) plus placebo or P (50 mg daily) plus phytoestrogen supplementation (1,500 mg daily) for luteal phase support starting from the evening of oocyte retrieval until either a serum pregnancy test result was negative or embryonic heartbeat was sonographically confirmed. Main outcome measure(s) The outcomes of IVF-ET were evaluated in both study groups in terms of implantation rate, biochemical pregnancy rate (PR), clinical PR, spontaneous abortion rate, and ongoing pregnancy/delivered rate. Result(s) Statistically significant higher values for implantation rate, clinical PR, and ongoing pregnancy/delivered rate were recorded in the patients who received P plus phytoestrogens for luteal phase support in comparison with patients receiving P and placebo. Conclusion(s) Although the results of this study encourage the use of phytoestrogens for luteal phase support in patients undergoing IVF-ET program, more studies are necessary to support the hypothesis that phytoestrogens have a beneficial effect in IVF cycles.

To assess if anti-mullerian hormone (AMH) concentrations decrease during the third trimester of pregnancy and puerperium and whether this is correlated to gestational diabetes mellitus (GDM). AMH serum concentrations were determined by ELISA, with lowest detection limit of 0.08 ng/ml, during the third trimester of pregnancy and puerperium in 34 patients with GDM and in 32 healthy control pregnant women. Three blood samples were collected at 28–32, 34–36 weeks’ gestation and 40 days after delivery, respectively. No differences in AMH concentration between GDM and healthy pregnant women were found at any follow-up time. On the contrary, significant differences in delta AMH values between the first and the second sample (p < 0.0001), the second and the third sample (p < 0.0001), and the first and the third sample (p = 0.004) were found in both groups. The multivariate analysis showed that maternal age was not correlated to delta AMH variations. The analysis of AMH concentrations did not show a significant relationship with body mass index-variation, newborn and placental weight, and GDM, while only maternal age was significantly correlated with AMH concentrations in all blood samples. A significant decrease in AMH values was observed during the third trimester of pregnancy and this was independent on maternal age. GDM does not seem to influence the AMH concentrations during pregnancy and after delivery.

Objective: To analyze the chromosomal status of human embryos obtained from frozen-thawed oocytes. Design: Fluorescence in situ hybridization analysis of embryos obtained after oocyte cryopreservation. Setting: Department of Obstetrics and Gynecology at the University of Perugia, Italy, and the Instituto Valenciano de Infertilidad, Spain. Patient(s): Oocyte donors ( n = 43). Fertilization, development, and chromosomal status of the embryos were compared with a control group ( n = 18) of patients undergoing preimplantation genetic diagnosis for sex chromosome–linked diseases. Intervention(s): Collection of oocytes after conventional ovarian stimulation and cryopreservation using propanediol as the cryoprotectant and a slow freezing procedure. Microinjection of surviving metaphase II oocytes and evaluation of fertilization and embryo development up to blastocyst stage. Chromosomal analysis after embryo biopsy. Main Outcome Measure(s): Survival, fertilization, and blastocyst rates. Embryo chromosomal analysis employing specific probes for chromosomes 13,18,21, X and Y. Result(s): The overall survival rate was 59.4%. There was no difference between cryopreservation and control groups in fertilization rates (76.5% vs. 90.5%) or blastocyst development (29.6% vs. 35%). The percentage of blastocysts from the original number of cryopreserved oocytes was only 5.6%, comparable to the 5.9% obtained in the control group. The percentage of embryos with abnormal number of chromosomes in the cryopreservation group (28.6%) was comparable to the 26% observed in the controls. Conclusion(s): Fertilization and cleavage rates after oocyte freezing are acceptable. Survival is, however, still poor, leading to overall results that make the technique clinically inefficient. There is no increase in the rate of chromosomal abnormalities, indicating that the technique is, nevertheless, safe enough to be further explored and improved.

The high risk attributed to multiples calls for close observation during pregnancy. Based on adequate predictions in singletons, it was expected that the biophysical profile (reactive fetal heart rate pattern on non-stress test, presence of fetal breathing and body movements, documentation of normal fetal tone and adequate amount of amniotic fluid) could be used in multiples as well. However, the paucity of studies could not demonstrate an equivalent predictive capacity in multiple pregnancies.

An early, pre-operative, ultrasonographic diagnosis of an abdominal pregnancy was made and successfully treated by laparoscopy in an asymptomatic woman with a 8-weeks abdominal pregnancy. The early, ultrasonographic diagnosis allowed an easy, mini-invasive, endoscopic treatment of the potentially life threatening pregnancy.

Clinical efficacy of human-derived follicle-stimulating hormone (FSH) versus recombinant FSH (rFSH) in IVF-ICSI cycles has long been compared, but no clear evidence of the superiority of a preparation over the other has been found. Human gonadotropins have been often grouped together, but a different glycosylation may be present in each preparation, therefore influencing the specific bioactivity. To exclude confounding factors, a meta-analysis and a cost-effectiveness analysis were designed to compare effectiveness and cost-effectiveness of a specific highly purified human FSH (HP-hFSH) (Fostimon®) versus rFSH (Gonal-F®) in IVF/ICSI cycles. Research methodology filters were applied in MEDLINE, Current Contents and Web of Science from 1980 to February 2012. Eight randomized trials met selection criteria. The meta-analysis showed no significant differences between rFSH and HP-hFSH treatment in live-birth rate (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.63-1.11), clinical pregnancy rate (OR 0.85, 95% CI 0.68-1.07), number of oocytes retrieved, number of mature oocytes and days of stimulation. The cost-effectiveness ratio was € 7174 in the rFSH group and € 2056 in the HP-hFSH group. HP-hFSH is as effective as rFSH in ovarian stimulation for IVF-ICSI cycles, but the human preparation is more cost-effective.

This trial was undertaken to evaluate the effects of high-cocoa-content chocolate supplementation in pregnancy on several haematochemical and clinical parameters. The study had as reference population the pregnant women requesting an obstetric control at Outpatient Clinic of Obstetrics and Gynaecology of the S. Maria della Misericordia University Hospital, Perugia, Italy. Candidates who participated in this study were all Caucasian women aged 18-40 years, who had a single gestation pregnancy between 11th + 0 and 13th + 0 week gestational age.We conducted a single-center randomized controlled trial. The pregnant women selected were randomized into Group A, which received daily doses of 30 g of chocolate (70% cocoa), and Group B, which was free to increase their diet with other foods.Ninety women were randomized. Significant difference was found between the two groups for diastolic blood pressure (p = 0.05), systolic (p0.0001) and levels of liver enzymes, with values lower in Group A than in Group B. Total cholesterol levels and weight gain in Group A did not increase more than in Group B.A modest daily intake of high-cocoa-content chocolate contributes to reduce blood pressure, glycemic and liver pattern during pregnancy without affecting the weight gain.