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SummaryThe announcement in 2019 of a new coronavirus disease that quickly became a major pandemic, is an exceptional challenge to healthcare systems never seen before. Such a public health emergency can largely influence various aspects of people’s health as well as reproductive outcome. IVF specialists should be vigilant, monitoring the situation whilst contributing by sharing novel evidence to counsel patients, both pregnant women and would-be mothers. Coronavirus infection might adversely affect pregnant women and their offspring. Consequently, this review paper aims to analyse its potential risks for reproductive health, as well as potential effects of the virus on gamete function and embryo development. In addition, reopening fertility clinics poses several concerns that need immediate addressing, such as the effect of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) on reproductive cells and also the potential risk of cross-contamination and viral transmission. Therefore, this manuscript summarizes what is currently known about the effect of the SARS-CoV-2 infection on medically assisted reproductive treatments and its effect on reproductive health and pregnancy.

In this retrospective study of 873 men enrolled for assisted reproduction techniques, relationships between sperm quality parameters, motile sperm organelle morphology examination (MSOME), DNA damage and live birth rate were evaluated. The presence of vacuoles in the sperm heads was detected by MSOME. Either chromatin decondensation or DNA fragmentation was used to study DNA damage. Results show that age significantly affected some of the examined parameters. In particular, sperm concentration was positively correlated (R = 0.088; P = 0.01) and chromatin decondensation was negatively correlated (R = -0.102; P = 0.003) with age. Furthermore, live birth rate was significantly lower in men aged 40 years or older (P < 0.02) compared with the younger age groups. The presence of sperm head vacuoles was not associated with head morphology, main sperm quality parameters, DNA fragmentation and live birth rate. Considering sperm heads in relation to the shape (normal/abnormal) and vacuoles (presence/absence), no significant variations in the occurrence of vacuoles in either normal or abnormal heads were found. These data suggest that vacuoles are physiological features that do not alter sperm functionality, and it seems that MSOME is not necessary for increasing the success of assisted reproduction techniques.

Infertile couples make up approximately 10% of the worldwide population, and around 1% of current live births are a result of assisted reproductive technology (ART). Since the time that this technology was first applied, many studies have been performed in order to determine the risk associated with infertility treatments. Short- and long-term risks have been identified, which confirm that the major complications are due to multiple pregnancies. In a previous study we described in detail the main reproductive processes, the techniques for in vitro fertilization (IVF) and the risks associated with each of them, with a focus on intracytoplasmic sperm injection (ICSI). In this review we provide an update from 2007 to the present. In particular, in addition to new information on post-pregnancy complications and infant morbidity and malformations, we report data on rare syndromes, including recent case reports. Although data are controversial, an association between IVF and a minor increase in the incidence of birth defects has been confirmed. Several lines of evidence also suggest that there may be a link between ART and psychological disorders in the parents and the child. Finally, recent findings draw attention to the need for accurate clinical and psychological counselling of couples before any treatment decisions are made.

An important component of quality of care is the use of evidence-base d practices. Three studies from three different continents (Africa, Asia and Latin America) have reported the suboptimal use of evidence - based interventions in obstetric care, proving that despite scientific evidence and dissemination efforts, there are harmful and/or unnecessary procedures still used, while others that are beneficial are ignored. This illustrates the existing bridges and barriers between practice guidelines based on research findings and practitioners. A theoretical framework could help explain these barriers and possibly help target interventions to specific barriers. A review of existing literature shows that an intervention aimed to increase the use of evidence-base d practices should have the following components: increase birth attendant concern about the effectiveness of routine clinical practices, stimulate their desire to review the effectiveness of their practice, provide them with skills to perform evidence based clinical guidelines appraisal and development and establish mechanisms through key hospital leaders to implement the guidelines and sustain them over time.

Objective To evaluate whether commonly used cytologic criteria for the diagnosis of endometriosis are sufficiently specific, to assess the possible role of special methods in the differential diagnosis and to assess the clinical meaning and drawbacks of a cytopathologic diagnosis of endometriosis by fine needle aspiration. Study design We retrieved 10 cases of endometriosis from our files that had been diagnosed primarily by fine needle cytology (FNC) with subsequent tissue study. In some cases additional cytospin preparations and/or smears had been used for cytochemistry (periodic acid-Schiff stain, mucicarmine) or immunocytochemistry (pan-cytokeratin, cytokeratin 7, vimentin, CD10) using a 3-step streptavidin-biotin-immunoperoxidase reaction. Results The cell pattern and immunocytochemical profile of the cases suggested a diagnosis of endometriosis. All cases were histologically confirmed. Conclusion With optimal preparations a confident cytologic diagnosis of endometriosis may be made with ease, permitting correct treatment of the disease and, in selected cases, planning of preoperative pharmacologic therapy.

Purpose: A retrospective study of 89 hypo-fertile male patients attending for in vitro fertilization was undertaken in order to evaluate possible correlations among sperm DNA damage, sperm analysis parameters and pregnancies. Methods: Sperm parameters (concentration, normal morphology and multiple anomalies) were evaluated according to the World Health Organization guidelines. DNA damages were simultaneously evaluated on each sperm sample by i) sperm chromatin decondensation test; ii) sperm DNA fragmentation evaluated by Sperm Chromatin Dispersion and Halo sperm Kit; iii) sperm DNA fragmentation evaluated by the Terminal Uridine Nick-End Labelling procedure. Results: Statistical analysis was performed by using analysis of variance and least squares regression. The sperm chromatin dispersion and fragmentation assays showed a statistically significant positive correlation (P=0.0017) in all the samples confirming the good efficacy of either of the two tests in detecting sperm DNA damage. Both the two test negatively correlated with normal sperm morphology (P=0.008), however only by using Halo sperm test we obtained a significant correlation with multiple sperm pathological morphologies (P=0.029) and an inverse correlation with pregnancies outcome (P=0.013). No correlation was detected among DNA damages, sperm concentration and chromatin decondensation. Conclusions: These data suggest a similar efficacy of sperm chromatin dispersion and Terminal Uridine Nick-End Labelling in detecting sperm DNA integrity. Due to the higher sensitivity of Halo test, its prognostic role in the diagnosis of fertilizing ability of a semen sample and possible pregnancy rate is discussed

Fetal committed erythroid progenitors CFU-E and M-BFU-E released into the maternal circulation during pregnancy are ideal candidates for in vitro proliferation since their lifespan is short and they can form colonies of 100-1000 cells in a semi-solid medium. In order to propagate these cells with a high rate of purity, a strategy was devised based on their prior enrichment with biotin-labelled human erythropoietin ligand and magnetic sorting before culturing in a suitable medium. Eight euploid pregnancies investigated in order to address this issue produced fetal clones in cultures with 18 per cent purity as assessed by polymerase chain reaction (PCR) analysis for Y-specific sequences, immunocytochemical staining for fetal gamma-globin, and fluorescence in situ hybridization (FISH) study. The CFU-E-type colony was the most represented progenitor, followed by M-BFU-E, and only occasionally was the detection of CFU-GEMM recorded. The retrospective diagnosis of two cases of fetal Down's syndrome by culturing fetal cells from maternal blood was accomplished for the first time. FISH analysis disclosed a strong presence of fetal trisomic cells (70 per cent and 40 per cent in the two cases). This strong presence would suggest a preferential leakage into maternal blood. The overall results of this study demonstrate that fetal cells can be cultured in vitro with reliable reproducibility, thus making the prospect of a non-invasive prenatal genetic diagnosis realistic.

SummaryThe integrity of sperm chromatin structure has proven to be of great importance for human fertility. In this study, we investigated whether sperm cryopreservation has an effect on nuclear DNA tertiary structure, (i.e. condensation), measured by aniline blue staining, in 103 male patients who required consultation for hypo-fertility. Sperm DNA damage was significantly higher in patients showing oligospermia and severe morphological abnormalities than in native sperm populations. Furthermore we observed that chromatin decondensation was related to the cryostorage technique and to the duration of storage. This increase in decondensation was highly significant (P < 0.01) immediately after cryopreservation and from 90 days of cryostorage onwards. The possible mechanisms involved in sperm chromatin cryoinjury and the need to incorporate new methods for testing sperm nuclear structure alteration into the routine spermiogram are discussed.

Spermiogenesis is the last phase of the process that give rise to a mature and competent spermatozoon. It occurs from a dramatic morphological and structural change of the spermatid, in particular replacement of DNA-linked histones by protamines leading to a highly compact chromatin structure consisting of DNA and heterogeneous nucleoproteins. The target of a fertilizing spermatozoon is to deliver into the oocyte the paternal genome and regulatory factors that are required for proper embryonic development [1]. To do this the sperm must be capable of undergoing decondensation at a peculiar moment of the fertilization process. Increasing evidence on the strong paternal effect on preimplantation embryo development [2] focus on the importance to identify a reliable sperm quality parameter. Although many different causes may give rise to male infertility [3], traditionally in IVF centres, routine laboratory investigations evaluate seminal parameters such as concentration, motility and morphology in order to assess semen quality prior to undergo assisted reproduction. Recent acquisitions correlate poor chromatin condensation to a failure in fertilization, embryo development and repeated miscarriages indicating even that sperm DNA damage over 30% impedes natural pregnancy.

Metaplastic breast carcinoma (MBC) may have a varied presentation on fine-needle cytology samples. We herewith describe three cases of MBC found in our series. One of these cases showed a peculiar mixture of malignant ductal, apocrine type, and squamous epithelial cells with fascicles of spindle cells with variable degree of atypia and was diagnosed as metaplastic carcinoma of the carcino-sarcomatous type. The other two lesions were characterized by an abundant chondroid extracellular matrix to which were variably admixed carcinomatous and chondroid-type cells, with variable degree of atypia. Both these latter cases were defined as matrix-producing metaplastic carcinomas. Because of the various presentation of MBC on fine-needle cytology samples and the possible influence of needle “sampling” on the cytological specimen, the spectrum of differential diagnoses to be considered may encompass a number of benign and malignant entities, like keratinous subareolar cysts, malignant fibroepithelial lesions with myxo-chondroid stroma, and true sarcomas of the breast, with cartilaginous metaplasia. It is the Authors' feeling that, with optimal samples, the cytomorphological findings of this rare variant of breast carcinoma permit its accurate pre-operative diagnosis. Diagn. Cytopathol. 2005;33: 205–209. © 2005 Wiley-Liss, Inc.

Purpose: Our goal was to study the activation current in physiologically competent metaphase II human oocytes, i.e., not previously exposed to spermatozoa or aged in vitro, and, in particular, to determine whether a soluble sperm factor triggers a fertilization current comparable to that observed with intact spermatozoa and to characterize the current involved. Methods: The whole-cell voltage-clamp technique was used on spare metaphase II oocytes, obtained with patient consent from IVF programs. In this configuration a soluble fraction from human spermatozoa was microinjected, and the current recorded. Results: Metaphase II human oocytes generate bell-shaped outward currents of 400–1000 pA (X=706±322;n=10), following injection of a cytosolic extract from human spermatozoa. The amount of sperm extract injected was less than 10% of the total oocyte volume and was equivalent to 1–10 spermatozoa. A similar current was generated following exposure to 20 µM of the calcium ionophore A23187 (n=10). The steady-state conductance of the oocyte increased from 10 to 19.8 nS (n=10) following injection of the sperm factor and from 5.3 to 27.7 nS following ionophore exposure. Both sperm factor- and ionophore-induced currents were reduced in amplitude when the unfertilized oocyte was preexposed to 25–75 µM iberiotoxin (n=8) and eliminated at a concentration of 100 µM iberiotoxin. Conclusions: The data support the hypothesis of a soluble sperm factor involved in the activation of human oocytes and shows that the initial activation response in the human oocyte is the gating of Ca2+-activated K+ channels.

Objective To study the molecular origin and functionality of the plasma membrane of round-head spermatozoa in the human. Design Clinical and laboratory study. Setting Patients in a clinical and academic environment. Patients Men with round-head spermatozoa. Results Pisum sativum lectin homogeneously stains the surface of round sperm; however, the staining pattern and transmission electron microscopy show that the plasma membrane does not alter after exposure to the calcium ionophore A23187. In a clinical program, round-head spermatozoa injected subzonally into metaphase II oocytes with or without pretreatment with the fusogen polyethylene glycol did not bind or fuse to the oocyte surface. Conclusion The data suggests that plasma membrane fusion in human gametes is regulated by specific surface molecules and that exposure of these molecules on the sperm surface cannot be triggered by elevating intracellular calcium alone.

We have isolated recombination deficient mutants of Bacillus subtilis on the basis of their sensitivity to methyl-methane-sulfonate or ultraviolet light, or of their inability to be transformed on solid medium. We have analyzed the mutants for several recombination and repair properties; we have grouped them in 5 classes on the basis of their phenotype and tested them for the activity of several enzymes acting on DNA, ie. DNA polymerase, polynucleotide ligase, ATP dependent DNase, and a DNase acting on single-stranded DNA. One mutant was found reduced in the latter DNase. Some of the mutants have been mapped, and they correspond to three different genes denominated rec D, rec F and rec G. All the recombination deficient mutants of B. subtilis described in the literature have been grouped in 7 classes; the mutations belong to 13 (and possibly 15) different genes distributed along the map. A coherent nomenclature and the criteria for a standard study of the rec mutants are proposed.

We have isolated a mutant of Bacillussubtilis deficient in DNA polymerase I, denominated polA42, which shows a reduced ability to repair the damage to DNA by UV radiation, MMS and mitomycin C;the ability to perform recombination is not appreciably impaired.DEAE cellulose chromatography allows the separation of polymerases I and II from the parental strain;a simple procedure is also described which allows to separate rapidly the polymerases II and III of the mutant strain. The three separated polymerases have similar catalytic properties but they can be distinguished for their sensitivity to inhibitors: PCMB inhibits polymerases II and III but not polymerase I; HPUra inhibits only polymerase III. All three enzymes are unaffected by nalidixate. The DNA synthesis occurring in cells of the polA42 strain permeabilized with toluene is inhibited by nalidixate, whereas the synthesis occurring in polA(+) toluenized cells is unaffected by the drug. The polA gene has been mapped by transduction and localized between the phe(12) and argA(3) genes.

The dnaP strains of Bacillus subtilis are altered in the initiation of DNA replication at high temperature (Riva et al., 1975). Fine mapping of the gene shows that it is located very close to the dnaF gene, described by Karamata and Gross (1970) and mapped by Love et al. (1976) in the polC region. The phenotype of both mutants is indistinguishable: the DNA synthesis stops at non permissive temperature after synthesizing an amount of DNA equivalent to the completion of the rounds of replication already initiated; at permissive temperature they are abnormally sensitive to MMS and are reduced in the ability to be transformed. Both mutants are to be considered as belonging to the dnaF locus. The dnaF gene is very close to the polC gene, which specifies the DNA polymerase III of B. subtilis. The DNA polymerase III of the dnaF mutants is not temperature sensitive in vitro, however, the level of this enzyme is lower by a factor of 4 or 5 in the dnaF mutants, at the permissive temperature. Following shift of dnaF cultures to the non permissive temperature, the level of DNA polymerase III activity specifically decreases further by a factor of at least 10 in the mutant, whereas the DNA polymerase I level is unaffected. The possible roles of the dnaF gene in the control of the cellular level of the DNA polymerase III, and the possibility of a regulatory role of DNA polymerase III in the initiation of DNA replication in bacteria are discussed.

We have fractionated from extracts of Bacillus subtilis the DNase activity specific for single-stranded DNA; the activity separates in two main fractions on Sephadex G-200, a larger one (Mr greater than 400 000) and a smaller one (Mr approximately 30 000). We have purified the smaller, more abundant fraction nearly 3000-fold. The purified enzyme has a pH optimum close to 8, is activated by Ca2+, and is inhibited by EDTA; the enzyme hydrolyses single-stranded DNA at a rate approximately 40 times greater than double-stranded DNA. The mode of action is endonucleolytic on both substrates, but the possiblility that the two activities may reside on different molecules is not ruled out. The products have 5'-P and 3'-OH ends. The enzyme is different from those purified from the culture media of the same organism in several respects; the latter are all extracellular enzymes, they are not specific for single-stranded DNA (except one) and have all an exonucleolytic mode of action.

A simple rapid method of separating mononuclear leucocytes, granulocytes and erythrocytes on continuous Percoll density gradients has been developed. The Percoll is mixed with increasing amounts of the blood, which forms the light phase of the gradient. Centrifugation at 400 × g for 30 min results in almost complete separation of the 3 groups of cells with high recoveries and degrees of purity. Blood samples from 3 patients with chronic granulomatous disease were separated with this technique and the pattern of cell separation was found to be different from normal.

A simple and reproducible procedure is described which allows the fast and almost quantitative removal of DNA polymerases I and II from DNA polymerase III, in crude extracts of polA+ strains of Bacillus subtilis. The procedure entails streptomycin sulfate and ammonium sulfate fractionations; subsequent analysis of the partially purified preparation by G-200 chromatography, DEAE cellulose chromatography and density gradient sedimentation, shows that the ammonium sulfate fraction contains less than 5% of the total activity as DNA polymerase I and less than 2% as DNA polymerase II. The purification procedure, up to the ammonium sulfate step, was utilized for the analysis of the level of DNA polymerase III in several B. subtilis mutants, with results comparable to those obtained from the corresponding polA- strains following more cumbersome purification procedures. The M.W. of the purified form is of 227.000, somewhat greater than the published values. The early fractions of the purification have revealed the existence of a form with a M.W. of 426.000; the nature of this form, which has been observed in several instances and which is very unstable and short-lived, is under investigation.