L. Parmegiani | University of Bologna- Rimini (original) (raw)

Papers by L. Parmegiani

Fertility and Sterility, 2014

Advances in Embryo Transfer, 2012

... Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I.(2008) Fol... more ... Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I.(2008) Follow-up of cognitive and motor development of 10-year-old singleton ... Younglai EV, Holt D, Brown P, Jurisicova A, Casper RF.(2001) Sperm swim-up techniques and DNA fragmentation. ...

Journal of Reproductive Biotechnology and Fertility, 2012

Vitrification is a cryopreservation technique increasingly applied in clinical practice for cells... more Vitrification is a cryopreservation technique increasingly applied in clinical practice for cells and tissue. This review article focuses mainly on the efficiency of vitrification of human reproductive cells and tissue, by analysing the clinical results reported in the literature. The second aspect discussed is safety of vitrification procedure. Different procedures and different types of carriers can be used, and in some cases vitrification requires a direct contact between cell/tissue/carrier and liquid nitrogen; this causes concern regarding the safety of this cryopreservation technique. Although the risk of contamination during cryopreservation remains negligible, this article explains how to overcome the hypothetical risk of contamination when using different types of vitrification carriers, in order to satisfy all existing directives.

Human reproduction (Oxford, England), 2003

To assess the clinical profile and efficacy in assisted reproductive treatment of a new human-der... more To assess the clinical profile and efficacy in assisted reproductive treatment of a new human-derived highly purified (HP) menotropin, we compared HP hMG and recombinant (r) FSHalpha use in ICSI within a prospective, randomized, controlled study. 100 infertile women were treated with HP hMG (50 patients) or rFSHalpha (50 patients). All patients received the same daily gonadotrophin dose (150 IU) following GnRH agonist suppression (long regimen) until more than three follicles >17 mm and estradiol (E(2)) levels >600 pg/ml were reached. Patients were monitored with daily LH, FSH, hCG, estradiol (E(2)), progesterone, and testosterone measurements; and alternate day pelvic ultrasound. Treatment duration (11.1 +/- 0.4 versus 12.9 +/- 0.5 days, P < 0.05) and gonadotrophin dose (22.4 +/- 1.0 versus 27.0 +/- 1.5 ampoules, P < 0.05) were lower in the HP hMG group. Conversely, peak pre-ovulatory E(2) (1342 +/- 127 versus 933 +/- 109 pg/ml, P < 0.005); and area under the curve o...

Reproductive BioMedicine Online, 2009

The potential, limits and safety of oocyte freezing are still being explored. Female age may play... more The potential, limits and safety of oocyte freezing are still being explored. Female age may play a relevant role in treatment outcome. The present study is the first report of the birth and normal development of a baby conceived from frozen oocytes of a 40-year-old woman. IVF was carried out in an infertile 40-year-old woman, and seven metaphase II (MII) oocytes were obtained after ovarian stimulation. Three fresh oocytes were inseminated by intracytoplasmic sperm injection (ICSI), according to Italian law. Two embryos were transferred, but pregnancy did not occur. The four remaining MII oocytes were frozen (by slow freezing protocol) and ICSI was performed in the two oocytes surviving after thawing. Two embryos were obtained on day 2. Both embryos were transferred, resulting in a singleton pregnancy, and a healthy male baby was born. So far, the child (now 3 years old) has scored normally according to the WHO Child Growth Standards. The Denver Developmental Screening Test for psychomotor development was normal. This report demonstrates that conception and pregnancy from cryopreserved oocytes belonging to women up to 40 years of age is possible, and can yield normal children. This finding has implications for women who want to preserve their reproductive potential.

Ovarian Stimulation, 2010

Reproductive BioMedicine Online, 2011

Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontami... more Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontamination of liquid nitrogen (LN 2 ). Design: Basic research. Setting: Private assisted reproduction center. Animal(s): Microorganisms (bacteria and fungi). Intervention(s): Two stainless steel open dewars containing LN 2 were contaminated in a two-step experiment with high titers of cultures of bacteria (Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli) and fungi (Aspergillus niger). One of the two dewars was subsequently exposed to UV irradiation at 253.7 nm to obtain a rapid microbial decontamination before the complete evaporation of LN 2 . Main Outcome Measure(s): Detection of the micro-organisms in LN 2 after UV sterilization through the assessment of bacterial and fungal growth in minimal and selective Petri dishes. Result(s): None of the contaminating micro-organisms were detected in LN 2 after UV sterilization. Conclusion(s): Decontamination of LN 2 with UV irradiation is feasible and straightforward. The fact that LN 2 can be quickly and safely sterilized should encourage the wider application of human oocyte and embryo vitrification with ''open carriers.'' (Fertil Steril Ò 2009;-:---.

Reproductive BioMedicine Online, 2011

The present study reports, as far as is known for the first time, the safety of UV sterilization ... more The present study reports, as far as is known for the first time, the safety of UV sterilization of liquid nitrogen and hermetical cryostorage of human oocytes by comparing the efficiency of fresh and vitrified sibling oocytes of infertile patients. A prospective randomized study on sibling oocytes of 31 patients was carried out. Metaphase-II oocytes were randomized for intracytoplasmic sperm injection and the supernumerary sibling oocytes were vitrified using a novel Cryotop aseptic procedure (UV liquid nitrogen sterilization and hermetical cryostorage). After unsuccessful attempts with fresh oocytes, vitrified sibling oocytes were injected. Mean outcome measures observed were fertilization, cleavage and top-quality embryo rates. No significant differences were observed between the fresh and vitrified-warmed sibling oocytes: oocyte fertilization was 88.3% versus 84.9%; cleavage 72.6% versus 71.0%; top-quality embryos 33.8% versus 26.3% and mean number of transferred embryos 2.6 ± 0.1 versus 2.5 ± 0.1, respectively. Clinical pregnancy rate per cycle with vitrified-warmed oocytes was 35.5% (implantation rate 17.1%) and seven healthy babies were born. This study demonstrated that UV liquid nitrogen sterilization and hermetical cryostorage does not adversely affect the developmental competence of vitrified oocytes, allowing safe aseptic open vitrification applicable under strict directives on tissue manipulation. RBMOnline

Reproductive BioMedicine Online, 2009

It has been demonstrated previously that freezing oocytes within 2 h of retrieval increases the e... more It has been demonstrated previously that freezing oocytes within 2 h of retrieval increases the efficiency of cryopreservation via a slow-freezing/rapid-thawing protocol with 0.3 mol/l sucrose (SF/RT 0.3). The aim of this multicentre survey was to verify this observation on a larger scale. This was a retrospective study on the clinical outcome of 510 SF/RT 0.3 cycles divided into two groups: group A, freezing oocytes within 2 h of retrieval; group B, freezing oocytes more than 2 h after retrieval. The rate of best-quality embryos was significantly higher (33.24%) in group A than in group B (16.20%, P < 0.001). Pregnancy and implantation rates were 30.07% and 15.08% in group A versus 8.97% and 4.57% in group B (P < 0.001). Clinical pregnancy rates per thawed and per injected oocyte in group A were 5.53% and 10.41%, versus 1.46% and 2.77% in group B (P < 0.001). The overall yield from oocytes cryopreserved within 2 h of retrieval (group A) was 6.49 implantations per 100 oocytes thawed versus 1.74 for group B (P < 0.001). Embryo quality, pregnancy and implantation rates, and clinical efficiency of thawing cycles were all significantly improved when cryopreservation was carried out within 2 h of oocyte retrieval.

Human Reproduction, 2007

BACKGROUND: In 2004, a law regulating assisted reproduction techniques (ART) was passed in Italy.... more BACKGROUND: In 2004, a law regulating assisted reproduction techniques (ART) was passed in Italy. The new rules allow for the formation and transfer of a maximum of three embryos at one time, whereas embryo selection and embryo storage are prohibited. The aim of this study is to evaluate the impact of these restrictions on ICSI outcome in couples affected by severe male factor infertility. METHODS: Thirteen Italian ART Units were involved in this study. Data were collected on ICSI cycles performed during 2 years before (control group) and 2 years after (study group) the enforcement of the law. Only cases of obstructive azoospermia (OA), non-obstructive azoospermia (NOA) and severe oligoastenoteratozoospermia (OAT) (sperm count 1 3 10 6 per ml; normal forms 5% according to WHO) were included. Laboratory results (fertilization rate, cleavage rate and embryo quality) and clinical outcomes (clinical pregnancy rate, implantation rate, abortion rate) were compared between the two groups. RESULTS: One thousand six hundred and forty ICSI cycles were examined. The control group included 843 cycles (51.4%), whereas the study group consisted in 797 cycles (48.6%). The restrictions imposed by the law significantly reduced the number of good-morphology embryos available for transfer (57.5 versus 50.1%; P < 0.001). In addition, the clinical pregnancy rate (32.6 versus 22.6%; P < 0.001) and the implantation rate (16.0 versus 12.3%; P < 0.05) per cycle were negatively affected by the enforcement of the law. In particular, dramatic reductions in the pregnancy rate (36.6 versus 15.5%; P < 0.001) and the implantation rate (17.8 versus 9.8%; P < 0.001) were observed in the NOA subgroup. CONCLUSIONS: Limiting the number of treated oocytes to three per ICSI cycle significantly reduces the chance of transferring good quality embryos and thus achieving a pregnancy in cases of severe male factor infertility. NOA patients are particularly affected by this restriction imposed by the new Italian law.

Fertility and Sterility, 2004

Fertility and Sterility, 2010

Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontami... more Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontamination of liquid nitrogen (LN 2 ). Design: Basic research. Setting: Private assisted reproduction center. Animal(s): Microorganisms (bacteria and fungi). Intervention(s): Two stainless steel open dewars containing LN 2 were contaminated in a two-step experiment with high titers of cultures of bacteria (Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli) and fungi (Aspergillus niger). One of the two dewars was subsequently exposed to UV irradiation at 253.7 nm to obtain a rapid microbial decontamination before the complete evaporation of LN 2 . Main Outcome Measure(s): Detection of the micro-organisms in LN 2 after UV sterilization through the assessment of bacterial and fungal growth in minimal and selective Petri dishes. Result(s): None of the contaminating micro-organisms were detected in LN 2 after UV sterilization. Conclusion(s): Decontamination of LN 2 with UV irradiation is feasible and straightforward. The fact that LN 2 can be quickly and safely sterilized should encourage the wider application of human oocyte and embryo vitrification with ''open carriers.'' (Fertil Steril Ò 2010;94:1525-8.

Fertility and Sterility, 2010

Objective: To evaluate the role of hyaluronic acid (HA) for sperm selection before intracytoplasm... more 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. Patient(s): Study 1: 20 men. Study 2: 15 men. Study 3: 206 couples treated with ICSI on a limited number of oocytes per patient (1-3) in accordance with Italian IVF law. Intervention(s): Study 1: determination of sperm DNA fragmentation of HA-bound spermatozoa versus spermatozoa in polyvinylpyrrolidone (PVP). Study 2: assessment of nuclear morphology of HA-bound spermatozoa versus spermatozoa in PVP. Study 3: randomized study comparing conventional PVP-ICSI to ICSI in which the spermatozoa are selected for their capacity to bind to HA (HA-ICSI). Main Outcome Measure(s): Study 1: sperm DNA fragmentation rate. Study 2: sperm nucleus normalcy rate according to motile sperm organellar morphology examination criteria. Study 3: fertilization, embryo quality and development, and implantation and pregnancy. Result(s): Spematozoa bound to HA show a significant reduction in DNA fragmentation (study 1) and a significant improvement in nucleus normalcy (study 2) compared with spermatozoa immersed in PVP. Furthermore, injection of HA-bound spermatozoa (HA-ICSI) significantly improves embryo quality and development (study 3). Conclusion(s): Hyaluronic acid may optimize ICSI outcome by favoring selection of spermatozoa without DNA fragmentation and with normal nucleus. Furthermore, HA may also be used to speed up the selection of spermatozoa with normal nucleus during intracytoplasmic morphologically selected sperm injection (IMSI). (Fertil Steril Ò 2010;93:598-604.

BJOG: An International Journal of Obstetrics & Gynaecology, 2005

Preterm birth is a frequent problem in women who undergo treatment for infertility. Many factors ... more Preterm birth is a frequent problem in women who undergo treatment for infertility. Many factors appear to contribute to the occurrence of this complication. Infertile women seem to have a predisposition to giving birth preterm and to having low birthweight babies. These complications also occur in women with a history of infertility who achieve pregnancy without treatment and who have singleton pregnancies. Assisted reproduction patients treated with in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) have a disproportionately high occurrence of preterm births even with singleton pregnancies. Spontaneous preterm labour may be related to underlying medical conditions of the female partner, as its occurrence is not increased in subjects treated with ICSI (i.e. when the infertility problem is associated with male reproductive dysfunction in normal female partners). Multiple pregnancy is the factor most likely to be related to preterm birth in infertile women. The administration of drugs to induce ovulation either alone or combined with intrauterine insemination causes a significant increase in multiple pregnancies. The occurrence of higher order multiple pregnancy is also increased. Multiple pregnancy in women undergoing IVF or ICSI is related to the number of embryos transferred at the end of treatment. The transfer of more than two embryos in women under 35 is not associated with an increased chance of conception, while the occurrence of multiple pregnancy is significantly increased. Women over 40 may benefit from the transfer of more than two embryos, with fewer risks of multiple pregnancy. Single embryo transfer is increasingly considered a workable clinical option, particularly in young women. Hopefully, a more cautious approach to infertility management will reduce the occurrence of multiple pregnancy, spontaneous preterm labour and the high number of low birthweight infants born after treating these women.

Fertility and Sterility, 2014

Advances in Embryo Transfer, 2012

... Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I.(2008) Fol... more ... Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I.(2008) Follow-up of cognitive and motor development of 10-year-old singleton ... Younglai EV, Holt D, Brown P, Jurisicova A, Casper RF.(2001) Sperm swim-up techniques and DNA fragmentation. ...

Journal of Reproductive Biotechnology and Fertility, 2012

Vitrification is a cryopreservation technique increasingly applied in clinical practice for cells... more Vitrification is a cryopreservation technique increasingly applied in clinical practice for cells and tissue. This review article focuses mainly on the efficiency of vitrification of human reproductive cells and tissue, by analysing the clinical results reported in the literature. The second aspect discussed is safety of vitrification procedure. Different procedures and different types of carriers can be used, and in some cases vitrification requires a direct contact between cell/tissue/carrier and liquid nitrogen; this causes concern regarding the safety of this cryopreservation technique. Although the risk of contamination during cryopreservation remains negligible, this article explains how to overcome the hypothetical risk of contamination when using different types of vitrification carriers, in order to satisfy all existing directives.

Human reproduction (Oxford, England), 2003

To assess the clinical profile and efficacy in assisted reproductive treatment of a new human-der... more To assess the clinical profile and efficacy in assisted reproductive treatment of a new human-derived highly purified (HP) menotropin, we compared HP hMG and recombinant (r) FSHalpha use in ICSI within a prospective, randomized, controlled study. 100 infertile women were treated with HP hMG (50 patients) or rFSHalpha (50 patients). All patients received the same daily gonadotrophin dose (150 IU) following GnRH agonist suppression (long regimen) until more than three follicles >17 mm and estradiol (E(2)) levels >600 pg/ml were reached. Patients were monitored with daily LH, FSH, hCG, estradiol (E(2)), progesterone, and testosterone measurements; and alternate day pelvic ultrasound. Treatment duration (11.1 +/- 0.4 versus 12.9 +/- 0.5 days, P < 0.05) and gonadotrophin dose (22.4 +/- 1.0 versus 27.0 +/- 1.5 ampoules, P < 0.05) were lower in the HP hMG group. Conversely, peak pre-ovulatory E(2) (1342 +/- 127 versus 933 +/- 109 pg/ml, P < 0.005); and area under the curve o...

Reproductive BioMedicine Online, 2009

The potential, limits and safety of oocyte freezing are still being explored. Female age may play... more The potential, limits and safety of oocyte freezing are still being explored. Female age may play a relevant role in treatment outcome. The present study is the first report of the birth and normal development of a baby conceived from frozen oocytes of a 40-year-old woman. IVF was carried out in an infertile 40-year-old woman, and seven metaphase II (MII) oocytes were obtained after ovarian stimulation. Three fresh oocytes were inseminated by intracytoplasmic sperm injection (ICSI), according to Italian law. Two embryos were transferred, but pregnancy did not occur. The four remaining MII oocytes were frozen (by slow freezing protocol) and ICSI was performed in the two oocytes surviving after thawing. Two embryos were obtained on day 2. Both embryos were transferred, resulting in a singleton pregnancy, and a healthy male baby was born. So far, the child (now 3 years old) has scored normally according to the WHO Child Growth Standards. The Denver Developmental Screening Test for psychomotor development was normal. This report demonstrates that conception and pregnancy from cryopreserved oocytes belonging to women up to 40 years of age is possible, and can yield normal children. This finding has implications for women who want to preserve their reproductive potential.

Ovarian Stimulation, 2010

Reproductive BioMedicine Online, 2011

Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontami... more Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontamination of liquid nitrogen (LN 2 ). Design: Basic research. Setting: Private assisted reproduction center. Animal(s): Microorganisms (bacteria and fungi). Intervention(s): Two stainless steel open dewars containing LN 2 were contaminated in a two-step experiment with high titers of cultures of bacteria (Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli) and fungi (Aspergillus niger). One of the two dewars was subsequently exposed to UV irradiation at 253.7 nm to obtain a rapid microbial decontamination before the complete evaporation of LN 2 . Main Outcome Measure(s): Detection of the micro-organisms in LN 2 after UV sterilization through the assessment of bacterial and fungal growth in minimal and selective Petri dishes. Result(s): None of the contaminating micro-organisms were detected in LN 2 after UV sterilization. Conclusion(s): Decontamination of LN 2 with UV irradiation is feasible and straightforward. The fact that LN 2 can be quickly and safely sterilized should encourage the wider application of human oocyte and embryo vitrification with ''open carriers.'' (Fertil Steril Ò 2009;-:---.

Reproductive BioMedicine Online, 2011

The present study reports, as far as is known for the first time, the safety of UV sterilization ... more The present study reports, as far as is known for the first time, the safety of UV sterilization of liquid nitrogen and hermetical cryostorage of human oocytes by comparing the efficiency of fresh and vitrified sibling oocytes of infertile patients. A prospective randomized study on sibling oocytes of 31 patients was carried out. Metaphase-II oocytes were randomized for intracytoplasmic sperm injection and the supernumerary sibling oocytes were vitrified using a novel Cryotop aseptic procedure (UV liquid nitrogen sterilization and hermetical cryostorage). After unsuccessful attempts with fresh oocytes, vitrified sibling oocytes were injected. Mean outcome measures observed were fertilization, cleavage and top-quality embryo rates. No significant differences were observed between the fresh and vitrified-warmed sibling oocytes: oocyte fertilization was 88.3% versus 84.9%; cleavage 72.6% versus 71.0%; top-quality embryos 33.8% versus 26.3% and mean number of transferred embryos 2.6 ± 0.1 versus 2.5 ± 0.1, respectively. Clinical pregnancy rate per cycle with vitrified-warmed oocytes was 35.5% (implantation rate 17.1%) and seven healthy babies were born. This study demonstrated that UV liquid nitrogen sterilization and hermetical cryostorage does not adversely affect the developmental competence of vitrified oocytes, allowing safe aseptic open vitrification applicable under strict directives on tissue manipulation. RBMOnline

Reproductive BioMedicine Online, 2009

It has been demonstrated previously that freezing oocytes within 2 h of retrieval increases the e... more It has been demonstrated previously that freezing oocytes within 2 h of retrieval increases the efficiency of cryopreservation via a slow-freezing/rapid-thawing protocol with 0.3 mol/l sucrose (SF/RT 0.3). The aim of this multicentre survey was to verify this observation on a larger scale. This was a retrospective study on the clinical outcome of 510 SF/RT 0.3 cycles divided into two groups: group A, freezing oocytes within 2 h of retrieval; group B, freezing oocytes more than 2 h after retrieval. The rate of best-quality embryos was significantly higher (33.24%) in group A than in group B (16.20%, P < 0.001). Pregnancy and implantation rates were 30.07% and 15.08% in group A versus 8.97% and 4.57% in group B (P < 0.001). Clinical pregnancy rates per thawed and per injected oocyte in group A were 5.53% and 10.41%, versus 1.46% and 2.77% in group B (P < 0.001). The overall yield from oocytes cryopreserved within 2 h of retrieval (group A) was 6.49 implantations per 100 oocytes thawed versus 1.74 for group B (P < 0.001). Embryo quality, pregnancy and implantation rates, and clinical efficiency of thawing cycles were all significantly improved when cryopreservation was carried out within 2 h of oocyte retrieval.

Human Reproduction, 2007

BACKGROUND: In 2004, a law regulating assisted reproduction techniques (ART) was passed in Italy.... more BACKGROUND: In 2004, a law regulating assisted reproduction techniques (ART) was passed in Italy. The new rules allow for the formation and transfer of a maximum of three embryos at one time, whereas embryo selection and embryo storage are prohibited. The aim of this study is to evaluate the impact of these restrictions on ICSI outcome in couples affected by severe male factor infertility. METHODS: Thirteen Italian ART Units were involved in this study. Data were collected on ICSI cycles performed during 2 years before (control group) and 2 years after (study group) the enforcement of the law. Only cases of obstructive azoospermia (OA), non-obstructive azoospermia (NOA) and severe oligoastenoteratozoospermia (OAT) (sperm count 1 3 10 6 per ml; normal forms 5% according to WHO) were included. Laboratory results (fertilization rate, cleavage rate and embryo quality) and clinical outcomes (clinical pregnancy rate, implantation rate, abortion rate) were compared between the two groups. RESULTS: One thousand six hundred and forty ICSI cycles were examined. The control group included 843 cycles (51.4%), whereas the study group consisted in 797 cycles (48.6%). The restrictions imposed by the law significantly reduced the number of good-morphology embryos available for transfer (57.5 versus 50.1%; P < 0.001). In addition, the clinical pregnancy rate (32.6 versus 22.6%; P < 0.001) and the implantation rate (16.0 versus 12.3%; P < 0.05) per cycle were negatively affected by the enforcement of the law. In particular, dramatic reductions in the pregnancy rate (36.6 versus 15.5%; P < 0.001) and the implantation rate (17.8 versus 9.8%; P < 0.001) were observed in the NOA subgroup. CONCLUSIONS: Limiting the number of treated oocytes to three per ICSI cycle significantly reduces the chance of transferring good quality embryos and thus achieving a pregnancy in cases of severe male factor infertility. NOA patients are particularly affected by this restriction imposed by the new Italian law.

Fertility and Sterility, 2004

Fertility and Sterility, 2010

Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontami... more Objective: To evaluate the efficacy of ultraviolet (UV) irradiation for rapid microbial decontamination of liquid nitrogen (LN 2 ). Design: Basic research. Setting: Private assisted reproduction center. Animal(s): Microorganisms (bacteria and fungi). Intervention(s): Two stainless steel open dewars containing LN 2 were contaminated in a two-step experiment with high titers of cultures of bacteria (Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli) and fungi (Aspergillus niger). One of the two dewars was subsequently exposed to UV irradiation at 253.7 nm to obtain a rapid microbial decontamination before the complete evaporation of LN 2 . Main Outcome Measure(s): Detection of the micro-organisms in LN 2 after UV sterilization through the assessment of bacterial and fungal growth in minimal and selective Petri dishes. Result(s): None of the contaminating micro-organisms were detected in LN 2 after UV sterilization. Conclusion(s): Decontamination of LN 2 with UV irradiation is feasible and straightforward. The fact that LN 2 can be quickly and safely sterilized should encourage the wider application of human oocyte and embryo vitrification with ''open carriers.'' (Fertil Steril Ò 2010;94:1525-8.

Fertility and Sterility, 2010

Objective: To evaluate the role of hyaluronic acid (HA) for sperm selection before intracytoplasm... more 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. Patient(s): Study 1: 20 men. Study 2: 15 men. Study 3: 206 couples treated with ICSI on a limited number of oocytes per patient (1-3) in accordance with Italian IVF law. Intervention(s): Study 1: determination of sperm DNA fragmentation of HA-bound spermatozoa versus spermatozoa in polyvinylpyrrolidone (PVP). Study 2: assessment of nuclear morphology of HA-bound spermatozoa versus spermatozoa in PVP. Study 3: randomized study comparing conventional PVP-ICSI to ICSI in which the spermatozoa are selected for their capacity to bind to HA (HA-ICSI). Main Outcome Measure(s): Study 1: sperm DNA fragmentation rate. Study 2: sperm nucleus normalcy rate according to motile sperm organellar morphology examination criteria. Study 3: fertilization, embryo quality and development, and implantation and pregnancy. Result(s): Spematozoa bound to HA show a significant reduction in DNA fragmentation (study 1) and a significant improvement in nucleus normalcy (study 2) compared with spermatozoa immersed in PVP. Furthermore, injection of HA-bound spermatozoa (HA-ICSI) significantly improves embryo quality and development (study 3). Conclusion(s): Hyaluronic acid may optimize ICSI outcome by favoring selection of spermatozoa without DNA fragmentation and with normal nucleus. Furthermore, HA may also be used to speed up the selection of spermatozoa with normal nucleus during intracytoplasmic morphologically selected sperm injection (IMSI). (Fertil Steril Ò 2010;93:598-604.

BJOG: An International Journal of Obstetrics & Gynaecology, 2005

Preterm birth is a frequent problem in women who undergo treatment for infertility. Many factors ... more Preterm birth is a frequent problem in women who undergo treatment for infertility. Many factors appear to contribute to the occurrence of this complication. Infertile women seem to have a predisposition to giving birth preterm and to having low birthweight babies. These complications also occur in women with a history of infertility who achieve pregnancy without treatment and who have singleton pregnancies. Assisted reproduction patients treated with in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) have a disproportionately high occurrence of preterm births even with singleton pregnancies. Spontaneous preterm labour may be related to underlying medical conditions of the female partner, as its occurrence is not increased in subjects treated with ICSI (i.e. when the infertility problem is associated with male reproductive dysfunction in normal female partners). Multiple pregnancy is the factor most likely to be related to preterm birth in infertile women. The administration of drugs to induce ovulation either alone or combined with intrauterine insemination causes a significant increase in multiple pregnancies. The occurrence of higher order multiple pregnancy is also increased. Multiple pregnancy in women undergoing IVF or ICSI is related to the number of embryos transferred at the end of treatment. The transfer of more than two embryos in women under 35 is not associated with an increased chance of conception, while the occurrence of multiple pregnancy is significantly increased. Women over 40 may benefit from the transfer of more than two embryos, with fewer risks of multiple pregnancy. Single embryo transfer is increasingly considered a workable clinical option, particularly in young women. Hopefully, a more cautious approach to infertility management will reduce the occurrence of multiple pregnancy, spontaneous preterm labour and the high number of low birthweight infants born after treating these women.