Loris Marin - Academia.edu (original) (raw)

Papers by Loris Marin

Research paper thumbnail of Fertility preservation in breast cancer patients

Breast Cancer, 2013

Systemic therapies have been shown to effectively improve prognosis in patients with breast cance... more Systemic therapies have been shown to effectively improve prognosis in patients with breast cancer. However, such therapies also become increasingly harmful as their duration increases, and they have adverse effects on fertility and ovarian function. Fertility preservation (FP) is important in young adult cancer survivors who may wish to have children. In Japan, some cancer societies recommend that the potentially serious effects of systemic therapy on ovarian function should be explained to women with cancer, and they should be encouraged to undergo FP prior to commencing treatment. Still, as there are no official guidelines, many oncologists lack the required knowledge and mind-set to advise young breast cancer patients on fertility issues. Counseling of patients and their families might improve their understanding about the influence of such treatment on fertility and ensure effective FP. There are several FP methods that can be selected before beginning treatment, and these methods have both advantages and disadvantages. Young adults with breast cancer who want to bear children in the future must be provided with FP counseling, in addition to advice about breast cancer treatment and prognosis.

Research paper thumbnail of Fertility Preservation in Breast Cancer Patients

Female and Male Fertility Preservation, 2022

Research paper thumbnail of Thyroid Dysfunction after Gonadotropin-Releasing Hormone Agonist Administration in Women with Thyroid Autoimmunity

International Journal of Endocrinology, Apr 12, 2022

GnRH agonists (GnRHa) are a useful tool for pretreatment before artificial endometrial preparatio... more GnRH agonists (GnRHa) are a useful tool for pretreatment before artificial endometrial preparation for frozen-thawed embryotransfer (FET). eir prolonged administration has been associated with thyroid dysfunction, both hyper and hypothyroidism. e aim of this study is to investigate the impact of GnRHa administration on thyroid function in women undergoing artificial endometrial preparation. Seventy-eight euthyroid women undergoing endometrial preparation with hormone replacement for FET were retrospectively reviewed. ey were divided into two groups according to pretreatment with GnRHa (group A, 42 women) or with an oral contraceptive (group B, 36 women). Group A was subsequently divided into two subgroups according to thyroid autoimmunity presence. yroid function has been evaluated and compared among groups and subgroups. Our results did not show any statistically significant differences in age, body mass index, and basal thyroid stimulating hormone (TSH). Total estradiol dosage, duration of treatment, and endometrial thickness were comparable among groups. When TSH was measured 14 days after embryo transfer, no significant differences between the two groups were reported. Among women of group A, TSH was significantly higher only in women with thyroid autoimmunity. GnRHa seems to be associated with thyroid dysfunction in women with thyroid autoimmunity undergoing hormone replacement therapy for FET.

Research paper thumbnail of P–680 Thyroid function in euthyroid women during controlled ovarian stimulation (COH): does the TSH fluctuations have an impact on IVF outcomes?

Human Reproduction

Study question TSH blood levels play a role in terms of ovarian stimulation and pregnancy? Do we ... more Study question TSH blood levels play a role in terms of ovarian stimulation and pregnancy? Do we need to treat patients with TSH out of range? Summary answer Euthyroid patients with negative autoantibodies during COS should not be treated even if basal TSH is higher than 2.5 U/L What is known already Abnormal thyroid function is associated with adverse pregnancy outcomes, being essential during embryo implantation and early pregnancy. TSH receptors can be found in endometrial and ovarian tissues and during controlled ovarian stimulation TSH levels suffer modifications because of hyperestrogenemia. Subclinical hypothyroidism is defined as a TSH level greater than 4.5 mIU/L with normal FT4 levels. It is controversial whether or not to use first-trimester pregnancy and infertility thresholds for upper limit of 2.5 mIU/L TSH. However, neither American Thyroid Association nor the American Society Reproductive Medicine recommendations have clearly defined how infertile patients need to be...

Research paper thumbnail of P–401 Frozen-thawed embryo-transfer adjuvant therapy: one size DOES NOT fit all

Human Reproduction, 2021

Does adjuvant therapy after frozen-thawed embryo-transfer (FRET) with CardioAspirin and Prednison... more Does adjuvant therapy after frozen-thawed embryo-transfer (FRET) with CardioAspirin and Prednisone enhance clinical pregnancy rate (CPR) and live birth rate (LBR)? Adjuvant therapy enhanced CPR and LBR in study-group. A significant correlation was found confronting blastocyst FRET in study-group versus controls. Embryo implantation is a rate-limiting step of FRET cycles. It’s a complex process resulting from a balance between inflammation pathways and maternal immune tolerance. Low-dose aspirin unlocks Prostaglandin-F2 synthesis by Cyclooxygenase–1, thus increasing uterine vascular permeability and attachment reaction while reducing vasoconstriction. Pregnancy results from a balance between helper and regulatory T-cells (Treg), the latter protect the embryo from maternal immune attack. Treg cells’ immunosuppressive function is pivotal in pregnancy establishment. Prednisone increases the proportion of Treg cells thus inhibiting inflammation. Many therapy schedules for implantation en...

Research paper thumbnail of Fertility Preservation in Girls and Women: State of Art and Future Possibilities

Clinical and Experimental Obstetrics & Gynecology

Background: Many women worldwide are diagnosed with cancer in prepubertal, postpubertal and child... more Background: Many women worldwide are diagnosed with cancer in prepubertal, postpubertal and childbearing age. Oncological treatments can compromise future fertility through different mechanisms mainly depending on the type of treatment and the age of the patient. International societies recommend that cancer patients should receive information regarding the effects of oncological treatments on their reproductive health and cancer survivors should not be discouraged from becoming pregnant. About a quarter of these patients still do not receive an adequate counselling and young cancer survivors may face several barriers to conceiving a pregnancy due to the concerns from gynaecologists and oncologists. Methods: This review aims to investigate the infertility risk for female cancer patients who undergo oncological treatments and to provide an overview of actual and future fertility preservation possibilities for female cancer patients. Results: Different fertility preservation techniques have been developed in order to ensure the possibility for cancer survivors to complete their family planning after cancer. Oocyte/embryo freezing and ovarian tissue cryopreservation are the established choices, but the research is still going on to increase the success rate of these techniques and to develop other techniques to overcome actual limitations. Patients with a systemic oncological disease such as leukaemia could particularly benefit from the new experimental techniques which involve the creation of an artificial ovary or the in vitro growth of follicles or even the obtaining of mature oocytes from stem cells. All these techniques would allow the achievement of pregnancy without the risk of reintroducing malignant cells within autologous cryopreserved ovarian tissue transplantation. Regarding the concerns over pregnancy in cancer survivors, research is rapidly advancing and reassuring data are increasing. Conclusions: The rate of utilisation of gametes, embryos or ovarian tissue previously stored for fertility preservation is still low and the motivations can be various. Further data are needed in order to reassure both women and oncologists about the safety of pregnancy in cancer survivors and in order to increase the rate of women experiencing pregnancy after cancer.

Research paper thumbnail of Telemedicine for Virtual Consultations During COVID-19 Pandemic in a Medically Assisted Reproduction Center: Patients' Perspective

Telemedicine and e-Health

Background: Restrictive measures imposed to prevent COVID-19 contagion have caused an increase in... more Background: Restrictive measures imposed to prevent COVID-19 contagion have caused an increase in waiting times for other health procedures. During the pandemic, utilization of telemedicine has increased to ensure patient care safely. The aim of this study was to evaluate the perspective of infertile patients who underwent virtual consultations for infertility. Materials and Methods: This was an observational study. A survey was submitted to patients who attended a virtual consultation at a single in vitro fertilization (IVF) unit between March 2020 and July 2021. The survey concerned their experience with telemedicine assessing the experience of video consulting and the software characteristics. Results: The survey response rate was 50.3% (n = 159). In total, 98.8% of patients positively rated the experience of telemedicine. Regarding the software itself, it was defined as intuitive and easy to use by 87.4% of patients. A majority (92.5%) of interviewed patients reported that they were able to receive the information and clear any doubts they had and 85.5% of interviewed patients would repeat the experience of video consultation. Conclusions: The acceptance of telemedicine was very high among infertile patients. However, IVF treatments have a strong emotional component and face-to-face consultation with medical staff might help to create the right climate of trust, and the empathy that can be demonstrated during a vis-a`-vis meeting cannot be achieved through a screen. The use of telemedicine should be considered in those situations where it is not possible to attend an in-person consultation or when couples prefer it.

Research paper thumbnail of Epigenetics of pregnancy: looking beyond the DNA code

Journal of Assisted Reproduction and Genetics

Epigenetics is the branch of genetics that studies the different mechanisms that influence gene e... more Epigenetics is the branch of genetics that studies the different mechanisms that influence gene expression without direct modification of the DNA sequence. An ever-increasing amount of evidence suggests that such regulatory processes may play a pivotal role both in the initiation of pregnancy and in the later processes of embryonic and fetal development, thus determining long-term effects even in adult life. In this narrative review, we summarize the current knowledge on the role of epigenetics in pregnancy, from its most studied and well-known mechanisms to the new frontiers of epigenetic regulation, such as the role of ncRNAs and the effects of the gestational environment on fetal brain development. Epigenetic mechanisms in pregnancy are a dynamic phenomenon that responds both to maternal–fetal and environmental factors, which can influence and modify the embryo-fetal development during the various gestational phases. Therefore, we also recapitulate the effects of the most notable...

Research paper thumbnail of Future Aspects of Ovarian Cryopreservation and Transplantation

Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation

Research paper thumbnail of Ovarian Tissue Cryopreservation for Delaying Childbearing and Menopause

Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation

Research paper thumbnail of Re: “Sex and Gender-Related Differences in COVID-19 Diagnoses and SARS-CoV-2 Testing Practices During the First Wave of the Pandemic: The Dutch Lifelines COVID-19 Cohort Study” by Ballering et al

Journal of Women's Health

Research paper thumbnail of Accuracy of transvaginal ultrasound, saline infusion sonohysterography, and office hysteroscopy in the diagnosis of endometrial polyps

Clinical and Experimental Obstetrics & Gynecology, 2019

Background: Endometrial polyps (EPs) derive from overgrowths of stromal or endometrial glands sup... more Background: Endometrial polyps (EPs) derive from overgrowths of stromal or endometrial glands supported by a fibrovascular core. Currently, there is no clear recommendation on the first-line tool to be employed between sonohysterography (SIS) and office hysteroscopy (ISC) in the evaluation of patients with the suspect of EPs. Materials and Methods: The authors performed a retrospective study on consecutive patients referred at their Unit with a suspicion of EP at transvaginal sonography (TVS). A total number of 1,243 patients were subject to TVS and ISC, while 128 ones were subject to TVS, SIS, and ISC. Primary outcome was the evaluation of the diagnostic performance of SIS and ISC in the detection of EPs. Results: ISC allowed the identification of EPs in all the cases (n=128/128 patients), with a sensitivity of 100% and specificity of 98%. For SIS, the sensitivity was 97% (n=124/128 patients) and specificity was 90%. Conclusions: ISC showed better diagnostic accuracy in comparison to SIS. Due to high diagnostic accuracy and the possibility to "see and treat" EPs in a single step, ISC should be considered as the gold standard approach in women with a suspect of EPs.

Research paper thumbnail of Rectovaginal endometriosis: head to head comparison between sonovaginography and magnetic resonance imaging

Clinical and Experimental Obstetrics & Gynecology, 2019

Background: Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis associ... more Background: Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis associated with dysmenorrhoea, pelvic pain, and dyspareunia. Diagnosis of RVE is a challenge for clinicians. Aim of outhe present study was to compare the diagnostic accuracy of sonovaginography with MRI on a consecutive cohort of women referred to this institution due to RVE suspect. Materials and Methods: The authors performed a retrospective study on consecutive patients undergoing surgery at this Unit due to a suspicion of RVE. All women were subject to MRI and sonovaginography. Primary endpoint was to compare the diagnostic accuracy of sonovaginography and MRI in the detection of RVE. Results: RVE was diagnosed (with surgery plus histology) in 60 women. In all cases, the surgical procedure was completed without complications. Sonovaginography and MRI showed high sensitivity (95% vs. 81.7%) and similar specificity (93.8% and 91.2%, respectively) in the diagnosis of RVE. Conclusions: Sonovaginography, when performed by an expert sonographer, may represent a valid alternative to MRI for the diagnosis of RVE, with lower costs and minimal time consumption

Research paper thumbnail of Perceived Elementary Grid (PEG) proposal for dyadic coping evaluation in the infertile couple during assisted reproductive treatments

Clinical and Experimental Obstetrics & Gynecology, 2022

Research paper thumbnail of Impact of chemotherapy on the ovarian reserve: Are all primordial follicles created equal?

Fertility and Sterility, 2022

Research paper thumbnail of Addressing Female Sexual Dysfunction during Novel 2019-Coronavirus Pandemic in Infertile Women Living in North-East Italy

Journal of Women's Health and Development, 2021

Objectives: To identify whether the coronavirus infection had a negative influence on female sexu... more Objectives: To identify whether the coronavirus infection had a negative influence on female sexual function of infertile women living in NorthEast Italy. Methods: A survey was submitted during SARS-CoV-2 pandemic to 570 infertile women. The survey consisted of questions regarding employment, whether respondents lived with a partner or other family members, the time spent seeking pregnancy and previously assisted reproductive technology treatments and of the selfreported validated Italian Female Sexual Function Index questionnaire. A cutoff total score of ≤ 26.55 has been used for diagnosis of female sexual dysfunction.

Research paper thumbnail of MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining

Journal of Assisted Reproduction and Genetics, 2021

Purpose The current gold standard for chronic endometritis (CE) diagnosis is immunohistochemistry... more Purpose The current gold standard for chronic endometritis (CE) diagnosis is immunohistochemistry (IHC) for CD-138. However, IHC for CD-138 is not exempt from diagnostic limitations. The aim of our study was to evaluate the reliability and accuracy of MUM-1 IHC, as compared with CD-138. Methods This is a multi-centre, retrospective, observational study, which included three tertiary hysteroscopic centres in university teaching hospitals. One hundred ninety-three consecutive women of reproductive age were referred to our hysteroscopy services due to infertility, recurrent miscarriage, abnormal uterine bleeding, endometrial polyps or myomas. All women underwent hysteroscopy plus endometrial biopsy. Endometrial samples were analysed through histology, CD138 and MUM-1 IHC. The primary outcome was to evaluate the diagnostic accuracy of MUM-1 IHC for CE, as compared with CD-138 IHC. Results Sensitivity and specificity of CD-138 and MUM-1 IHC were respectively 89.13%, 79.59% versus 93.48% and 85.03%. The overall diagnostic accuracy of MUM-1 and CD-138 IHC were similar (AUC = 0.893 vs AUC = 0.844). The intercorrelation coefficient for single measurements was high between the two techniques (ICC = 0.831, 0.761–0.881 95%CI). However, among CE positive women, MUM-1 allowed the identification of higher number of plasma cells/hpf than CD-138 (6.50 [SD 4.80] vs 5.05 [SD 3.37]; p = 0.017). Additionally, MUM-1 showed a higher inter-observer agreement as compared to CD-138. Conclusion IHC for MUM-1 and CD-138 showed a similar accuracy for detecting endometrial stromal plasma cells. Notably, MUM-1 showed higher reliability in the paired comparison of the individual samples than CD-138. Thus, MUM-1 may represent a novel, promising add-on technique for the diagnosis of CE.

Research paper thumbnail of Ovarian transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold: a case series in comparison to meta-analytic data

Fertility and Sterility, 2021

To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transpl... more To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transplantation (ACOTT) with the use of a neovascularizing extracellular matrix scaffold. Case series with meta-analytic update. Academic. Seven recipients of RA-ACOTT. Before or shortly after initiating chemotherapy, ovarian tissue was cryopreserved from 7 women, who then underwent RA-ACOTT 9.9 ± 1.8 years (range, 7-12 years) later. Perioperatively, they received transdermal estrogen and low-dose aspirin to enhance graft vascularization. Ovarian cortical pieces were thawed and sutured on an extracellular matrix scaffold, which was then robotically anastomosed to the bivalved remaining ovary in 6 cases and retroperitoneally (heterotopic) to the lower abdomen in 1 case. Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data. Ovarian function returned 13.9 ± 2.7 weeks (11-16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation. In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.

Research paper thumbnail of Delaying Reproductive Aging by Ovarian Tissue Cryopreservation and Transplantation: Is it Prime Time?

Trends in Molecular Medicine, 2021

Ovarian tissue cryopreservation and autotransplantation can restore ovarian endocrine function an... more Ovarian tissue cryopreservation and autotransplantation can restore ovarian endocrine function and fertility and recently were changed from experimental to fertility preservation procedures for medical indications by the American Society of Reproductive Medicine. Such advances have resulted in discussions around the utility of ovarian cryopreservation in healthy women to preserve fertility and delay menopause or as a hormone replacement approach. Such 'elective' use of ovarian tissue cryopreservation requires a risk-benefit assessment. Here, we review evidence for and against the utility of ovarian tissue harvesting in healthy women, scrutinize recent and needed advances to enhance the feasibility of such an approach, and provide practice and future research guidelines.

Research paper thumbnail of Hyaluronic acid in vulvar and vaginal administration: evidence from a literature systematic review

Climacteric, 2021

Vulvovaginal pathology impairs the quality of life of both women in menopause and those who are n... more Vulvovaginal pathology impairs the quality of life of both women in menopause and those who are not. Different therapies have been proposed, mainly related to estrogen therapy in postmenopausal women. However, some contraindications limit its use, and different moisturizers or lubricants have been tested. Hyaluronic acid is a promising and widely used vaginal medical treatment with a moisturizing action and appears to provide a solution. For this reason, we performed a systematic review of the literature. We searched for original articles without date restriction until 30 April 2020. We included all clinical trials which administered local hyaluronic acid in the vulva or vagina. Only English studies and those performed in humans were eligible. Seventeen original studies were included in the review (from randomized controlled trials to longitudinal studies). Hyaluronic acid was generally found to be effective in improving vulvovaginal symptoms (dyspareunia, itching, burning, dryness) and signs (bleeding, atrophy, vaginal pH). In conclusion, hyaluronic acid has the properties to be an efficient moisturizer for women suffering from vulvovaginal atrophy who have contraindications for estrogen therapy and for vulvovaginal signs and symptoms affecting sexual well-being. However, a well-designed randomized controlled trial is needed in order to clarify its efficacy and safety profile.

Research paper thumbnail of Fertility preservation in breast cancer patients

Breast Cancer, 2013

Systemic therapies have been shown to effectively improve prognosis in patients with breast cance... more Systemic therapies have been shown to effectively improve prognosis in patients with breast cancer. However, such therapies also become increasingly harmful as their duration increases, and they have adverse effects on fertility and ovarian function. Fertility preservation (FP) is important in young adult cancer survivors who may wish to have children. In Japan, some cancer societies recommend that the potentially serious effects of systemic therapy on ovarian function should be explained to women with cancer, and they should be encouraged to undergo FP prior to commencing treatment. Still, as there are no official guidelines, many oncologists lack the required knowledge and mind-set to advise young breast cancer patients on fertility issues. Counseling of patients and their families might improve their understanding about the influence of such treatment on fertility and ensure effective FP. There are several FP methods that can be selected before beginning treatment, and these methods have both advantages and disadvantages. Young adults with breast cancer who want to bear children in the future must be provided with FP counseling, in addition to advice about breast cancer treatment and prognosis.

Research paper thumbnail of Fertility Preservation in Breast Cancer Patients

Female and Male Fertility Preservation, 2022

Research paper thumbnail of Thyroid Dysfunction after Gonadotropin-Releasing Hormone Agonist Administration in Women with Thyroid Autoimmunity

International Journal of Endocrinology, Apr 12, 2022

GnRH agonists (GnRHa) are a useful tool for pretreatment before artificial endometrial preparatio... more GnRH agonists (GnRHa) are a useful tool for pretreatment before artificial endometrial preparation for frozen-thawed embryotransfer (FET). eir prolonged administration has been associated with thyroid dysfunction, both hyper and hypothyroidism. e aim of this study is to investigate the impact of GnRHa administration on thyroid function in women undergoing artificial endometrial preparation. Seventy-eight euthyroid women undergoing endometrial preparation with hormone replacement for FET were retrospectively reviewed. ey were divided into two groups according to pretreatment with GnRHa (group A, 42 women) or with an oral contraceptive (group B, 36 women). Group A was subsequently divided into two subgroups according to thyroid autoimmunity presence. yroid function has been evaluated and compared among groups and subgroups. Our results did not show any statistically significant differences in age, body mass index, and basal thyroid stimulating hormone (TSH). Total estradiol dosage, duration of treatment, and endometrial thickness were comparable among groups. When TSH was measured 14 days after embryo transfer, no significant differences between the two groups were reported. Among women of group A, TSH was significantly higher only in women with thyroid autoimmunity. GnRHa seems to be associated with thyroid dysfunction in women with thyroid autoimmunity undergoing hormone replacement therapy for FET.

Research paper thumbnail of P–680 Thyroid function in euthyroid women during controlled ovarian stimulation (COH): does the TSH fluctuations have an impact on IVF outcomes?

Human Reproduction

Study question TSH blood levels play a role in terms of ovarian stimulation and pregnancy? Do we ... more Study question TSH blood levels play a role in terms of ovarian stimulation and pregnancy? Do we need to treat patients with TSH out of range? Summary answer Euthyroid patients with negative autoantibodies during COS should not be treated even if basal TSH is higher than 2.5 U/L What is known already Abnormal thyroid function is associated with adverse pregnancy outcomes, being essential during embryo implantation and early pregnancy. TSH receptors can be found in endometrial and ovarian tissues and during controlled ovarian stimulation TSH levels suffer modifications because of hyperestrogenemia. Subclinical hypothyroidism is defined as a TSH level greater than 4.5 mIU/L with normal FT4 levels. It is controversial whether or not to use first-trimester pregnancy and infertility thresholds for upper limit of 2.5 mIU/L TSH. However, neither American Thyroid Association nor the American Society Reproductive Medicine recommendations have clearly defined how infertile patients need to be...

Research paper thumbnail of P–401 Frozen-thawed embryo-transfer adjuvant therapy: one size DOES NOT fit all

Human Reproduction, 2021

Does adjuvant therapy after frozen-thawed embryo-transfer (FRET) with CardioAspirin and Prednison... more Does adjuvant therapy after frozen-thawed embryo-transfer (FRET) with CardioAspirin and Prednisone enhance clinical pregnancy rate (CPR) and live birth rate (LBR)? Adjuvant therapy enhanced CPR and LBR in study-group. A significant correlation was found confronting blastocyst FRET in study-group versus controls. Embryo implantation is a rate-limiting step of FRET cycles. It’s a complex process resulting from a balance between inflammation pathways and maternal immune tolerance. Low-dose aspirin unlocks Prostaglandin-F2 synthesis by Cyclooxygenase–1, thus increasing uterine vascular permeability and attachment reaction while reducing vasoconstriction. Pregnancy results from a balance between helper and regulatory T-cells (Treg), the latter protect the embryo from maternal immune attack. Treg cells’ immunosuppressive function is pivotal in pregnancy establishment. Prednisone increases the proportion of Treg cells thus inhibiting inflammation. Many therapy schedules for implantation en...

Research paper thumbnail of Fertility Preservation in Girls and Women: State of Art and Future Possibilities

Clinical and Experimental Obstetrics & Gynecology

Background: Many women worldwide are diagnosed with cancer in prepubertal, postpubertal and child... more Background: Many women worldwide are diagnosed with cancer in prepubertal, postpubertal and childbearing age. Oncological treatments can compromise future fertility through different mechanisms mainly depending on the type of treatment and the age of the patient. International societies recommend that cancer patients should receive information regarding the effects of oncological treatments on their reproductive health and cancer survivors should not be discouraged from becoming pregnant. About a quarter of these patients still do not receive an adequate counselling and young cancer survivors may face several barriers to conceiving a pregnancy due to the concerns from gynaecologists and oncologists. Methods: This review aims to investigate the infertility risk for female cancer patients who undergo oncological treatments and to provide an overview of actual and future fertility preservation possibilities for female cancer patients. Results: Different fertility preservation techniques have been developed in order to ensure the possibility for cancer survivors to complete their family planning after cancer. Oocyte/embryo freezing and ovarian tissue cryopreservation are the established choices, but the research is still going on to increase the success rate of these techniques and to develop other techniques to overcome actual limitations. Patients with a systemic oncological disease such as leukaemia could particularly benefit from the new experimental techniques which involve the creation of an artificial ovary or the in vitro growth of follicles or even the obtaining of mature oocytes from stem cells. All these techniques would allow the achievement of pregnancy without the risk of reintroducing malignant cells within autologous cryopreserved ovarian tissue transplantation. Regarding the concerns over pregnancy in cancer survivors, research is rapidly advancing and reassuring data are increasing. Conclusions: The rate of utilisation of gametes, embryos or ovarian tissue previously stored for fertility preservation is still low and the motivations can be various. Further data are needed in order to reassure both women and oncologists about the safety of pregnancy in cancer survivors and in order to increase the rate of women experiencing pregnancy after cancer.

Research paper thumbnail of Telemedicine for Virtual Consultations During COVID-19 Pandemic in a Medically Assisted Reproduction Center: Patients' Perspective

Telemedicine and e-Health

Background: Restrictive measures imposed to prevent COVID-19 contagion have caused an increase in... more Background: Restrictive measures imposed to prevent COVID-19 contagion have caused an increase in waiting times for other health procedures. During the pandemic, utilization of telemedicine has increased to ensure patient care safely. The aim of this study was to evaluate the perspective of infertile patients who underwent virtual consultations for infertility. Materials and Methods: This was an observational study. A survey was submitted to patients who attended a virtual consultation at a single in vitro fertilization (IVF) unit between March 2020 and July 2021. The survey concerned their experience with telemedicine assessing the experience of video consulting and the software characteristics. Results: The survey response rate was 50.3% (n = 159). In total, 98.8% of patients positively rated the experience of telemedicine. Regarding the software itself, it was defined as intuitive and easy to use by 87.4% of patients. A majority (92.5%) of interviewed patients reported that they were able to receive the information and clear any doubts they had and 85.5% of interviewed patients would repeat the experience of video consultation. Conclusions: The acceptance of telemedicine was very high among infertile patients. However, IVF treatments have a strong emotional component and face-to-face consultation with medical staff might help to create the right climate of trust, and the empathy that can be demonstrated during a vis-a`-vis meeting cannot be achieved through a screen. The use of telemedicine should be considered in those situations where it is not possible to attend an in-person consultation or when couples prefer it.

Research paper thumbnail of Epigenetics of pregnancy: looking beyond the DNA code

Journal of Assisted Reproduction and Genetics

Epigenetics is the branch of genetics that studies the different mechanisms that influence gene e... more Epigenetics is the branch of genetics that studies the different mechanisms that influence gene expression without direct modification of the DNA sequence. An ever-increasing amount of evidence suggests that such regulatory processes may play a pivotal role both in the initiation of pregnancy and in the later processes of embryonic and fetal development, thus determining long-term effects even in adult life. In this narrative review, we summarize the current knowledge on the role of epigenetics in pregnancy, from its most studied and well-known mechanisms to the new frontiers of epigenetic regulation, such as the role of ncRNAs and the effects of the gestational environment on fetal brain development. Epigenetic mechanisms in pregnancy are a dynamic phenomenon that responds both to maternal–fetal and environmental factors, which can influence and modify the embryo-fetal development during the various gestational phases. Therefore, we also recapitulate the effects of the most notable...

Research paper thumbnail of Future Aspects of Ovarian Cryopreservation and Transplantation

Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation

Research paper thumbnail of Ovarian Tissue Cryopreservation for Delaying Childbearing and Menopause

Principles and Practice of Ovarian Tissue Cryopreservation and Transplantation

Research paper thumbnail of Re: “Sex and Gender-Related Differences in COVID-19 Diagnoses and SARS-CoV-2 Testing Practices During the First Wave of the Pandemic: The Dutch Lifelines COVID-19 Cohort Study” by Ballering et al

Journal of Women's Health

Research paper thumbnail of Accuracy of transvaginal ultrasound, saline infusion sonohysterography, and office hysteroscopy in the diagnosis of endometrial polyps

Clinical and Experimental Obstetrics & Gynecology, 2019

Background: Endometrial polyps (EPs) derive from overgrowths of stromal or endometrial glands sup... more Background: Endometrial polyps (EPs) derive from overgrowths of stromal or endometrial glands supported by a fibrovascular core. Currently, there is no clear recommendation on the first-line tool to be employed between sonohysterography (SIS) and office hysteroscopy (ISC) in the evaluation of patients with the suspect of EPs. Materials and Methods: The authors performed a retrospective study on consecutive patients referred at their Unit with a suspicion of EP at transvaginal sonography (TVS). A total number of 1,243 patients were subject to TVS and ISC, while 128 ones were subject to TVS, SIS, and ISC. Primary outcome was the evaluation of the diagnostic performance of SIS and ISC in the detection of EPs. Results: ISC allowed the identification of EPs in all the cases (n=128/128 patients), with a sensitivity of 100% and specificity of 98%. For SIS, the sensitivity was 97% (n=124/128 patients) and specificity was 90%. Conclusions: ISC showed better diagnostic accuracy in comparison to SIS. Due to high diagnostic accuracy and the possibility to "see and treat" EPs in a single step, ISC should be considered as the gold standard approach in women with a suspect of EPs.

Research paper thumbnail of Rectovaginal endometriosis: head to head comparison between sonovaginography and magnetic resonance imaging

Clinical and Experimental Obstetrics & Gynecology, 2019

Background: Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis associ... more Background: Rectovaginal endometriosis (RVE) is a severe form of deep pelvic endometriosis associated with dysmenorrhoea, pelvic pain, and dyspareunia. Diagnosis of RVE is a challenge for clinicians. Aim of outhe present study was to compare the diagnostic accuracy of sonovaginography with MRI on a consecutive cohort of women referred to this institution due to RVE suspect. Materials and Methods: The authors performed a retrospective study on consecutive patients undergoing surgery at this Unit due to a suspicion of RVE. All women were subject to MRI and sonovaginography. Primary endpoint was to compare the diagnostic accuracy of sonovaginography and MRI in the detection of RVE. Results: RVE was diagnosed (with surgery plus histology) in 60 women. In all cases, the surgical procedure was completed without complications. Sonovaginography and MRI showed high sensitivity (95% vs. 81.7%) and similar specificity (93.8% and 91.2%, respectively) in the diagnosis of RVE. Conclusions: Sonovaginography, when performed by an expert sonographer, may represent a valid alternative to MRI for the diagnosis of RVE, with lower costs and minimal time consumption

Research paper thumbnail of Perceived Elementary Grid (PEG) proposal for dyadic coping evaluation in the infertile couple during assisted reproductive treatments

Clinical and Experimental Obstetrics & Gynecology, 2022

Research paper thumbnail of Impact of chemotherapy on the ovarian reserve: Are all primordial follicles created equal?

Fertility and Sterility, 2022

Research paper thumbnail of Addressing Female Sexual Dysfunction during Novel 2019-Coronavirus Pandemic in Infertile Women Living in North-East Italy

Journal of Women's Health and Development, 2021

Objectives: To identify whether the coronavirus infection had a negative influence on female sexu... more Objectives: To identify whether the coronavirus infection had a negative influence on female sexual function of infertile women living in NorthEast Italy. Methods: A survey was submitted during SARS-CoV-2 pandemic to 570 infertile women. The survey consisted of questions regarding employment, whether respondents lived with a partner or other family members, the time spent seeking pregnancy and previously assisted reproductive technology treatments and of the selfreported validated Italian Female Sexual Function Index questionnaire. A cutoff total score of ≤ 26.55 has been used for diagnosis of female sexual dysfunction.

Research paper thumbnail of MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining

Journal of Assisted Reproduction and Genetics, 2021

Purpose The current gold standard for chronic endometritis (CE) diagnosis is immunohistochemistry... more Purpose The current gold standard for chronic endometritis (CE) diagnosis is immunohistochemistry (IHC) for CD-138. However, IHC for CD-138 is not exempt from diagnostic limitations. The aim of our study was to evaluate the reliability and accuracy of MUM-1 IHC, as compared with CD-138. Methods This is a multi-centre, retrospective, observational study, which included three tertiary hysteroscopic centres in university teaching hospitals. One hundred ninety-three consecutive women of reproductive age were referred to our hysteroscopy services due to infertility, recurrent miscarriage, abnormal uterine bleeding, endometrial polyps or myomas. All women underwent hysteroscopy plus endometrial biopsy. Endometrial samples were analysed through histology, CD138 and MUM-1 IHC. The primary outcome was to evaluate the diagnostic accuracy of MUM-1 IHC for CE, as compared with CD-138 IHC. Results Sensitivity and specificity of CD-138 and MUM-1 IHC were respectively 89.13%, 79.59% versus 93.48% and 85.03%. The overall diagnostic accuracy of MUM-1 and CD-138 IHC were similar (AUC = 0.893 vs AUC = 0.844). The intercorrelation coefficient for single measurements was high between the two techniques (ICC = 0.831, 0.761–0.881 95%CI). However, among CE positive women, MUM-1 allowed the identification of higher number of plasma cells/hpf than CD-138 (6.50 [SD 4.80] vs 5.05 [SD 3.37]; p = 0.017). Additionally, MUM-1 showed a higher inter-observer agreement as compared to CD-138. Conclusion IHC for MUM-1 and CD-138 showed a similar accuracy for detecting endometrial stromal plasma cells. Notably, MUM-1 showed higher reliability in the paired comparison of the individual samples than CD-138. Thus, MUM-1 may represent a novel, promising add-on technique for the diagnosis of CE.

Research paper thumbnail of Ovarian transplantation with robotic surgery and a neovascularizing human extracellular matrix scaffold: a case series in comparison to meta-analytic data

Fertility and Sterility, 2021

To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transpl... more To report our experience with robot-assisted (RA) autologous cryopreserved ovarian tissue transplantation (ACOTT) with the use of a neovascularizing extracellular matrix scaffold. Case series with meta-analytic update. Academic. Seven recipients of RA-ACOTT. Before or shortly after initiating chemotherapy, ovarian tissue was cryopreserved from 7 women, who then underwent RA-ACOTT 9.9 ± 1.8 years (range, 7-12 years) later. Perioperatively, they received transdermal estrogen and low-dose aspirin to enhance graft vascularization. Ovarian cortical pieces were thawed and sutured on an extracellular matrix scaffold, which was then robotically anastomosed to the bivalved remaining ovary in 6 cases and retroperitoneally (heterotopic) to the lower abdomen in 1 case. Ovarian function return, the number of oocytes/embryos, aneuploidy %, live births, and neonatal outcomes were recorded. Graft longevity was compared with the mean from the meta-analytic data. Ovarian function returned 13.9 ± 2.7 weeks (11-16.2 weeks) after ACOTT, and oocytes were retrieved in all cases with 12.3 ± 6.9 embryos generated. In contrast to orthotopic, the heterotopic ACOTT demonstrated low embryo quality and an 80% aneuploidy rate. A recipient did not attempt to conceive and 2 needed a surrogate, whereas 4 of 4 delivered 6 healthy children, compared with 115 of 460 (25% pregnancy rate) from the meta-analytic data (n = 79). The mean graft longevity (43.2 ± 23.6/47.4 ± 22.8 months with/without sensitivity analysis) trended longer than the meta-analytic mean (29.4 ± 22.7), even after matching age at cryopreservation. In this series, RA-ACOTT resulted in extended graft longevity, with ovarian functions restored in all cases, even when the tissues were cryopreserved after chemotherapy exposure.

Research paper thumbnail of Delaying Reproductive Aging by Ovarian Tissue Cryopreservation and Transplantation: Is it Prime Time?

Trends in Molecular Medicine, 2021

Ovarian tissue cryopreservation and autotransplantation can restore ovarian endocrine function an... more Ovarian tissue cryopreservation and autotransplantation can restore ovarian endocrine function and fertility and recently were changed from experimental to fertility preservation procedures for medical indications by the American Society of Reproductive Medicine. Such advances have resulted in discussions around the utility of ovarian cryopreservation in healthy women to preserve fertility and delay menopause or as a hormone replacement approach. Such 'elective' use of ovarian tissue cryopreservation requires a risk-benefit assessment. Here, we review evidence for and against the utility of ovarian tissue harvesting in healthy women, scrutinize recent and needed advances to enhance the feasibility of such an approach, and provide practice and future research guidelines.

Research paper thumbnail of Hyaluronic acid in vulvar and vaginal administration: evidence from a literature systematic review

Climacteric, 2021

Vulvovaginal pathology impairs the quality of life of both women in menopause and those who are n... more Vulvovaginal pathology impairs the quality of life of both women in menopause and those who are not. Different therapies have been proposed, mainly related to estrogen therapy in postmenopausal women. However, some contraindications limit its use, and different moisturizers or lubricants have been tested. Hyaluronic acid is a promising and widely used vaginal medical treatment with a moisturizing action and appears to provide a solution. For this reason, we performed a systematic review of the literature. We searched for original articles without date restriction until 30 April 2020. We included all clinical trials which administered local hyaluronic acid in the vulva or vagina. Only English studies and those performed in humans were eligible. Seventeen original studies were included in the review (from randomized controlled trials to longitudinal studies). Hyaluronic acid was generally found to be effective in improving vulvovaginal symptoms (dyspareunia, itching, burning, dryness) and signs (bleeding, atrophy, vaginal pH). In conclusion, hyaluronic acid has the properties to be an efficient moisturizer for women suffering from vulvovaginal atrophy who have contraindications for estrogen therapy and for vulvovaginal signs and symptoms affecting sexual well-being. However, a well-designed randomized controlled trial is needed in order to clarify its efficacy and safety profile.