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Papers by Roberto Palermo

Research paper thumbnail of Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits

Journal of Assisted Reproduction and Genetics, May 10, 2019

Purpose To explore the association between patient-centered communication, patients' satisfaction... more Purpose To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits. Methods ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary Bpatient-centered communication^ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. Results Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. Conclusions Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is Bpatient-centered^in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.

Research paper thumbnail of Induction of ovulation in normo-androgenic women, affected by primary hypothalamic amenorrhea, with chronic pulsatile administration of GnRH, using an automatic portable pump (Zyklomat)

PubMed, Mar 1, 1987

Pulsatile administration of GnRH appears to be the most rational and physiological treatment of i... more Pulsatile administration of GnRH appears to be the most rational and physiological treatment of infertility in patients affected by hypothalamic amenorrhea. The authors conclude that the results obtained with this method of treatment in patients with severe hypothalamic amenorrhea suggest that the choice of pulsatile GnRH therapy is an effective and practical method for induction of ovulation.

Research paper thumbnail of Gamete intra-fallopian transfer (GIFT): a new technique for the treatment of unexplained infertility

PubMed, Sep 1, 1985

The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertil... more The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertility, in 2 cases with infertility associated with mild endometriosis, in 1 case of hostile mucus and 3 cases in which phymosis of the ampulla and/or periadnexal adhesions were previously identified. In 7 couples GIFT was carried out after several AID cycles for husband azoospermia or severe oligospermia. Three different protocols were used for the controlled ovarian hyperstimulation. In all cases an adequate follicular growth was obtained and mature oocytes were recovered. At first attempt 12 ongoing pregnancies (1 triplet, 1 twin) were obtained with a present pregnancy rate of 48%.

Research paper thumbnail of P-074. Does exogenous LH affect oocyte and embryo quality following multiple follicular development for ICSI?—results of a prospective, randomized, assessor-blind study

Research paper thumbnail of R-071. Effect of Vero cell short-term co-culture on pregnancy rate after ICSI

Human Reproduction, 1997

in group II (1255 ± 213 pg/ml) (P < 0.05). There was no significant difference in treatment outco... more in group II (1255 ± 213 pg/ml) (P < 0.05). There was no significant difference in treatment outcome between the two groups. Treatment outcome for the two groups Pregnancy rate per cycle (%) Pregnancy rate per patient (n) Delivery rate per patient (n) Miscarriage rate (n) Multiple pregnancy rate (n) Group I 61 16 15 1 3 Group II 43 7 5 2 1 Total 54 23 20 3 4 Conclusion: The use of IVI after ovarian stimulation for the treatment of ovulatory disorder infertility may improve the pregnancy rate per cycle. In addition, less costly protocols (clomiphene citratelHMG) may be as effective as expensive protocols (GnRHlHMG). R-071. Effect of Vero cell short-term co-culture on pregnancy rate after ICSI

Research paper thumbnail of P-072. Effects of two GnRH agonist dosages on ovarian stimulation outcome after induction of multiple follicular development by long GnRH agonist/menotrophin protocols for assisted reproductive techniques

Human Reproduction, 1997

in this clinical context means a totally different pharmacological mode of action. Instead of dow... more in this clinical context means a totally different pharmacological mode of action. Instead of down-regulation, a competitive blockage of the GnRH receptors of the gonadotrophic cells takes place, causing an immediate suppression. This would offer advantages in terms of reducing treatment duration and improving subjective symptoms more quickly.

Research paper thumbnail of Operative laparoscopy in assisted reproduction

Acta Europaea fertilitatis

After the introduction of transvaginal ultrasound guided recovery of oocyte, the use of laparosco... more After the introduction of transvaginal ultrasound guided recovery of oocyte, the use of laparoscopy in Assisted Reproductive Technology is limited to GIFT and ZIFT or TET method and to the selection of patients. In this paper the Authors discuss about these methods, the advantages of tubal gametes or embryos transfer versus uterine transfer.

Research paper thumbnail of The 2004 Italian legislation regulating assisted reproduction technology: a multicentre survey on the results of IVF cycles

Human Reproduction, 2005

on behalf of the Società Italiana della Riproduzione (S.I.d.R.) study group on the impact of the ... more on behalf of the Società Italiana della Riproduzione (S.I.d.R.) study group on the impact of the law 40/2004*

Research paper thumbnail of Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR)

Journal of Assisted Reproduction and Genetics

Purpose Infertility is increasing worldwide, and many couples seek IVF. Clinical management and l... more Purpose Infertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required. Methods An Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance. Results The working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneup...

Research paper thumbnail of Gene expression profiles of cumulus cells obtained from women treated with r-hLH D r-hFSH or hp-hMG versus r-hFSH alone

Valentina Gatta, Ph.D., Carla Tatone, Ph.D., Rosanna Ciriminna, B.Sc., Marilena Vento, B.Sc., Sar... more Valentina Gatta, Ph.D., Carla Tatone, Ph.D., Rosanna Ciriminna, B.Sc., Marilena Vento, B.Sc., Sara Franchi, M.T., Marco d'Aurora, B.Sc., Samantha Sperduti, B.Sc., Vito Cela, Ph.D., Placido Borzi, M.D., Roberto Palermo, M.D., Liborio Stuppia, M.D., and Paolo Giovanni Artini, Ph.D. a Department of Psychology, Humanities, and Territory Sciences, ‘‘G. d'Annunzio’’ University, Chieti; b CeSI-Center for Research on Ageing ‘‘G. d'Annunzio’’ Foundation, Chieti; c Department of Life, Health, and Environmental Sciences, University of l'Aquila, l'Aquila; d AMBRA-Associazione Medici e Biologi per la Riproduzione Assistita, Palermo; e IVF Unit, Cannizzaro Hospital, Catania; f Department of Neuroscience and Imaging, ‘‘G. d'Annunzio’’ University, Chieti; and g Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

Research paper thumbnail of COVID-19 and ART: the view of the Italian Society of Fertility and Sterility and Reproductive Medicine

Reproductive BioMedicine Online, 2020

The COVID-19 pandemic is an unprecedented global situation. As assisted reproductive technology (... more The COVID-19 pandemic is an unprecedented global situation. As assisted reproductive technology (ART) specialists, we should be cautious, carefully monitoring the situation while contributing by sharing novel evidence to counsel our patients, both pregnant women and would-be mothers. Time to egg collection and drop-out rates are critical parameters for scheduling treatments once the curve of infections has peaked and plateaued in each country. In order to reduce the values for these two parameters, infertile patients now require even more support from their IVF team: urgent oocyte collection for oncology patients must be guaranteed, and oocyte retrievals for women of advanced maternal age and/or reduced ovarian reserve cannot be postponed indefinitely. This document represents the position of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) in outlining ART priorities during and after this emergency.

Research paper thumbnail of Gamete intrafallopian transfer in the treatment of infertility: the first series at the University of Palermo

Fertility and Sterility, 1986

Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artifi... more Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artificial insemination with donor semen (AID), three women with mild endometriosis, three with periadnexal adhesions, one with hostile (not immunologic) cervical mucus, and one couple in which the male partner was affected by asthenospermia were treated by the gamete intrafallopian transfer (GIFT) technique. Three different protocols for controlled ovarian hyperstimulation were used, and an adequate follicular growth and oocyte maturation were achieved in all cases. Seventeen pregnancies were obtained, for a global pregnancy rate of 38.6%. Two pregnancies (11.7%) ended in clinical abortions, and one (5.8%) was a tubal pregnancy. Of the ongoing pregnancies, one is twin and two are triplets. Seven pregnancies (six ongoing, one abortion) were obtained in the UI group (26%), six (all ongoing) in the failed AID group (66.6%), two continuing pregnancies in the three patients with endometriosis (66.6%); the tubal pregnancy and one clinical abortion occurred in the group with adnexal adhesions. No pregnancies were obtained in the patient with hostile cervical mucus and in the couple with infertility presumably due to poor semen. These encouraging results and the simplicity of the technique suggest that GIFT could be an effective approach that could be programmed during a welltimed laparoscopy where persistent infertility exists in association with apparently normal fallopian tubes. Fertil Steril 46:417, 1986

Research paper thumbnail of Concomitant gonadotropin-releasing hormone agonist and menotropin treatment for the synchronized induction of multiple follicles

Fertility and Sterility, 1988

Research paper thumbnail of The use of ovarian reserve markers in IVF clinical practice: a national consensus

Gynecological Endocrinology, 2015

Ovarian reserve markers have been documented to perform very well in the clinical practice. While... more Ovarian reserve markers have been documented to perform very well in the clinical practice. While this is widely recognized, still now there is no consensus on how to use new biomarkers in the clinical practice. This study was conducted among Italian IVF centres using the Delphi technique, a validated consensus-building process. Briefly three consecutive questionnaires were developed for clinicians in charge of IVF centres. In the first rounds, participants were asked to rate the importance of a list of statements regarding the categorization of ovarian response and the diagnostic role of biomarkers. In round 3, participants were asked to rate their agreement and consensus on the list of statements derived from the first two rounds. There were 120 respondents. Consensus was achieved for many points: (a) poor ovarian response is predicted on the basis of the following: AMH &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 1 ng/ml or AFC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 7, FSH ≥ 10 IU/l, age ≥ 40 yrs; (b) hyper-response is predicted on the basis of the following: AMH &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 ng/ml or AFC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 14; (c) day 3 FSH measurement should always be associated to estradiol; (d) AMH can be measured on a random basis; (e) the measurement of the AFC with the 2D technology may be considered adequate and (f) the AFC should be measured in the early follicular phase and consists in the total number of 2-9 mm follicles in both the ovaries. The present study suggests that extensive consensus on the importance and use of new ovarian reserve markers to improve IVF safety and performance is already present among clinicians.

Research paper thumbnail of Oocyte Quality According to Protocols for Controlled Ovarian Hyperstimulation and Patients’ Age

Advances in Assisted Reproductive Technologies, 1990

In in vitro fertilization (IVF) and embryo transfer (ET), the induction of multiple follicular gr... more In in vitro fertilization (IVF) and embryo transfer (ET), the induction of multiple follicular growth represents the first and necessary step for the efficient performance of the technique.

Research paper thumbnail of Differential actions of FSH and LH during folliculogenesis

Reproductive BioMedicine Online, 2007

In the gonadotrophin-dependent stage of follicular development, FSH-and LH-signalling pathways pl... more In the gonadotrophin-dependent stage of follicular development, FSH-and LH-signalling pathways play an obligatory role in follicle differentiation, selection and survival. Under the effect of LH the theca−interstitial cell layer acts as an androgen producer. Thus, androgen diffusing into the mural granulosa cell layer represents the substrate for FSH-induced aromatase for follicular oestradiol synthesis. This is the landmark 'two cell-two gonadotrophin' concept in the physiology of ovarian function in mammals. The increase in plasma FSH during luteo−follicular transition is the basis for follicle selection. The rise of FSH to the threshold concentration represents a critical condition for the growth of the most sensitive follicle in a given time frame of the last 14 days of the dominant follicle odyssey. The gonadotrophin-induced follicular oestradiol secretion inhibits pituitary secretion of FSH, which in turn causes the concentration of FSH in the developing cohort follicles to drop below threshold concentrations and the arrest of the development of the less FSH-sensitive follicle (FSH threshold and window concept). In the gonadotrophin-dependent phase of follicular development, LH also seems to acts within a critical window of the hormone concentration framed between the minimal threshold and a ceiling for the normal functions of the follicle unit

Research paper thumbnail of Gene expression profiles of cumulus cells obtained from women treated with recombinant human luteinizing hormone + recombinant human follicle-stimulating hormone or highly purified human menopausal gonadotropin versus recombinant human follicle-stimulating hormone alone

Fertility and Sterility, 2013

To evaluate cumulus cell (CC) expression profile modulation after different stimulation protocols... more To evaluate cumulus cell (CC) expression profile modulation after different stimulation protocols. Design: CCs transcriptome variations were evaluated by microarray in patients undergoing different treatments for ovarian stimulation, namely, r-hLH þ r-hFSH and hp-hMG, compared with a control group treated with r-hFSH. Setting: Healthy patients undergoing assisted reproduction protocols. Patient(s): Sixteen healthy women with regular cycles and tubal disease or unexplained infertility. Intervention(s): Four patients received hp-hMG, four received r-hFSH þ r-hLH, and eight received r-hFSH daily. Aspiration of the oocytes was performed 36 hours after hCG administration. Only samples derived from cumulus-oocyte complexes containing mature oocytes showing polar body were processed. Main Outcome Measure(s): Comparison of genes differentially expressed in both treatment groups with the use of a hierarchic clustering analysis. Result(s): Data clustering analysis allowed detection of four clusters containing genes differentially expressed in both treatment groups compared with control. Functional analysis of the affected transcripts revealed genes involved in oocyte development and maturation.

Research paper thumbnail of Solubilization, gel filtration and sedimentation behaviour of prolactin receptors from human ovarian tissue

Biochimica et Biophysica Acta (BBA) - General Subjects, 1983

Receptors for 125I-labelled human prolactin have been identified in the crude membrane fraction i... more Receptors for 125I-labelled human prolactin have been identified in the crude membrane fraction isolated from human ovarian tissue. The non-ionic detergent Triton X-100, has been used to solubilize the membrane fraction. The presence of the receptor in the detergent extract was demonstrated by gel filtration and sucrose density gradient centrifugation. The binding was time-temperature dependent, being maximal at 23°C after 15 h of incubation. Large amounts of other peptide hormones did not inhibit the binding of 1251-labelled human prolactin. The binding Scatchard analysis demonstrated that the affinity of the soluble receptor (K a 1.13 ± 0.15-101° M-1) for the labelled hormone was slightly greater than that of the crude membrane fraction (K a 0.91 ± 0.12.101° M-1). The binding capacity of the solubilized receptor was also significantly greater than that seen in the partic~ate before solubilization. The apparent Stokes radius of the solubilized receptor was estimated to be 57 A and that the hormone-receptor complex 60 A. The sedimentation coefficient of the solubilized receptor was 7.0 _ 0.1 s, whereas that of the hormone-receptor complex was 7.5 ± 0.2 s.

Research paper thumbnail of The Endometrium in Human Assisted Reproduction

Annals of the New York Academy of Sciences, 1991

The assessment of endometrial function in physiological conditions is one of the most controversi... more The assessment of endometrial function in physiological conditions is one of the most controversial areas in reproduction, and the situation is further complicated in human assisted reproduction by the multitude of variables associated with any form of treatment. So-called medically assisted reproduction implies different degrees of intervention, which are intended to overcome an identified or even a non-identified factor of reproductive failure, but these interventions may potentially alter endometrial receptivity for adequate implantation. Thus, when we select an infertile female patient with evident ovarian function, either normal or abnormal, for a specific assisted reproductive treatment, the first "manipulation" we do, to improve the chance of establishing pregnancy, is controlled ovarian hyperstimulation: a key and critical step between the selection of patients and the adoption of one of the treatment techniques (FIG. 1). Different strategies are adopted for inducing multiple follicular growth. The protocols mainly used are the combination of clomiphene citrate (CC) with human menopausal gonadotropins (hMG), the combination of hMG with gonadotropin releasing hormone agonists (GnRH-a) or hMG alone. Whichever protocol is used, the expected multiple follicular growth will produce supraphysiological levels of estradiol during the follicular phase and the resulting multiple corpora lutea will produce supraphysiological levels of estradiol and progesterone during the luteal phase. Another important aspect regarding the endometrial environment, which differentiates in virro fertilization with intrauterine embryo transfer from other techniques and natural conception, is the different timing of arrival of embryos into the uterine cavity and the different developmental stage of the embryo at that time. In fact, in spontaneous conception, and we have to suppose the same situation exists after the replacement of embryos or gametes into the tubes, a morula or an early blastocyst will arrive into the uterine cavity 5-6 days after the ovulation. In in vitro fertilization (IVF) embryos at 4-8 blastomeric stage are usually replaced into the uterine cavity 48 hours after the oocyte retrieval. Most studies designed to investigate endometrial function have been conducted in IVF and embryo transfer (ET) studies, so we have to keep in mind these points in reviewing this topic.

Research paper thumbnail of Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits

Journal of Assisted Reproduction and Genetics, May 10, 2019

Purpose To explore the association between patient-centered communication, patients' satisfaction... more Purpose To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits. Methods ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary Bpatient-centered communication^ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. Results Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. Conclusions Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is Bpatient-centered^in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.

Research paper thumbnail of Induction of ovulation in normo-androgenic women, affected by primary hypothalamic amenorrhea, with chronic pulsatile administration of GnRH, using an automatic portable pump (Zyklomat)

PubMed, Mar 1, 1987

Pulsatile administration of GnRH appears to be the most rational and physiological treatment of i... more Pulsatile administration of GnRH appears to be the most rational and physiological treatment of infertility in patients affected by hypothalamic amenorrhea. The authors conclude that the results obtained with this method of treatment in patients with severe hypothalamic amenorrhea suggest that the choice of pulsatile GnRH therapy is an effective and practical method for induction of ovulation.

Research paper thumbnail of Gamete intra-fallopian transfer (GIFT): a new technique for the treatment of unexplained infertility

PubMed, Sep 1, 1985

The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertil... more The Gamete Intrafallopian Transfer (GIFT) was carried out in 12 couples with unexplained infertility, in 2 cases with infertility associated with mild endometriosis, in 1 case of hostile mucus and 3 cases in which phymosis of the ampulla and/or periadnexal adhesions were previously identified. In 7 couples GIFT was carried out after several AID cycles for husband azoospermia or severe oligospermia. Three different protocols were used for the controlled ovarian hyperstimulation. In all cases an adequate follicular growth was obtained and mature oocytes were recovered. At first attempt 12 ongoing pregnancies (1 triplet, 1 twin) were obtained with a present pregnancy rate of 48%.

Research paper thumbnail of P-074. Does exogenous LH affect oocyte and embryo quality following multiple follicular development for ICSI?—results of a prospective, randomized, assessor-blind study

Research paper thumbnail of R-071. Effect of Vero cell short-term co-culture on pregnancy rate after ICSI

Human Reproduction, 1997

in group II (1255 ± 213 pg/ml) (P < 0.05). There was no significant difference in treatment outco... more in group II (1255 ± 213 pg/ml) (P < 0.05). There was no significant difference in treatment outcome between the two groups. Treatment outcome for the two groups Pregnancy rate per cycle (%) Pregnancy rate per patient (n) Delivery rate per patient (n) Miscarriage rate (n) Multiple pregnancy rate (n) Group I 61 16 15 1 3 Group II 43 7 5 2 1 Total 54 23 20 3 4 Conclusion: The use of IVI after ovarian stimulation for the treatment of ovulatory disorder infertility may improve the pregnancy rate per cycle. In addition, less costly protocols (clomiphene citratelHMG) may be as effective as expensive protocols (GnRHlHMG). R-071. Effect of Vero cell short-term co-culture on pregnancy rate after ICSI

Research paper thumbnail of P-072. Effects of two GnRH agonist dosages on ovarian stimulation outcome after induction of multiple follicular development by long GnRH agonist/menotrophin protocols for assisted reproductive techniques

Human Reproduction, 1997

in this clinical context means a totally different pharmacological mode of action. Instead of dow... more in this clinical context means a totally different pharmacological mode of action. Instead of down-regulation, a competitive blockage of the GnRH receptors of the gonadotrophic cells takes place, causing an immediate suppression. This would offer advantages in terms of reducing treatment duration and improving subjective symptoms more quickly.

Research paper thumbnail of Operative laparoscopy in assisted reproduction

Acta Europaea fertilitatis

After the introduction of transvaginal ultrasound guided recovery of oocyte, the use of laparosco... more After the introduction of transvaginal ultrasound guided recovery of oocyte, the use of laparoscopy in Assisted Reproductive Technology is limited to GIFT and ZIFT or TET method and to the selection of patients. In this paper the Authors discuss about these methods, the advantages of tubal gametes or embryos transfer versus uterine transfer.

Research paper thumbnail of The 2004 Italian legislation regulating assisted reproduction technology: a multicentre survey on the results of IVF cycles

Human Reproduction, 2005

on behalf of the Società Italiana della Riproduzione (S.I.d.R.) study group on the impact of the ... more on behalf of the Società Italiana della Riproduzione (S.I.d.R.) study group on the impact of the law 40/2004*

Research paper thumbnail of Clinical and laboratory key performance indicators in IVF: A consensus between the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) and the Italian Society of Embryology, Reproduction and Research (SIERR)

Journal of Assisted Reproduction and Genetics

Purpose Infertility is increasing worldwide, and many couples seek IVF. Clinical management and l... more Purpose Infertility is increasing worldwide, and many couples seek IVF. Clinical management and laboratory work are fundamental in the IVF journey. Therefore, the definition of reliable key performance indicators (KPIs) based on clinical and laboratory parameters, is essential for internal quality control (IQC). Laboratory performance indicators have been identified and a first attempt to also determine clinical ones has been recently published. However, more detailed indicators are required. Methods An Italian group of experts in Reproductive Medicine from both public and private clinics on behalf of SIFES-MR and SIERR was established to define IVF indicators to monitor clinical performance. Results The working group built a consensus on a list of KPIs, performance indicators (PIs) and recommendation indicators (RIs). When deemed necessary, the reference population was stratified by woman age, response to ovarian stimulation and adoption of preimplantation genetic testing for aneup...

Research paper thumbnail of Gene expression profiles of cumulus cells obtained from women treated with r-hLH D r-hFSH or hp-hMG versus r-hFSH alone

Valentina Gatta, Ph.D., Carla Tatone, Ph.D., Rosanna Ciriminna, B.Sc., Marilena Vento, B.Sc., Sar... more Valentina Gatta, Ph.D., Carla Tatone, Ph.D., Rosanna Ciriminna, B.Sc., Marilena Vento, B.Sc., Sara Franchi, M.T., Marco d'Aurora, B.Sc., Samantha Sperduti, B.Sc., Vito Cela, Ph.D., Placido Borzi, M.D., Roberto Palermo, M.D., Liborio Stuppia, M.D., and Paolo Giovanni Artini, Ph.D. a Department of Psychology, Humanities, and Territory Sciences, ‘‘G. d'Annunzio’’ University, Chieti; b CeSI-Center for Research on Ageing ‘‘G. d'Annunzio’’ Foundation, Chieti; c Department of Life, Health, and Environmental Sciences, University of l'Aquila, l'Aquila; d AMBRA-Associazione Medici e Biologi per la Riproduzione Assistita, Palermo; e IVF Unit, Cannizzaro Hospital, Catania; f Department of Neuroscience and Imaging, ‘‘G. d'Annunzio’’ University, Chieti; and g Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

Research paper thumbnail of COVID-19 and ART: the view of the Italian Society of Fertility and Sterility and Reproductive Medicine

Reproductive BioMedicine Online, 2020

The COVID-19 pandemic is an unprecedented global situation. As assisted reproductive technology (... more The COVID-19 pandemic is an unprecedented global situation. As assisted reproductive technology (ART) specialists, we should be cautious, carefully monitoring the situation while contributing by sharing novel evidence to counsel our patients, both pregnant women and would-be mothers. Time to egg collection and drop-out rates are critical parameters for scheduling treatments once the curve of infections has peaked and plateaued in each country. In order to reduce the values for these two parameters, infertile patients now require even more support from their IVF team: urgent oocyte collection for oncology patients must be guaranteed, and oocyte retrievals for women of advanced maternal age and/or reduced ovarian reserve cannot be postponed indefinitely. This document represents the position of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) in outlining ART priorities during and after this emergency.

Research paper thumbnail of Gamete intrafallopian transfer in the treatment of infertility: the first series at the University of Palermo

Fertility and Sterility, 1986

Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artifi... more Twenty-six couples with unexplained infertility (UI), nine women with repeated failures of artificial insemination with donor semen (AID), three women with mild endometriosis, three with periadnexal adhesions, one with hostile (not immunologic) cervical mucus, and one couple in which the male partner was affected by asthenospermia were treated by the gamete intrafallopian transfer (GIFT) technique. Three different protocols for controlled ovarian hyperstimulation were used, and an adequate follicular growth and oocyte maturation were achieved in all cases. Seventeen pregnancies were obtained, for a global pregnancy rate of 38.6%. Two pregnancies (11.7%) ended in clinical abortions, and one (5.8%) was a tubal pregnancy. Of the ongoing pregnancies, one is twin and two are triplets. Seven pregnancies (six ongoing, one abortion) were obtained in the UI group (26%), six (all ongoing) in the failed AID group (66.6%), two continuing pregnancies in the three patients with endometriosis (66.6%); the tubal pregnancy and one clinical abortion occurred in the group with adnexal adhesions. No pregnancies were obtained in the patient with hostile cervical mucus and in the couple with infertility presumably due to poor semen. These encouraging results and the simplicity of the technique suggest that GIFT could be an effective approach that could be programmed during a welltimed laparoscopy where persistent infertility exists in association with apparently normal fallopian tubes. Fertil Steril 46:417, 1986

Research paper thumbnail of Concomitant gonadotropin-releasing hormone agonist and menotropin treatment for the synchronized induction of multiple follicles

Fertility and Sterility, 1988

Research paper thumbnail of The use of ovarian reserve markers in IVF clinical practice: a national consensus

Gynecological Endocrinology, 2015

Ovarian reserve markers have been documented to perform very well in the clinical practice. While... more Ovarian reserve markers have been documented to perform very well in the clinical practice. While this is widely recognized, still now there is no consensus on how to use new biomarkers in the clinical practice. This study was conducted among Italian IVF centres using the Delphi technique, a validated consensus-building process. Briefly three consecutive questionnaires were developed for clinicians in charge of IVF centres. In the first rounds, participants were asked to rate the importance of a list of statements regarding the categorization of ovarian response and the diagnostic role of biomarkers. In round 3, participants were asked to rate their agreement and consensus on the list of statements derived from the first two rounds. There were 120 respondents. Consensus was achieved for many points: (a) poor ovarian response is predicted on the basis of the following: AMH &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 1 ng/ml or AFC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 7, FSH ≥ 10 IU/l, age ≥ 40 yrs; (b) hyper-response is predicted on the basis of the following: AMH &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 3 ng/ml or AFC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 14; (c) day 3 FSH measurement should always be associated to estradiol; (d) AMH can be measured on a random basis; (e) the measurement of the AFC with the 2D technology may be considered adequate and (f) the AFC should be measured in the early follicular phase and consists in the total number of 2-9 mm follicles in both the ovaries. The present study suggests that extensive consensus on the importance and use of new ovarian reserve markers to improve IVF safety and performance is already present among clinicians.

Research paper thumbnail of Oocyte Quality According to Protocols for Controlled Ovarian Hyperstimulation and Patients’ Age

Advances in Assisted Reproductive Technologies, 1990

In in vitro fertilization (IVF) and embryo transfer (ET), the induction of multiple follicular gr... more In in vitro fertilization (IVF) and embryo transfer (ET), the induction of multiple follicular growth represents the first and necessary step for the efficient performance of the technique.

Research paper thumbnail of Differential actions of FSH and LH during folliculogenesis

Reproductive BioMedicine Online, 2007

In the gonadotrophin-dependent stage of follicular development, FSH-and LH-signalling pathways pl... more In the gonadotrophin-dependent stage of follicular development, FSH-and LH-signalling pathways play an obligatory role in follicle differentiation, selection and survival. Under the effect of LH the theca−interstitial cell layer acts as an androgen producer. Thus, androgen diffusing into the mural granulosa cell layer represents the substrate for FSH-induced aromatase for follicular oestradiol synthesis. This is the landmark 'two cell-two gonadotrophin' concept in the physiology of ovarian function in mammals. The increase in plasma FSH during luteo−follicular transition is the basis for follicle selection. The rise of FSH to the threshold concentration represents a critical condition for the growth of the most sensitive follicle in a given time frame of the last 14 days of the dominant follicle odyssey. The gonadotrophin-induced follicular oestradiol secretion inhibits pituitary secretion of FSH, which in turn causes the concentration of FSH in the developing cohort follicles to drop below threshold concentrations and the arrest of the development of the less FSH-sensitive follicle (FSH threshold and window concept). In the gonadotrophin-dependent phase of follicular development, LH also seems to acts within a critical window of the hormone concentration framed between the minimal threshold and a ceiling for the normal functions of the follicle unit

Research paper thumbnail of Gene expression profiles of cumulus cells obtained from women treated with recombinant human luteinizing hormone + recombinant human follicle-stimulating hormone or highly purified human menopausal gonadotropin versus recombinant human follicle-stimulating hormone alone

Fertility and Sterility, 2013

To evaluate cumulus cell (CC) expression profile modulation after different stimulation protocols... more To evaluate cumulus cell (CC) expression profile modulation after different stimulation protocols. Design: CCs transcriptome variations were evaluated by microarray in patients undergoing different treatments for ovarian stimulation, namely, r-hLH þ r-hFSH and hp-hMG, compared with a control group treated with r-hFSH. Setting: Healthy patients undergoing assisted reproduction protocols. Patient(s): Sixteen healthy women with regular cycles and tubal disease or unexplained infertility. Intervention(s): Four patients received hp-hMG, four received r-hFSH þ r-hLH, and eight received r-hFSH daily. Aspiration of the oocytes was performed 36 hours after hCG administration. Only samples derived from cumulus-oocyte complexes containing mature oocytes showing polar body were processed. Main Outcome Measure(s): Comparison of genes differentially expressed in both treatment groups with the use of a hierarchic clustering analysis. Result(s): Data clustering analysis allowed detection of four clusters containing genes differentially expressed in both treatment groups compared with control. Functional analysis of the affected transcripts revealed genes involved in oocyte development and maturation.

Research paper thumbnail of Solubilization, gel filtration and sedimentation behaviour of prolactin receptors from human ovarian tissue

Biochimica et Biophysica Acta (BBA) - General Subjects, 1983

Receptors for 125I-labelled human prolactin have been identified in the crude membrane fraction i... more Receptors for 125I-labelled human prolactin have been identified in the crude membrane fraction isolated from human ovarian tissue. The non-ionic detergent Triton X-100, has been used to solubilize the membrane fraction. The presence of the receptor in the detergent extract was demonstrated by gel filtration and sucrose density gradient centrifugation. The binding was time-temperature dependent, being maximal at 23°C after 15 h of incubation. Large amounts of other peptide hormones did not inhibit the binding of 1251-labelled human prolactin. The binding Scatchard analysis demonstrated that the affinity of the soluble receptor (K a 1.13 ± 0.15-101° M-1) for the labelled hormone was slightly greater than that of the crude membrane fraction (K a 0.91 ± 0.12.101° M-1). The binding capacity of the solubilized receptor was also significantly greater than that seen in the partic~ate before solubilization. The apparent Stokes radius of the solubilized receptor was estimated to be 57 A and that the hormone-receptor complex 60 A. The sedimentation coefficient of the solubilized receptor was 7.0 _ 0.1 s, whereas that of the hormone-receptor complex was 7.5 ± 0.2 s.

Research paper thumbnail of The Endometrium in Human Assisted Reproduction

Annals of the New York Academy of Sciences, 1991

The assessment of endometrial function in physiological conditions is one of the most controversi... more The assessment of endometrial function in physiological conditions is one of the most controversial areas in reproduction, and the situation is further complicated in human assisted reproduction by the multitude of variables associated with any form of treatment. So-called medically assisted reproduction implies different degrees of intervention, which are intended to overcome an identified or even a non-identified factor of reproductive failure, but these interventions may potentially alter endometrial receptivity for adequate implantation. Thus, when we select an infertile female patient with evident ovarian function, either normal or abnormal, for a specific assisted reproductive treatment, the first "manipulation" we do, to improve the chance of establishing pregnancy, is controlled ovarian hyperstimulation: a key and critical step between the selection of patients and the adoption of one of the treatment techniques (FIG. 1). Different strategies are adopted for inducing multiple follicular growth. The protocols mainly used are the combination of clomiphene citrate (CC) with human menopausal gonadotropins (hMG), the combination of hMG with gonadotropin releasing hormone agonists (GnRH-a) or hMG alone. Whichever protocol is used, the expected multiple follicular growth will produce supraphysiological levels of estradiol during the follicular phase and the resulting multiple corpora lutea will produce supraphysiological levels of estradiol and progesterone during the luteal phase. Another important aspect regarding the endometrial environment, which differentiates in virro fertilization with intrauterine embryo transfer from other techniques and natural conception, is the different timing of arrival of embryos into the uterine cavity and the different developmental stage of the embryo at that time. In fact, in spontaneous conception, and we have to suppose the same situation exists after the replacement of embryos or gametes into the tubes, a morula or an early blastocyst will arrive into the uterine cavity 5-6 days after the ovulation. In in vitro fertilization (IVF) embryos at 4-8 blastomeric stage are usually replaced into the uterine cavity 48 hours after the oocyte retrieval. Most studies designed to investigate endometrial function have been conducted in IVF and embryo transfer (ET) studies, so we have to keep in mind these points in reviewing this topic.