Obstetrics and Gynecology Center

Rome, Italy

Obstetrics and Gynecology Center

Rome, Italy

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Vella B.D.,Umberto I Hospital | Unfer V.,Obstetrics and Gynecology Center | Nania C.,University of Rome La Sapienza | Borgia M.L.,University of Rome La Sapienza | And 2 more authors.
European Review for Medical and Pharmacological Sciences | Year: 2012

We report an uncommon case of a 38-years-old pregnant woman affected by HHT (Hereditary haemorrhagic telangiectasia; Osler- Weber-Rendu syndrome) who underwent to a caesarean section (CS) without any complication. The patient at 36th weeks+1 day pregnancy referred to the Emergency Obstetric Unit due to a intercostals pain on left side. On third day after admission the woman started travailing and physicians decided to perform the CS. Considering that no AVMs was found at MRI, a continuous spinal anaesthesia was planned. On postpartum day 4 the patient was discharged. This represents the only case published in the literature. Women with HHT, especially those with arteriovenous malformations (AVM), are at high risk in pregnancy due to physiological haemodynamic changes pregnancy associated. Early screening of patients with HHT for the presence of spinal cord or cerebral AVMs is recommended to optimise perioperative anaesthetic management and to avoid severe complications.


Unfer V.,Obstetrics and Gynecology Center | Raffone E.,G Martino Hospital | Rizzo P.,G Martino Hospital | Buffo S.,Casa di Cura Psichiatrica Colle Cesarano
Gynecological Endocrinology | Year: 2011

Background.Several factors can affect oocyte quality and therefore pregnancy outcome in assisted reproductive technology (ART) cycles. Recently, a number of studies have shown that the presence of several compounds in the follicular fluid positively correlates with oocyte quality and maturation (i.e., myo-inositol and melatonin). Aim.In the present study, we aim to evaluate the pregnancy outcomes after the administration of myo-inositol combined with melatonin in women who failed to conceive in previous in vitro fertilization (IVF) cycles due to poor oocyte quality. Materials and methods.Forty-six women were treated with 4 g/day myo-inositol and 3 mg/day melatonin (inofolic® and inofolic® Plus, Lo.Lipharma, Rome) for 3 months and then underwent a new IVF cycle. Results.After treatment, the number of mature oocytes, the fertilization rate, the number of both, total and top-quality embryos transferred were statistically higher compared to the previous IVF cycle, while there was no difference in the number of retrieved oocyte. After treatment, a total of 13 pregnancies occurred, 9 of them were confirmed echographically; four evolved in spontaneous abortion. Conclusion.The treatment with myo-inositol and melatonin improves ovarian stimulation protocols and pregnancy outcomes in infertile women with poor oocyte quality. © 2011 Informa UK, Ltd.


Carlomagno G.,Obstetrics and Gynecology Center | Unfer V.,Obstetrics and Gynecology Center | Buffo S.,Casa di Cura Psichiatrica Colle Cesarano | D'Ambrosio F.,University of Rome Tor Vergata
Human Psychopharmacology | Year: 2011

Objective: Premenstrual dysphoric disorder (PMDD) is a mood disorder disrupting social and/or occupational life of affected women. Premenstrual dysphoric disorder etiology is unknown, although a pivotal role is played by the serotoninergic system. Indeed, one of the most effective treatments is selective serotonin reuptake inhibitors. Several studies have proposed a selective serotonin reuptake inhibitor-like role for myo-inositol, likely due to the fact that myo-inositol is the second messenger of serotonin. In the present study, we aimed to investigate the effect of myo-inositol in the treatment of PMDD. Methods: We used a two-phase clinical trial approach (phase I: placebo washout; phase II: comparisons between treatment and placebo) and treated PMMD patients with two different myo-inositol formulations: powder or soft gel capsules. We decided to test these two formulations because according to the manufacturer, 0.6 of myo-inositol in soft gel capsule has a pharmacokinetic equivalent to 2g of myo-inositol in powder. Results: Our results showed a significant improvement of three different scales: a reduction in the Daily Symptoms Records scale and an improvement of the Hamilton Depression Rating and Clinical Global Impression Severity of Illness scales. Results were similar for both formulations. Conclusions: In the present study, by using a new pharmaceutical formulation, we were able to clearly prove the efficacy of myo-inositol in PMDD. Copyright © 2011 John Wiley & Sons, Ltd.


Unfer V.,Obstetrics and Gynecology Center | Carlomagno G.,Obstetrics and Gynecology Center | Rizzo P.,Messina University | Raffone E.,Messina University | Roseff S.,Palm Beach Center for Reproductive Medicine
European Review for Medical and Pharmacological Sciences | Year: 2011

Objective: Polycystic ovary syndrome (PCOS) is the most common cause of infertility due to menstrual dysfunction, and the most promising treatments for this disease are insulin sensitising agents. Myo-inositol and D-chiro-inositol are insulin sensitizing agents used in PCOS treatment. In the present paper, we aimed to compare the effects myo-inositol and D-chiro-inositol on oocyte quality in euglycemic PCOS patients. Materials and Methods: Eighty-four euglycemic PCOS patients, undergoing ovulation induction for ICSI, were recruited for this study. Forty-three participants received Myo-Inositol 2 g twice a day and forty-one patients received D-chiro inositol 0.6 g twice a day. Results: The results of our study showed that the total number of oocytes retrieved did not differ in the two treatments groups. However, the number of mature oocytes was significantly increased in the myo-inositol group compared to D-chiro-inositol. Concurrently, the number of immature oocytes decreased in myo-inositol treated patients. Furthermore, the myo-inositol-treated group showed an increase in the mean number of top quality embryos and in the total number of pregnancies compared to the D-chiro-inositol-treated group. Conclusions: Our data show that, in PCOS patients having a normal insulin response, myo-inositol treatment rather than D-chiro-inositol is able to improve oocyte and embryo quality during ovarian stimulation protocols.


Unfer V.,Obstetrics and Gynecology Center | Carlomagno G.,Obstetrics and Gynecology Center | Dante G.,University of Modena and Reggio Emilia | Facchinetti F.,University of Modena and Reggio Emilia
Gynecological Endocrinology | Year: 2012

Polycystic ovary syndrome (PCOS) affects 5%-10% of women in reproductive age, and it is the most common cause of infertility due to ovarian dysfunction and menstrual irregularity. Several studies have reported that insulin resistance is common in PCOS women, regardless of the body mass index. The importance of insulin resistance in PCOS is also suggested by the fact that insulin-sensitizing compounds have been proposed as putative treatments to solve the hyperinsulinemia-induced dysfunction of ovarian response to endogenous gonadotropins. Rescuing the ovarian response to endogenous gonadotropins reduces hyperandrogenemia and re-establishes menstrual cyclicity and ovulation, increasing the chance of a spontaneous pregnancy. Among the insulin-sensitizing compounds, there is myo-inosiol (MYO). Previous studies have demonstrated that MYO is capable of restoring spontaneous ovarian activity, and consequently fertility, in most patients with PCOS. With the present review, we aim to provide an overview on the clinical outcomes of the MYO use as a treatment to improve ovarian function and metabolic and hormonal parameters in women with PCOS. © 2012 Informa UK, Ltd.


Condorelli R.A.,University of Catania | Lavignera S.,University of Catania | Di Bari F.,University of Catania | Unfer V.,University of Catania | And 2 more authors.
European Review for Medical and Pharmacological Sciences | Year: 2011

Background and Objectives: Inositol is a component of the vitamin B complex. Myo-inositol (MYO) is the most biologically important form in nature. It is involved in several systemic processes and in mechanisms of signal transduction in the plasma membrane as precursor of second messengers. On the male reproductive function, MYO appears to regulate seminal plasma osmolarity and volume; the expression of proteins essential for embryogenetic development and sperm chemiotaxis; and sperm motility, capacitation, and acrosome reaction. Recently, a seminal antioxidant action has also been suggested. Aim of the Study: To evaluate the effects of MYO on sperm mitochondrial function and apoptosis. Materials and Methods: Spermatozoa isolated from 5 normozoospermic men and from 7 patients with oligo-astheno-teratozoospermia (OAT) were incubated in-vitro with 2 mg/ml of MYO or placebo (control) for 2 hours. After this incubation period, the following sperm parameters were evaluated by flow cytometry: mitochondrial membrane potential (MMP) by JC-1 staining; phosphatidylserine (PS) externalization by annexin V and propidium iodide double staining; and chromatin compactness following propidium iodide staining. Results: MYO did not affect the mitochondrial function of spermatozoa isolated from normozoospermic men, whereas it increased significantly the number of spermatozoa with high MMP and decreased significantly the number of those with low MMP in OAT patients. No effect of MYO was observed on PS externalization and chromatin compactness in both normozoospermic men and OAT patients. Conclusion: The data suggest that MYO is able to ameliorate mitochondrial function in OAT patients. We conclude that this compound may be useful for the treatment of male infertility.


Minozzi M.,University of Rome La Sapienza | Costantino D.,Centro Salute Donna Azienda Usl Ferrara Italy | Guaraldi C.,Hospital of Valdagno Italy | Unfer V.,Obstetrics and Gynecology Center
Gynecological Endocrinology | Year: 2011

Aim.Compare the effects of a combined contraceptive pill (OCP) in combination with myo-inositol (MI) on endocrine, metabolic, and clinical parameters in patients with polycystic ovary syndrome (PCOS). Methods.One hundred fifty-five patients with PCOS were enrolled in this prospective, open-label clinical study. Patients were assigned to receive oral treatment with OCP alone (estradiol (EE) 30μg/gestodene 75μg) or in combination with myo-inositol 4 g/die, for 12 months. Results.OCP plus MI therapy resulted in a higher reduction of FG score compared with OCP alone therapy. The combined therapy (OCP plus MI) significantly decreased hyperinsulinaemia, by positively affecting the fasting insulin and glucose levels and homeostasis model assessment-insulin resistance parameters, while no significant changes were observed in the OCP group. Androgens serum levels decreased in both groups, but significantly more in the combined therapy group. The lipid profile was improved in the combined therapy group, by reducing low-density lipoprotein cholesterol levels and enhancing high-density lipoprotein cholesterol levels. Conclusions.Our data show that a combination of combined contraceptive pill and MI may be more effective in controlling endocrine, metabolic, and clinical profile in patients with PCOS than OCP alone, and may reduce insulin levels and insulin resistance. Hence, combined treatment may become a more effective long-term therapeutic choice for controlling PCOS symptoms. © 2011 Informa UK, Ltd.


Carlomagno G.,Obstetrics and Gynecology Center | Unfer V.,Obstetrics and Gynecology Center
European Review for Medical and Pharmacological Sciences | Year: 2011

Myo-inositol is a six carbon cyclitol that contains five equatorial and one axial hydroxyl groups. Myo-inositol has been classified as an insulin sensitizing agent and it is commonly used in the treatment of the Polycystic Ovary Syndrome (PCOS). However, despite its wide clinical use, there is still scarce information on the myo-inositol safety and/or side effects. The aim of the present review was to summarize and discuss available data on the myo-inositol safety both in non-clinical and clinical settings. The main outcome was that only the highest dose of myo-inositol (12 g/day) induced mild gastrointestinal side effects such as nausea, flatus and diarrhea. The severity of side effects did not increase with the dosage.


PubMed | Obstetrics and Gynecology Center
Type: Journal Article | Journal: Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology | Year: 2012

Polycystic ovary syndrome (PCOS) affects 5%-10% of women in reproductive age, and it is the most common cause of infertility due to ovarian dysfunction and menstrual irregularity. Several studies have reported that insulin resistance is common in PCOS women, regardless of the body mass index. The importance of insulin resistance in PCOS is also suggested by the fact that insulin-sensitizing compounds have been proposed as putative treatments to solve the hyperinsulinemia-induced dysfunction of ovarian response to endogenous gonadotropins. Rescuing the ovarian response to endogenous gonadotropins reduces hyperandrogenemia and re-establishes menstrual cyclicity and ovulation, increasing the chance of a spontaneous pregnancy. Among the insulin-sensitizing compounds, there is myo-inosiol (MYO). Previous studies have demonstrated that MYO is capable of restoring spontaneous ovarian activity, and consequently fertility, in most patients with PCOS. With the present review, we aim to provide an overview on the clinical outcomes of the MYO use as a treatment to improve ovarian function and metabolic and hormonal parameters in women with PCOS.


PubMed | Obstetrics and Gynecology Center
Type: Journal Article | Journal: Expert opinion on drug delivery | Year: 2012

Neural tube defects (NTDs) are classified as folate sensitive (about 70%) and folate resistant (about 30%); although folic acid is able to prevent the former, several data have shown that inositol may prevent the latter. It has recently been proposed that coffee intake might represent a risk factor for NTD, likely by interfering with the inositol signaling. In the present study, we tested the hypothesis that, beside affecting the inositol signaling pathway, coffee also interferes with inositol absorption.In order to evaluate coffee possible negative effects on inositol gastrointestinal absorption, a single-dose bioavailability trial was conducted. Pharmacokinetics (PK) parameters of myo-inositol (MI) powder and MI soft gelatin capsules swallowed with water and with a single espresso were compared. PK profiles were obtained by analysis of MI plasma concentration, and the respective MI bioavailability was compared.Myo-inositol powder administration was negatively affected by coffee intake, thus suggesting an additional explanation to the interference between inositol deficiency and coffee consumption. On the contrary, the concomitant single espresso consumption did not affect MI absorption following MI soft gelatin capsules administration. Furthermore, it was observed that MI soft gelatin capsule administration resulted in improved bioavailability compared to the MI powder form.Myo-inositol soft gelatin capsules should be considered for the preventive treatment of NTDs in folate-resistant subjects due to their higher bioavailability and to the capability to reduce espresso interference.

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