Reproductive Medicine Unit

Catania, Italy

Reproductive Medicine Unit

Catania, Italy
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Kamath M.S.,Reproductive Medicine Unit | Kalampokas E.E.,National and Kapodistrian University of Athens | Kalampokas T.E.,University of Aberdeen
European Journal of Obstetrics Gynecology and Reproductive Biology | Year: 2014

GnRH analogues are commonly used before hysteroscopic myomectomy to make surgery easier and safer, but they are expensive, have potential side effects and lack a robust evidence base to support this practice. We undertook a systematic review of the literature to determine whether, in women with submucous fibroids, pre-operative GnRH analogues were more effective than placebo/no treatment in terms of symptom relief, complications and ease of surgery. The outcomes were patient-reported relief of symptoms, complete resection of the fibroids, operative time and complications. Meta-analysis was performed where appropriate. Two trials including 86 women were identified. The assessment of symptom relief differed in the two trials: hence it was not possible to combine these data. The relative risk for completion of surgery and mean differences (95% confidence intervals) for operating time and fluid deficit were [0.94 (0.68-1.31); -5.34 min, (-7.55 min to -3.12 min) and -176.2 ml, (-281.05 ml to -71.5 ml)] respectively. Our results suggest that GnRHa may improve some outcomes but there is insufficient evidence to support their routine use prior to hysteroscopic resection of submucous fibroids. More randomised trials are needed to inform definitive conclusions. © 2014 Elsevier Ireland Ltd.

Harper J.,University College London | Cristina Magli M.,Reproductive Medicine Unit | Lundin K.,Sahlgrenska University Hospital | Barratt C.L.R.,University of Dundee | Brison D.,University of Manchester
Human Reproduction | Year: 2012

There are many examples in assisted reproduction technology, where new technology and methods have been introduced into the clinical setting without appropriate development and evidence-based medicine to show that the procedure is safe and beneficial to the patient. Examples include preimplantation genetic screening, assisted hatching, in vitro maturation, blastocyst transfer and vitrification. Changes to culture media composition, stimulation regimes and laboratory protocols are also often established internationally without adequate validation. More recently, novel equipment that needs to be validated before it enters routine clinical use is being developed for IVF. With technologies such as producing gametes from stem cells around the corner, it is vital to ensure that the necessary research and development is conducted before bringing new techniques into clinical practice. Ideally, this should include preliminary work on animal models, such as mice/rats/rabbits/larger mammals, followed by studies on human embryos donated for research and finally well-designed RCTs with a follow up of all children born from the procedure. If such preliminary studies are not performed and published, it is possible that technology bringing no clinical benefit or leading to adverse health outcomes in the children born by these practices may be introduced. All IVF clinics need to consider the safety and efficacy of new technologies before introducing them. © The Author 2011. Published by Oxford University Press. All rights reserved.

Kamath M.S.,Reproductive Medicine Unit | Bhattacharya S.,University of Aberdeen
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2012

The cause of infertility is unexplained in about 22-28% of all infertile couples. The prognosis for spontaneous pregnancy in such couples is better than in those with diagnosed causes of infertility. Traditional treatment options in this group have included expectant management, clomifene citrate, intrauterine insemination with (super ovulation plus intrauterine insemination) or without (intrauterine insemination) super ovulation and in-vitro fertilisation. Despite being more expensive, empirical clomifene and intrauterine insemination in an unstimulated cycle do not improve the chances of live birth compared with expectant management. Although unlikely to be more effective than no treatment in couples with a reasonably good prognosis, super ovulation plus intrauterine insemination has been shown to be more effective than intrauterine insemination. Any potential advantage of super ovulation plus intrauterine insemination has to be balanced against the relatively high risk of iatrogenic multiple pregnancy. In-vitro fertilisation remains the treatment of choice in longstanding unresolved infertility and, when coupled with the use of elective single embryo transfer, can minimise the risk of multiple pregnancies. Data from randomised trials confirming the superiority of in-vitro fertilisation over expectant management is limited. © 2012 Elsevier Ltd. All rights reserved.

Younis J.S.,Reproductive Medicine Unit | Younis J.S.,Bar - Ilan University | Laufer N.,Hebrew University of Jerusalem
Journal of Women's Health | Year: 2015

Maternal age at first pregnancy and age-related infertility are steadily increasing, and the demand for assisted reproductive technologies (ART) to treat age-related infertility is also on the rise. The latest registry findings from Europe and the United States show that the meager results of ART in women above 43 years of age have not improved much over the past 10 years. The latest evidence shows that the demand for oocyte donation (OD) is steadily increasing. Contrary to previous belief - attributing increased perinatal complications in OD recipients to advanced maternal age and multifetal pregnancy - accumulating evidence from the past few years suggests that OD itself is a significant and independent risk factor for pregnancy complications, mostly for pre-eclampsia. The increased rate of chronic maternal disease and medical complications in pregnancy observed in advanced maternal age, coupled with the growing demand for OD, with its independent association with pre-eclampsia, create an urgent need to adopt a clear policy taking these risks into account. We present recent evidence showing that OD is an independent risk factor for pre-eclampsia and suggest recommendations for women approaching OD treatment in advanced age. © Copyright 2015, Mary Ann Liebert, Inc.

Chittawar P.B.,Bansal Hospital | Kamath M.S.,Reproductive Medicine Unit
Current Opinion in Obstetrics and Gynecology | Year: 2015

Purpose of review The main purpose of this review is to collect the most recent evidence with regards to safety and effectiveness of the nonsurgical and minimally invasive treatment options for uterine fibroids. Recent findings Among the nonsurgical options, uterine artery embolization (UAE), and in eligible patients, magnetic resonance-guided high-intensity focused ultrasound (MRgFUS) are emerging as effective alternatives to surgical options for treatment of symptomatic fibroids. MRgFUS is comparable to UAE, and appears to be a cost effective treatment option, especially in older women, although long-term data are awaited. The transvaginal route for radiofrequency ablation is a promising new nonsurgical alternative, which needs to be studied in larger trials to establish its safety and efficacy. The laparoscopic myomectomy results in less postoperative pain, reduced febrile morbidity, and shorter hospital stay when compared with open laparotomy. The newer robotic approach is comparable to traditional laparoscopic technique in short surgical outcomes but is associated with higher costs. Hysteroscopic myoma resection is an effective surgical intervention for submucous fibroids and prior misoprostol use can help in reducing cervical lacerations. Summary UAE and MRgFUS can be offered as an alternative nonsurgical option for eligible women with symptomatic fibroids. Laparoscopic myomectomy remains a safe and effective surgical option with advantage of less postoperative pain and faster recovery compared with open laparotomy for women who wish to retain their fertility options. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Taraborrelli S.,Reproductive Medicine Unit
Acta Obstetricia et Gynecologica Scandinavica | Year: 2015

Introduction. The aim of this article is to review the physiology of progesterone and focus on its physiological actions on tissues such as endometrium, uterus, mammary gland, cardiovascular system, central nervous system and bones. In the last decades, the interest of researchers has focused on the role of progesterone in genomic and non-genomic receptor mechanisms. Materials and Methods. We searched PubMed up to December 2014 for publications on progesterone/steroidogenesis. Results and Conclusions. A better understanding of the biological genomic and non-genomic receptor mechanisms could enable us in the near future to obtain a more comprehensive knowledge of the safety and efficacy of this agent during hormone replacement therapy (natural progesterone), in vitro fertilization (water-soluble subcutaneous progesterone), in traumatic brain injury, Alzheimer's disease and diabetic neuropathy, even though further clinical studies are needed to prove its usefulness. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Ciampaglia W.,Reproductive Medicine Unit | Cognigni G.E.,Reproductive Medicine Unit
Acta Obstetricia et Gynecologica Scandinavica | Year: 2015

Introduction. Progesterone is essential in establishing and maintaining early pregnancy. This article discusses the clinical applications of progesterone in reproductive medicine and in the management of infertile patients, focusing on the different available formulations of this drug. Material and methods. The literature of the last 20 years was reviewed and the most rilevant studies were critically analyzed. Conclusions. Intramuscular or vaginal progesterone administration is critical to support the luteal phase following in-vitro fertilization and is widely employed in intrauterine insemination cycles as well. Furthermore, this hormone is usually administered in many disorders of the first trimester of pregnancy, including threatened abortion and recurrent miscarriage, but the evidence supporting its clinical efficiency is inconsistent. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Filicori M.,Reproductive Medicine Unit
Acta Obstetricia et Gynecologica Scandinavica | Year: 2015

The physiologic and clinical value of progesterone is undisputed and a cornerstone of human reproduction. Better understanding of the exact dynamics and effects of endogenous progesterone secretion, as well as its therapeutic actions, is critical to ensure optimal clinical results in artificial reproduction technology, and to enhance chances of successfully completing pregnancy. Novel progesterone-based drugs and administration regimens will provide clinicians with greater options to make the management and treatment of infertile couples less burdensome and more successful. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Younis J.S.,Reproductive Medicine Unit
Obstetrics and Gynecology | Year: 2010

Objective: To prospectively compare the Protein C Global assay results in a cohort of infertile women who conceived after assisted reproductive technology (ART) with results from women who conceived spontaneously. Methods: Sixty-four infertile women who conceived after ART and 47 fertile women who conceived spontaneously were prospectively evaluated. All women in the study and control groups had singleton pregnancies. The Protein C Global assay was performed in the two groups on four occasions: during the first, second, and third trimesters, as well as 6 weeks or later after delivery (baseline). Results: Protein C Global assay results declined gradually during pregnancy in both groups. However, basal as well as first-and second-trimester Protein C Global assay results were significantly lower in the infertile group compared with the fertile group, corresponding to 0.89±0.22 and 1.06±0.33 (P=.025), 0.79±0.15 and 0.87±0.19 (P=.036), and 0.73±0.10 0.79±0.13 (P=.012), respectively. Conclusion: These findings support the notion that infertile women conceiving singleton pregnancies after ART are a priori at an increased hypercoagulation state. Protein C Global assay levels decline gradually during pregnancy in women who conceived naturally, as well as in infertile women who conceived after ART treatment. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.

Ferraretti A.P.,Reproductive Medicine Unit | Gianaroli L.,Reproductive Medicine Unit
Human Reproduction | Year: 2014

The Bologna criteria were published by the European Society of Human Reproduction and Embryology (ESHRE) in 2011 to help address the lack of a clear definition of poor ovarian responders. Since its publication, aspects of the criteria have been cited several times, whilst others have been criticized. In this debate, we re-examine the criteria (which address age, the number of oocytes retrieved and the results of ovarian reserve tests) following new evidence produced and we analyse the criticism received in an attempt to determine if revisions are needed. © 2014 The Author.

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