Mercorio, A.; Della Corte, L.; De Angelis, M.C.; Buonfantino, C.; Ronsini, C.; Bifulco, G.; Giampaolino, P. Ovarian Drilling: Back to the Future. Medicina 2022, 58, 1002. https://doi.org/10.3390/ medicina58081002

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. The complex metabolic dysregulation at the base of this syndrome often renders infertility management challenging. Many pharmacological strategies have been applied for the induction of ovulation with a non-negligible rate of severe complications such as ovarian hyperstimulation syndrome and multiple pregnancies. Ovarian drilling (OD) is currently being adopted as a second-line treatment, to be performed in case of medical therapy. Laparoscopic ovarian drilling (LOD), the contemporary version of ovarian wedge resection, is considered effective for gonadotropins in terms of live birth rates, but without the risks of iatrogenic complications in gonadotropin therapy. Its endocrinal effects are longer lasting and, after the accomplishment of this procedure, ovarian responsiveness to successive ovulation induction agents is enhanced. Traditional LOD, however, is burdened by the potential risks of iatrogenic adhesions and decreased ovarian reserve and, therefore, should only be considered in selected cases. To overcome these limits, novel tailored and mini-invasive approaches, which are still waiting for wide acceptance, have been introduced, although their role is still not well-clarified and none of them have provided enough evidence in terms of efficacy and safety

Fractional Microablative CO2 Laser-Related Histological Changes on Vulvar Tissue in Patients With Genitourinary Syndrome of Menopause

Background and Objectives: Fractional CO2 laser has been proposed as an effective treatment for the genitourinary syndrome of menopause (GSM). However, the effects of laser treatment on vulvar tissue have never been assessed. We aimed to assess histological changes related to fractional CO2 laser in vulvar tissue from GSM patients. Study Design/Materials and Methods: A single-center observational prospective cohort study was performed enrolling all GSM patients from July 2017 to October 2018. Patients underwent three outpatient vulvovaginal applications of fractional CO2 laser and vulvar biopsy before and after treatment. Rates of histological changes in vulvar tissue, the difference in means of Vulva Health Index (VuHI), Vaginal Health Index (VHI), Visual Analogue Scale scores for GSM symptoms, and procedure-related pain, and rate of patient's overall satisfaction with treatment were assessed. Univariate comparisons between continuous variables were performed by using the paired t-test (α error = 0.05). Results: Of 20 enrolled patients, 18 underwent all laser applications, and 15 underwent both vulvar biopsies. 93.3% of patients showed remodeling of vulvar connective tissue; 80% showed improvement in vulvar epithelium trophism and 86.7% showed neovascularization. Differences in means between before and after treatment were significant for VuHI, VHI, and all GSM symptoms. Means ± standard deviation of the degree of pain at each laser application were 4.4 ± 0.9, 3.7 ± 1.6, and 2.9 ± 1.9. The rate of overall satisfaction with the treatment was 72.2%. Conclusions: Fractional CO2 laser leads to a restoration of the normal architecture of vulvar tissue, with significant improvement in GSM-related signs and symptoms, and overall satisfaction with the treatment in most GSM patients. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

Microbiome and PCOS: State-of-art and future aspects

Polycystic ovary syndrome (PCOS) is a complex and heterogeneous endocrine disease. The hypothesis that alterations in the microbiome are involved in the genesis of PCOS has been postulated. Aim of this review is to summarize the available literature data about the relationship between microbiome and PCOS. A search on PubMed and Medline databases was performed from inception to November 20Most of evidence has focused on the connection of intestinal bacteria with sex hormones and insulin-resistance: while in the first case, a relationship with hyperandrogenism has been described, although it is still unclear, in the second one, chronic low-grade inflammation by activating the immune system, with increased production of proinflammatory cytokines which interfere with insulin receptor function, causing IR (Insulin Resistance)/hyperinsulinemia has been described, as well as the role of gastrointestinal hormones like Ghrelin and peptide YY (PYY), bile acids, interleukin-22 and Bacteroides vulgatus have been highlighted. The lower genital tract mi-crobiome would be affected by changes in PCOS patients too. The therapeutic opportunities include probiotic, prebiotics and synbiotics, as well as fecal microbiota transplantation and the use of IL-22, to date only in animal models, as a possible future drug. Current evidence has shown the involvement of the gut microbiome in PCOS, seen how humanized mice receiving a fecal transplant from women with PCOS develop ovarian dysfunction, immune changes and insulin resistance and how it is capable of disrupting the secondary bile acid biosynthesis. A future therapeutic approach for PCOS may involve the human administration of IL-22 and bile acid glycodeoxycholic acid

Bisphenol A-Induced Epigenetic Changes and Its Effects on the Male Reproductive System

Bisphenol A (BPA) is a widespread chemical agent which can exert detrimental effects on the male reproductive system. Exposure to BPA has been shown to induce several epigenetic modifications in both animal and human cells. Specifically, BPA could not only modify the methylation pattern of multiple genes encoding proteins related to reproductive physiology but also directly influence the genes responsible for DNA methylation. BPA effects include hormonal alterations, microscopic and macroscopic alteration of male reproductive organs, and inheritable epigenetic changes involving human reproduction. BPA exposure was also linked to prostate cancer. This review aims to show the current scenario of BPA-induced epigenetic changes and its effects on the male reproductive system. Possible strategies to counter the toxic effect of BPA were also addressed

Effect of rescue fractional microablative CO2 laser on symptoms and sexual dysfunction in women affected by vulvar lichen sclerosus resistant to long-term use of topic corticosteroid: a prospective longitudinal study

OBJECTIVE: The objective of this study was to evaluate the efficacy of rescue fractional microablative CO2 laser treatment in women with severe symptoms and sexual dysfunction related to lichen sclerosus not responsive to long-term ultra-potent topical corticosteroid treatment. METHODS: Consecutive eligible women with lichen sclerosus referred to our unit who received fractional microablative CO2 laser treatment after failure of ultra-potent topical corticosteroid treatment were enrolled in the study. The diagnosis was confirmed by histological assessment in all cases. Patients underwent two cycles of CO2 laser every 30 to 40 days. The severity of lichen sclerosus-related symptoms, sexual function, and procedure discomfort were evaluated with a visual analog scale in the same individual at baseline, after completion of each treatment cycle. Follow-up visits were scheduled during each treatment cycle and at least 1 month after completion of the treatment. The Friedman ANOVA test was used to evaluate differences in the visual analog scale scores of each symptom during treatment. RESULTS: A total of 100 patients with vulvar lichen sclerosus were screened, 40 of whom fulfilled the eligibility criteria. We found a significant improvement in vulvar itching (χ [2] = 31,182, P < 0.001), vulvar dryness (χ [2] = 40,364, P < 0.001), superficial dyspareunia (χ [2] = 37,488, P < 0.001), and sensitivity during intercourse (χ [2] = 22,143, P < 0.001) after two CO2 laser cycles. Pain related to probe movement and laser application was low and did not change significantly consequent to treatment. No systemic or local adverse effects occurred during or after laser treatment. CONCLUSION: Fractional microablative CO2 laser treatment is safe and might represent an effective rescue procedure for patients suffering from lichen sclerosus who fail to respond to long-term ultra-potent topical corticosteroid treatment. These preliminary findings require further study with adequately powered randomized controlled trials

Ivf during coronavirus pandemic: Who comes first? the poseidon viewpoint

COVID-19 is the world’s most massive epidemic known to date. In order to prevent hospital burdens, governments around the world have adopted restrictive containment mea-sures. Such measures have led to a temporary suspension of all non-urgent clinical procedures. With the reduction of con-tagions, in some country there is a slow and gradual restoration of clinical treatments including reproductive medicine. Even with all safety precautions, the risk of infection is real for infertility patients, medical staff, and the community, making it crucial to establish which infertile patients should be prioritized for treatment provision. Indeed, postponing treatments in infertile patients who show a strictly time-de-pendent reproductive prognosis, could definitely affect reproductive chances. In this sense, POSEIDON group propose the use of a specific algorithm that could help clinicians to most optimally manage who need immediate IVF treatment during COVID-19 pandemic

Preimplantation genetic testing: Comparative analysis of jurisprudential regulations

Preimplantation genetic testing (PGT) is used to screen for genetic diseases or chromosomal abnormalities in couples at risk of transmission to the offspring. It can be applied also to determine the gender or phenotypical features of the unborn and to type the Human Leucocyte Antigen (HLA), in order to search for future potential stem cell or bone marrow donors. Aim of this review is to provide a comprehensive description of Italian jurisprudential approach on PGT, and in addition, to compare the jurisprudential orientation of other nations of West Europe and USA. PGT is allowed for almost any indication in some countries (United Kingdom and USA), but is forbidden in others (Austria). In the majority of countries PGT is authorized to prevent the transmission of genetic diseases, being considered unacceptable for gender selection for non-medical reasons. Less frequently, PGT is allowed to provide therapeutic options for an already born sibling. In some cases, prior authorization from a health authority or a healthcare provider is requested. Social, healthcare and ethical issues underpin the request for PGT. Given the difficulty to identify a list of genetic diseases for which could be authorized the access to PGT, the European Society of Human Reproduction and Embriology (ESHRE) proposes to limit such test to cases characterized by a “high risk of a serious condition”. In such a framework, it has been proposed that the access to PGT is allowed through a prior in-depth meeting between the couple and a multidisciplinary equipe of healthcare professionals (obstetrician, geneticist, psychologist, expert in bioethics, legal-medicine specialist) to evaluate the medical, but also juridical and ethical acceptability of the request

PHENYLTHIOCARBAMIDE TASTING STATUS AFFECTS QUININE-MEDIATED REDUCTION OF FOOD INTAKE

Background and aim: Intra-duodenal administration of quinine is able to reduce calorie intake, likely acting on gut bitter taste receptors (T2R) expressed by enteroendocrine cells in the gut. Genetic variability to taste phenylthiocarbamide (PTC) is closely related to oral bitter taste perception of quinine. Our aim is to assess whether PTC tasting status could affect quinine-mediated reduction of food intake. Material and methods: Twenty healthy subjects (12 women, 8 men; median age 27 years) were screened to determine PTC tasting status. In two different days, each subject received an acid-resistant capsule containing either placebo or 18 mg of hydrochloride (HCl) quinine in a double-blind crossover fashion. After 60 minutes, all subjects were allowed to eat an ad libitum meal until they achieve satiation. Calorie intake and meal duration were recorded at the end of the test. Data (mean±SD) were compared by using unpaired t test. Results: Eleven out of 20 subjects were identified as “tasters”, while 9 subjects were not able to identify any bitter sensation and were classified as “non-tasters”. PTC tasters ingested a significantly lower amount of calories when they received quinine compared to placebo (526±275 vs. 659±320 kcal; p=0.005), whereas no significant differences were found for PTC non-tasters (499±227 vs. 519±231 kcal; p=NS). PTC tasters presented a significantly higher difference in calorie intake between two experiments (1 kcal = kcal quinine − kcal placebo) compared to non-tasters (−134±124 vs. −20±89 kcal; p=0.034). Conclusions: Intra-duodenal administration of quinine is able to reduce calorie intake in PTC tasters but not in PTC non-tasters. This result suggests that the mechanism involved in PTC perception in the oral cavity is analogousin the gut, enhancing the role of T2R in quinine-mediated reduction of food intake. Further studies are needed to elucidate the role of T2R in the control of food intake

The negative impact of most relevant infections on fertility and assisted reproduction technology

Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments