Freezing spermatozoa obtained by testicular fine needle aspiration: a new technique.

Testicular fine needle aspiration (TEFNA) of spermatozoa in azoospermic patients in advance of intracytoplasmic sperm injection could be useful to avoid the possibility of no recovery of spermatozoa on the day of oocyte retrieval. The conventional freezing procedure for these spermatozoa is not appropriate because of their very low number and poor in-situ motility. This article presents a new procedure for the freezing of TEFNA-recovered spermatozoa. A total of 1063 spermatozoa (10-340 cells/sample) were frozen by this method for research purposes. Before freezing, 13.7% were motile. The recovery rate after thawing was 100%. After thawing, 3.6% motility was observed. In a separate study group, the total number of frozen spermatozoa was 431 (2-300 cells/sample). Before freezing, the sperm motility rate was 3.5%. After thawing, 100% of the spermatozoa were retrieved with a motility rate of 2.3%. One biochemical pregnancy was obtained. The procedure yielded excellent recovery and good motility rates after thawing. However, because of the low number of cases, any conclusion about the efficiency of the technique is premature.

[Congenital factor XIII deficiency in pregnancy. A case report]. / Deficit congenito del fattore XIII in gravidanza. Esposizione di un caso clinico.

Congenital factor XIII deficiency is a rare hemorrhagic syndrome with an altered fibrin stability, hemorrhagic diathesis and habitual abortions. After a short introduction, a case report is described and the clinical differences between plasmatic and platelet deficiency pointed out.

[Clinical-diagnostic considerations of a case of endometrial ossification as a cause of secondary infertility]. / Considerazioni clinico-diagnostiche su un caso di ossificazione endometriale quale causa di sterilità secondaria.

Endometrial ossification is a rare finding. Its aetiology and pathogenesis are controversial. However a history of previous abortion is usually present. It has variable clinical presentations. We report a case in which the patient presented with secondary infertility.

[Authors' experience with transvaginal administration of progestagens]. / Nostra esperienza sulla somministrazione dei progestinici per via transvaginale.

The authors, after a short introducing on the most used kinds of progestins in Hormonal Replacement Therapy (HRT), report this own clinical experience on the efficacy of a micronized progestin treatment given by the vaginal route in comparison with oral somministration, studying in details the protective effects on endometrial hyperplasia and cancer. The role of danazolo on the hormonal balance during HRT has been also evaluated. The results suggest a positive effects of the vaginal somministration of micronized HRT progesterone or danazolo.

[Current orientation about congenital Cytomegalovirus infection]. / Attuali orientamenti in tema di infezione congenita da Cytomegalovirus.

The CMV infection in pregnancy make serious problems about the diagnosis and the fetal prognosis. Infact primary infection by CMV is loaded by an high risk of congenital infection and the presence of antibodies IgG do not prevent a possible reinfection. Furthermore, the latent presence in the host of CMV induces his reactivation when the immunosorveillance decreases during pregnancy. The consequences of primary infection are well shown during pregnancy and they are very grave, but also the reactivations induce especially neurological consequences, that however are shown only after some months from delivery. Therefore in consideration of the prognosis and the poor therapeutics, the management in these cases is essentially to give minute details to the mother about all the consequences for the fetus without to exclude, because of serious sequels, so that just she can to decide the future of her pregnancy.

[Myelodysplasia in triplet pregnancy]. / Mielodisplasia in gravidanza trigemina.

INTRODUCTION: The myelodysplastic syndromes (MSD) are a group of hematologic disorders that manifest dysplastic hematopoiesis and usually a hypercellular bone marrow. Ineffective hematopoiesis leads to haematologic failure in these syndromes. The MDS are a rare event during pregnancy although the exact incidence is unknown it is likely to be less than that for leukaemia. CLINICAL REPORT: The case, a 29 year old woman, presented during 23rd week of her first, triplet, pregnancy with symptoms of anemia and thrombocytopenia is described. DISCUSSION: The pathogenetic aspect and diagnostic management is discussed, underlined especially under the point of view of the triplet pregnancy. It is suggested that the association of myelodysplastic syndromes during pregnancy is coincidental and that acute leukemia evolves in a majority of these cases. Furthermore, refractory macrocytic anemias in pregnancy need to be carefully evaluated for a primary myelodysplastic state.

[Preoperative treatment with GnRH analogs in hysterectomy]. / Trattamento preoperatorio con analoghi del GnRH nella isterectomia.

The authors discuss the usefulness of GnRH analogues inducing, through pituitary desensitization, a transient block of gonadal steroidogenesis--before hysterectomy for uterine leiomyomas. In patients with severe anemia these drugs proved to be very effective in improving the haematologic parameters; they also cause a significant reduction of uterine volume, thus allowing, in selected cases, vaginal hysterectomy in selected cases.

[Clinical use of progestins]. / L'impiego clinico dei progestinici.

The development of progestogens from the thirties till now and their main clinical uses are considered. Progestogens play an essential role not only in the treatment of dysfunctional uterine bleeding and endometrial carcinoma, but also in oral contraception and in hormone replacement therapy for menopausal women. In the last two cases the attention is focused on the relationship between the use of progestogens and the risk of mammary carcinoma.

[Human papillomavirus infections in pregnancy]. / Infezioni da Human Papilloma Virus in gravidanza.

After an overview on the diffusion and transmission of the Human Papilloma Virus infection, the authors' attention is focused on clinical and therapeutic aspects of the disease. Following the most recent findings on congenital transmission, problems related to prophylaxis and therapy are discussed.

Oocyte donation: comparison between recipients from different age groups.

Oocyte donation was carried out in 87 patients in 141 replacement cycles. These patients received oocytes from 108 women undergoing assisted reproductive technology procedures at our centre. Standardized hormonal replacement therapy and in-vitro fertilization procedures were performed. We divided recipients into four groups according to their age (group A, 21-35 years; B, 36-40 years; C, 41-49 years; and D, 50-61 years). Oocytes donors were 21-35 years old, and equally spread across these different age groups. There were significant differences in the pregnancy and implantation rates according to the age of the recipients; which were 45% and 23% respectively in women 21-35 years old (group A) versus 23% and 10% in women 41-49 years old (group C). A comparison of data between oocyte donors and young recipients, with similar results in donors and young recipients, with pregnancy rates of 45% and 42% and implantation rates of 23% and 19.5% respectively. Statistically significant differences were found between donors and the older recipients, pregnancy rates being 43% versus 23%, and implantation rates 18% versus 10%. These data seem to demonstrate a lesser likelihood of pregnancy and implantation in older recipients because of increasing uterine age.