Emilio Giugliano

Procreative sex in infertile couples: the decay of pleasure?

BackgroundInfertility represents a major challenge to the emotional balance and sexual life of couples, with long-lasting and gender-specific effects. The objective of this study is to explore personality features of infertile patients and detect possible sexual disorders in couples undergoing infertility treatment.Materials and methodsIn this prospective study 60 infertile couples and 52 fertile control couples were asked to complete standardized and validated questionnaires: the Adjective Check List (ACL) to enquire about personality features and the Female Sexual Function Index (FSFI) or the International Index of Erectile Function (IIEF) to assess sexual functioning of female and male partners. The study population was divided into 3 groups: Group A (N = 30, recently diagnosed infertile couples) Group B (N = 30, infertile couples already undergoing Intrauterine Insemination) and Group C (N = 52, fertile control group).ResultsInfertile patients did not display any distinguishing personality features. Regarding sexual function, men of all the three groups scored higher in both questionnaires (sexual satisfaction, desire and orgasm) than their female partners. Comparing results between groups, Group A male partners obtained lower scores in all the subscales. Women belonging to Group A and Group B showed an impairment of sexual arousal, satisfaction, lubrification and orgasm when compared to fertile controls.ConclusionsEven if at the very first stages of infertility treatment no personality disturbances can be detected, the couples’ sexual life is already impaired with different sexual disorders according to gender.

The adjuvant use of N-palmitoylethanolamine and transpolydatin in the treatment of endometriotic pain

OBJECTIVE To test the adjuvant use of the combination of N-palmitoylethanolamine and transpolydatin in the medical treatment of endometriotic pain. STUDY DESIGN We enrolled 47 patients admitted to the Outpatient Endometriosis Care Unit of Ferrara University from January 2011 to December 2011. They were divided into two groups according to the endometriosis site (group A: recto-vaginal septum; group B: ovary). One tablet, containing 400 mg of micronized N-palmitoylethanolamine plus 40 mg transpolydatin, was administered twice daily on a full stomach for 90 days. Each patient was requested to grade the severity of dysmenorrhea, chronic pelvic pain, dyspareunia and dyschezia using a 0-10 cm visual analogic scale prior to beginning treatment (T0), after 30 days (T1), 60 days (T2) and 90 days (T3). The continuous and categorical variables were compared, respectively, using Students t-test and the chi-square test. Analysis of variance for repeated measures was used to verify the reduction of endometriotic pain. RESULTS The intensity of endometriotic pain decreased significantly for both groups (p<0.0001). The efficacy of drug treatment was significant after 30 days. Pain intensity decreased equally in the two groups except for dysmenorrhea, which was reduced more rapidly in group B. CONCLUSIONS The combination of N-palmitoylethanolamine and transpolydatin reduced pain related to endometriosis irrespective of lesion site. It had a marked effect on chronic pelvic pain determined by deep endometriosis and on dysmenorrhea correlated to ovarian endometriosis.

Vaginal Lactoferrin Administration before Genetic Amniocentesis Decreases Amniotic Interleukin-6 Levels

Aim: To verify the eventual efficacy of lactoferrin (LF), an iron-binding glycoprotein, to decrease the amniotic concentration of interleukin-6 (IL-6). Methods: We prospectively enrolled 60 Caucasian patients at the 16th week of their singleton physiological gestation. A vaginal compound containing 300 mg of LF was administered randomly 4 or 12 h prior to amniocentesis, as to obtain 3 groups: A, 20 untreated patients; B, 20 treated 4 h before amniocentesis; C, 20 treated 12 h before amniocentesis. Results: A normal karyotype was registered in all cases. The comparison of the distribution of IL-6 among the 3 groups showed a highly significant difference (p = 0.001). The difference between mean values of group B and both groups C and A was shown to be highly significant (p = 0.006 and p = 0.03, respectively). In contrast, there was no significant difference between mean values of groups A and C. Conclusion: Vaginal LF administration decreases amniotic IL-6 concentration. We therefore suggest that the glycoprotein may exert a protective role against ominous pregnancy complications linked to an increased level of the cytokine, such as abortion secondary to amniocentesis.

Can Doppler study of the ovarian artery predict the fertility outcome of intrauterine insemination

To test the velocimetric pattern of the ovarian artery as a routine ovarian reserve test.

The Prevention of Gestational Diabetes

The negative impact of the gestational diabetes on the maternal and fetal health is well known and this impact is closely related to gestational age at which the diagnosis is done. Therefore, the use of therapeutic options able to prevent or delay the gestational diabetes occurrence has a positive impact on maternal and neonatal outcomes. Physical activity and dietary advice represent the first choice and they are the most studied as well. They represent a non-pharmacological option and have a positive impact on insulin resistance although they do not seem to prevent the gestational diabetes onset.The preconceptional use of metformin in women with polycystic ovary syndrome protects the pancreatic beta cell reserve preventing or delaying the occurrence of gestational diabetes. However, there are also doubts on the drug safety in pregnancy since it completely crosses the placenta.From this point of view, the inositol could represent an excellent alternative.Its role as insulin sensitizing agent is well documented on improving both the hormonal and reproductive parameters. However, the studies on its preconceptional use in preventing gestational diabetes are too limited though the first results are extremely encouraging.

Ovarian stimulation and liver dysfunction: Is a clinical relationship possible? A case of hepatic failure after repeated cycles of ovarian stimulation

Liver damage induced by ovarian stimulation has been demonstrated in some cases reported in the literature. However, there has never been a fruitful debate on this topic. The present manuscript tried to fill this gap. We reported a case of a 35-year-old nulliparous woman admitted to our obstetric emergency room for severe pre-eclampsia. She had been subjected to four cycles of controlled ovarian stimulation for intrauterine insemination. At 32 weeks of gestation, she developed severe pre-eclampsia, which led to HELLP syndrome complicated by fatal liver failure. The etiological link between ovarian stimulation and HELLP syndrome is intriguing. Further investigations are needed to understand whether repeated ovarian stimulation may represent a risk factor in pre-eclamptic patients.

Doppler velocimetry of the ovarian artery as a tool to detect LH surge in stimulated cycles

Abstract Our aim was to assess the velocimetric pattern of the ovarian artery as a possible marker of LH surge in stimulated cycles. A total of 130 women undergoing ovarian stimulation for intrauterine insemination were randomized in two groups. Each woman was stimulated with 75 IU of recombinant FSH starting from the third day of the cycle. Velocimetric indices of the dominant ovarian artery were compared between patients with spontaneous LH surge and those needing HCG administration to trigger dominant follicle rupture. The pulsatility index and the ratio between peak systolic flow and lowest diastolic flow were significantly higher in women that had a spontaneous triggering of ovulation. These parameters had a high and very significant positive correlation with the dosage of luteinizing hormone. Threshold values of 2.60 for PI and 7.68 for S/D had a high sensitivity and specificity to predict LH surge. These velocimetric results demonstrated that an increased resistance in the dominant ovarian artery is correlated to LH surge in stimulated cycles. It may represent a sign of relevant clinical utility in timing of intrauterine insemination and/or natural intercourse. Chinese abstract 我们的目的是评价在促排卵周期中卵巢动脉的血流速度形式可能作为一个LH峰的标志物。将130名正在进行促排卵拟行宫腔内人工授精的女性随机分为两组。比较有自发LH峰患者和需要给予HCG以诱发优势卵泡破裂患者的主要卵巢动脉的血流指数。有自发排卵的女性，其脉动指数和收缩期峰值流量与最低舒张流量之比明显较高。这些参数与黄体生成素的水平有较高和极其显著的正相关。这些参数的阈值（PI为2.60，S/D为7.68）对于预测LH峰有较高的敏感性和特异性。这些测速结果说明，主要卵巢动脉的阻力增加与促排卵周期中的LH峰相关联。它可作为一项临床相关的指标，应用于指导选择宫腔内人工授精和/或夫妻同房的时机。

Pruritic urticarial papules and plaques of pregnancy.

Introduction The term pruritic urticarial papules and plaques of pregnancy (PUPPP) was first proposed by Lawley et al. in 1979 to describe benign dermatoses of pregnancy characterised by erythema, urticarial plaques and papules. It is a skin disorder whose incidence is estimated to occur in one in 200 pregnancies (0.5%) (Aronson et al. 1998). In the present study, an unusual case of PUPPP is reported. The interesting presentation of this case may render new insights regarding the aetiological factors of this disease.

Pseudo-Meigs’ Syndrome Caused by a Uterine Leiomyosarcoma: A New Clinical Condition

Introduction: Pseudo-Meigs’ syndrome is a rare condition characterized by female genital cancer, ascites, hydrothorax and tumors other than benign ovarian tumors. Case report: A 30-year-old woman arrived at our clinic with pelvic pain and dyspnea. She underwent an exploratory laparotomy for a large pelvic mass complicated by ascites and hydrothorax. Cytological examination of the effusions was negative for malignant cells. Histological analysis of the tumor mass revealed a uterine epithelioid leiomyosarcoma. After surgery, we observed resolution of the effusions. Conclusion: Uterine leiomyosarcoma and pseudo-Meigs’ syndrome are two rare entities. To our knowledge, there are no similar reports in the literature, and therefore we present this new clinical condition due to its high scientific evidence.

The ultrasonographic detection of follicular rupture at the time of intrauterine insemination: is it really decisive?

Abstract Our aim is to assess the impact of the ultrasonographic detection of follicular rupture on the intrauterine insemination success. A total of 313 women undergoing ovarian stimulation for intrauterine insemination were enrolled. Transvaginal ultrasonography was performed to check whether the dominant follicle had ruptured and according to that the patients were divided into two groups. The ultrasound detection of follicular rupture was observed in 156 patients (54%). The independent variables favoring follicular rupture were: Age (t: 7.646, p < 0.0005), FSH value (t: −5.637, p < 0.0005), duration of infertility (t: −4.265, p < 0.0005), menstrual cycle length (t: −4.927, p < 0.0005). Moreover, the logistic regression analysis demonstrated that the predictive variables for follicular rupture were: FSH value (OR 1.7, CI 95% 1.3–2.3, p < 0.0005), duration of infertility (OR 2.6, CI 95% 1.6–4.2, p < 0.0005) and menstrual cycle length (OR 2.4, CI 95% 1.7–3.4, p < 0.0005). Pregnancy occurred in 23 patients of the group A (14.7%) and in 22 patients of the group B (16.5%) without a significant difference (p = 0.6). The logistic regression analysis confirmed that neither the evidence of follicular rupture nor any other variables influenced the pregnancy rate.