Influence of male human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection on the reproductive outcomes in serodiscordant couples: a case-control study.

BACKGROUND: Nowadays, serodiscordant couples (SDCs) with human immunodeficiency virus (HIV) or hepatitis C virus (HCV)-infected men have the chance to conceive safely, giving birth with a minimum risk of cross-infection. OBJECTIVE: To assess the impact of male HIV and HCV infection on the assisted reproductive technologies (ART) outcomes in SDCs, with HIV or HCV seropositive men and negative partners. MATERIALS AND METHODS: Of 153 couples: 24 in Group 1 (HIV-seropositive men), 60 in Group 2 (HCV-seropositive men) and 69 in Group 3 (controls). Sperm-washing procedure was performed using a three-step system. Fresh ICSI cycles were carried out in HIV SDCs, HCV SDCs and controls. Seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate per cycle (PR/C), miscarriage rate, implantation rate (IR) and live birth rate were evaluated. RESULTS: All the seropositive men have undetectable viral loads at the time of insemination, and both partners were free from co-morbid infections. The median number of embryos transferred was 2.0 (IQR 1.0-3.0), with no differences among groups. FR was significantly reduced in HIV and HCV SDCs compared to the controls (66%, 61% and 75%, respectively; p < 0.01). CR was similar between groups (p = 0.3). IR was 12.1%, 11.1% and 14.1%, respectively, in the three groups (p = 0.30). PR/C was 21.7%, 17.6% and 20.2% in HIV, HCV and controls, respectively. Live birth rate per cycle was 17.4%, 15.7% and 15.9%, respectively. There were no significant differences in clinical pregnancies per cycle, as well as miscarriages and live births (p = 0.30; 0.30; 0.60, respectively). CONCLUSIONS: The sperm-washing technique with ICSI may generate a promising way to improve pregnancy outcomes and to reduce the risk of viral transmission in these couples. In this setting, we can correctly counsel HIV- and HCV-infected men of SDCs with regard to the likelihood of father their own biological child.

Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study.

Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralph's shortened modified protocol. The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4-weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0-40)° or 42.9 (0-67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains). This prospective multicentric study confirms that the three-injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment.

Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review.

Azoospermia can be diagnosed in about 10%-15% of the infertile male population. To overcome the problem of failure to produce spermatozoa in the ejaculate in patients with nonobstructive azoospermia (NOA), testicular sperm extraction (TESE) may be performed to find the focal area of spermatogenesis. A 47-year-old man with NOA presented for treatment of secondary couple infertility. The patient underwent a first TESE 7 years earlier with cryopreservation, and an intracytoplasmic sperm injection-embryo transfer ended in a term pregnancy. He reported a history of repeated testicular traumas. At the present time, a complete medical workup was carried out, including clinical history, general and genital physical examination, scrotal and transrectal ultrasounds. Hormone measurements showed follicle-stimulating hormone level of 42.7 IU/L, luteinising hormone of 11.4 IU/L, total testosterone of 2.6 ng/ml and right and left testicular volume, respectively, of 4 and 3.9 ml. He underwent a second TESE, with successful sperm retrieval and cryopreservation. The histological pattern was hypospermatogenesis. In cases of extreme testicular impairment, although in the presence of very high follicle-stimulating hormone value and small testicular volume, estimating poor sperm recovery potential, the integration of clinical and anamnestic data, could help the surgeon to practise the more appropriate method of treatment.

Testicular sperm extraction after laparoscopic orchiectomy for bilateral postpubertal intra-abdominal cryptorchidism: What chance of sperm retrieval?

Infertility occurs in up to 54% of men with bilateral undescended testes. Orchiectomy is considered the best therapeutic approach, especially when cryptorchidism is diagnosed in adulthood, due to a high risk of malignancy. A 33-year-old man was referred with a clinical presentation of empty scrotum and an ultrasonography and magnetic resonance imaging evaluation of intra-abdominal bilateral cryptorchidism. Follicle-stimulating hormone was 23.20 IU/L, luteinising hormone was 14.10 IU/L, total testosterone was 12.1 nmol/L, and 17-beta-oestradiol was 0.16 nmol/L. Semen analysis showed absolute azoospermia. Tumour marker levels were in the normal range. Testicular volume was 4.0 ml for right testis and 4.6 ml for left testis. The patient underwent a laparoscopy bilateral orchiectomy and subsequently a testicular sperm extraction (TESE), in the purpose to finding mature spermatozoa. The biological examination revealed the presence of immature sperm cells, not efficient for a cryopreservation. The histologic analyses show a pattern of Sertoli cell-only syndrome and maturation arrest. TESE might be a good option for patients with absolute azoospermia and cryptorchidism, especially if bilateral. The procedure, performed after orchiectomy, is safe and does not have any impact on patient's health, although it is important to clarify the very low potential of sperm recovery.

[Sexual activity, cardiotocographic findings and time of delivery in physiologic pregnancy. Survey of a population controlled by ambulatory cardiotocography]. / Attività sessuale, rilievi cardiotocografici ed epoca del parto in gravidanze fisiologiche. Osservazione su una popolazione di utenti del servizio ambulatoriale di cardiotocografia.

STUDY DESIGN: Out of 720 patients with physiological pregnancy coming weekly to the cardiotocography service, it was decided to verify if, in comparison with controls, sexual activity after the 37th week, might make some differences as regard to duration of pregnancy, incidence of PROM and cesarean section. RESULTS: Only a small minority was sexually active. From statistical tests it was observed that sexual intercourse coincided with a greater parity, a lower maternal age, a greater number of nonstress test with uterine contractions and an average duration of pregnancy, slightly lower than in controls (38.80 vs 39.76 weeks). Most of the pregnancies over the 40th week and the greatest incidence of cesarean sections due to fetal distress were observed in sexually inactive patients. A sexual activity after the 37th week did not indicate a greater incidence of PROM CONCLUSIONS: According to personal opinion and provided there is not an obstetric pathology, there are advantages and not disadvantages from a less prohibitionist habit concerning sex by the end of the period of pregnancy.

[Screening for bacterial vaginosis in a population of pregnant women reporting to cardiotocographic tests]. / Screening delle vaginosi batteriche in una popolazione di gravide afferenti al servizio di cardiotocografia.

Of 753 patients repeatedly controlled by nonstress test the incidence of bacterial vaginosis amounted to 11.28%. As regards the bacterial kinds isolated we have not noticed expressive differences in relation to the different periods of pregnancy, with the exception of the Candida albicans that instead has been the more frequent and in constant increase. Before the 30th week of pregnancy until the 35th, more variety of bacterial flora, with prevalence of aspecific vaginitis has been observed. The incidence of premature birth has been 5.86% for positive cases only and 0.66% for all cases controlled by nonstress test. In the five cases observed the bacterial kinds Gardnerella vaginalis, Ureaplasma urealitycum and Streptococci beta hemol of B group in association with Candida a. have been isolated.

[Scanning electron microscopic studies of the umbilical arteries and veins of newborn infants of smoking mothers]. / Osservazioni in microscopia elettronica a scansione dell'intima di arterie e vene ombelicali di neonati da madri fumatrici.

We have examined the umbilical cord of ten newborn children of nonsmoking (five) and of smoking (five) mothers (10-20 cigarettes/day). The patients chosen for the study resulted "normal" before and during pregnancy. Immediately after delivery the umbilical cords were tied (to avoid collapse) and cut about 10 cm from the placenta. Umbilical cords were submitted to pressure-perfusion-fixation according to Kjelsen and Thomsen (7). Three randomly chosen specimens for SEM were cut and postfixation was performed in 1% buffered osmium tetroxide (pH 7.4) and after dehydration, were submitted to critical point drying (CO2), coated with gold palladium (sputtering technique), and observed by means of a Super ISI Mini SEM at 7,5 Kv. Luminal surfaces of umbilical arteries and veins from non-smoking mothers revealed a regular endothelial layer all over the surface. Large disendothelialised areas were instead found not only in arteries (1) but also in veins from newborn children of smoking mothers.

[Variations in erythrocyte enzymatic activity in the first days of life]. / Variazinni di attività enzimatiche eritrocitarie nei primi giorni di vita.

The erythrocyte activities of glucose 6-phosphate dehydrogenase, pyruvate kinase and glucose phosphate isomerase decrease during the first days of life. Furthermore the level of these enzymatic activities is higher in newborn infants with higher percentage of carboxyhemoglobin. It is likely that a premature and rapid fall of reticulocytes causes a decrease in enzymatic activities sensitive to aging and that the higher hemolysis can represent a disappearance of oldest erythrocytes which present lower enzymatic activities. These data therefore confirm the block in erythropoiesis in the first hours of life.