Sexual function after vaginal erbium laser: the results of a large, multicentric, prospective study.

The aim of this multicentric, prospective study was to evaluate the effects of vaginal erbium laser (VEL-SMOOTH®) on sexual function in postmenopausal women suffering from the genitourinary syndrome of menopause (GSM). This study was performed on an outpatient basis without anesthesia or drug use before or after the intervention, using an erbium laser (XS Fotona Smooth®, Fotona, Ljubljana, Slovenia) in 1081 postmenopausal women (age 54.3 ± 3.9 years) treated with up to three laser applications every 30 days. Patients were assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). No adverse events were recorded during the study. The FSDS-R scores (n = 554), from basal values of 25.5 ± 3.5, were 11.5 ± 3.0, 10.5 ± 3.5 and 11.5 ± 3.5 at the 4-, 12- and 24-week follow-ups, respectively (p < 0.01 vs. corresponding basal values). Individual FSFI domain scores (n = 569) significantly (p < 0.001) increased after VEL-SMOOTH® treatment and remained significantly higher up to the 24th week after the end of treatment. The total scores, from basal values of 15.5 ± 1.5, were 27.5 ± 2.5, 27.6 ± 2.7and 27.0 ± 3.5 at the 4-, 12- and 24-week follow-ups, respectively (p < 0.01 vs. corresponding basal values). Albeit not randomized, this large, prospective study shows that VEL-SMOOTH® treatment may improve sexual function in postmenopausal women suffering from GSM.

Rationale and design for the Vaginal Erbium Laser Academy Study (VELAS): an international multicenter observational study on genitourinary syndrome of menopause and stress urinary incontinence.

The genitourinary syndrome of menopause (GSM) and stress urinary incontinence (SUI) are common clinical challenges for women's health and quality of life. The laser treatment and particularly the vaginal erbium laser (VEL) may provide a new non-invasive treatment for both GSM and SUI. However, the estimation of the ultimate results of different laser treatments may be altered by different issues, such as patient selection, concomitant treatments, and long-term effect of vaginal laser thermotherapy. In the present paper, we present the protocol for a large multicenter study on the evaluation of the efficacy and safety of VEL for the treatment of GSM and SUI, the Vaginal Erbium Laser Academy Study (VELAS). This study will evaluate the effects of three laser applications in 1500 postmenopausal women. Subjective and objective symptoms will be evaluated prior to the first laser treatment with follow-up visits after 4 weeks from the last laser application, and subsequently after every 3 months for 1 year. Findings from the VELAS have the potential to affect clinical care practice and health decisions for millions of women world-wide for a non-hormonal treatment for GSM and a non-invasive treatment of SUI.

Recurrent empty follicle syndrome.

We report a case of recurrent empty follicle syndrome over two stimulated cycles in a patient having immunological infertility. All follicles contained follicular fluid but aspirated granulosa cells were rarely observed. No oocytes were obtained from a total of 24 follicles.

[Cardiocirculatory adaptations during the initial phases of pregnancy. An echo-Doppler assessment]. / Adattamenti cardiocircolatori durante le fasi iniziali della gravidanza. Valutazione eco-Doppler.

During pregnancy the cardiovascular apparatus meets an important process of morphofunctional adjustment. However the very moment when this happens is not very well known. We observed thirty patients during the various GIFT phases (Gamete Intrafallopian Transfer) that consists in the intratubal transfer of male and female gametes and that represents also an ideal model for the study of pregnancy in the early phases. With echo-Doppler technique morphological and functional parameters of the left ventricle have been evaluated and at the same time estradiol and progesterone blood variations have been determined. In all the thirty patients to the increase of E2 corresponds a significative increment of telediastolic (Dd) and telesystolic (Ds) diameter and of systolic index (SI) and cardiac index (CI). At the same time a significant reduction of mean arterial pressure and of the index of a systemic vascular resistance has been observed. These data say that the systolic flow increment is not due to an increase of the ejection fraction but to an increase of the diastolic filling. The utilised mechanism has nothing to do with inotropism but to the preload reserve according Starling principle. The increase of the systolic output is the almost unique cause of the cardiac capacity increment because there is only a light increase of heart rate. Those patients in which GIFT gave a positive results, these variations are sustained while in the group of those patients not pregnant one can see a rapid return to basic values of the various parameters (except the presence of a significative Dd increment) together with the reduction of plasmatic E2. In conclusion our work results say that significative cardiovascular adjustments are evident from the earliest pregnancy phases and that these changes one can related to E2 plasmatic variations.

Noninvasive evaluation of cardiovascular hemodynamics during multiple follicular stimulation, late luteal phase and early pregnancy.

A noninvasive hemodynamic study in three moments of the gamete intrafallopian transfer (GIFT) cycle was carried out on 25 patients: before beginning multiple follicular stimulation (MFS) (study I); after rapid increase of serum estradiol (E2) (study II); and 12 days after GIFT (study III). In the 25 patients, the rapid increase in E2 proved to be combined with a significant increase in the left ventricular end diastolic dimension (LVEDD), the left ventricular end systolic dimension, the heart rate (HR), the systolic index, the cardiac index, and a significant reduction in the mean arterial pressure, in the systolic arterial pressure and in the systemic vascular resistence index. In the 14 pregnant patients in study III, all of the hemodynamic parameters studied proved to be significantly modified with respect to study I. In the 11 nonpregnant patients between Studies I and III were no significant cardiovascular modifications except for a significant increase in LVEDD in Study III. It is concluded that, during MFS, the rapid increase in E2 is combined with hemodynamic modifications and that, in pregnancy, the cardiovascular adaptation modifications occur in the very early stages.

Induction of ovulation for gamete intrafallopian transfer (GIFT) using a gonadotropin-releasing hormone agonist and "pure" FSH: results obtained in 30 normally menstruating women.

About 30% of the ovulation induction cycles in GIFT and FIVET programmes are cancelled due to an inadequate response of patients to gonadotropins and/or clomiphene citrate. GnRH agonist-gonadotropins and/or "pure" FSH combination has been successful in inducing ovulation in patients with a previous history of cycle cancellation and/or alterations in the menstrual cycles. In order to reduce the number of cycle cancellations and obtain more homogeneous oocytes, GnRH agonist-gonadotropins and/or "pure" FSH combination in all candidates for GIFT and FIVET has been recently hypothesised. The Authors report results obtained from GnRH agonist-"pure" FSH combination in 30 normally menstruating patients of the GIFT programme: in 93% of cases the harvested oocytes were preovulatory, in 27.6% of cycles and in 28.6% of the GIFTs respectively an ongoing pregnancy was obtained. While the results obtained must be considered preliminary, they nevertheless suggest that the use of a combination of GnRH-agonist "pure" FSH in all patients in the GIFT programme may be of real clinical validity.

Birth after direct intraperitoneal insemination with frozen semen of donor.

For the first time, as least as far we known, a pregnancy and a normal baby obtained with DII with frozen semen of donor are reported. Our experience not only shows DII with frozen semen may be used successfully in AID but that it poses interesting hypotheses, to be verified in future, of its use in association with, or as an alternative to, GIFT and IVF/ET in cases of AID failure and as a first approach to an insemination technique in AID in general.

Human chorionic gonadotropin regression following removal of ectopic pregnancy.

Plasmatic Human Chorionic Gonadotropin (hCG) was studied in 41 patients undergoing salpingectomy for tubal pregnancy. On the temporal scale of our research, a biexponential model proved to be adequate to describe hCG clearance; the combined reading of the results of this research and those of other Authors have led us to maintain that hCG clearance is characterised by at least three components. HCG clearance was faster in patients with a higher initial hCG. Nevertheless the problem of hCG clearance depending on its initial value remains unsolved and requires further investigation. The regression curve and relative hCG values obtained in this study can be used as reliable models of comparison in the monitoring of patients undergoing conservative surgical treatment of tubal pregnancy.

The direct IgG-MAR test (mixed antiglobulin reaction test): results and correlations with seminal analysis in 1176 men from infertile couples.

The direct IgG mixed antiglobulin reaction (IgG-MAR) test was carried out as a screening test and as a routine test of semen analysis in 1176 male patients from infertile couples. We correlated the results of the IgG-MAR test with the semen analysis parameters. The test was only positive in 3.1% of the cases; other Authors describe incidences of much higher positive results than ours, for which reason we emphasize that our patients had not previously undergone any kind of preliminary section. The positive IgG-MAR test proved to correlate significantly both with the number and motility of the spermatozoa, while there appeared to be no correlation between its positiveness and the other parameters of the seminal liquid.

Panoramic diagnostic microhysteroscopy and female sterility: analysis of results in 284 patients.

The results of panoramic diagnostic microhysteroscopy are reported in 284 patients with sterility or infertility problems. In 33.5% of the patients, microhysteroscopy revealed uterine pathology; in the majority of cases they were pathologies which are unanimously recognized as being causes of sterility, while in others there were pathologies whose role infertilities is still unclear. There was a good correlation between microhysteroscopy and histology in cases of endometrial hyperplasia and of endometritis, whereas in cases of endometrial polyps and functional diagnosis of the endometrium, the correlation was less satisfactory. Although it is not possible at present to draw definite conclusions about the real value and advantages of microhysteroscopy in the diagnosis of female infertility, we are convinced that it is of great use and that it should be at the basis of any investigation involving the infertile woman.

Panoramic diagnostic microhysteroscopy: analysis of results obtained from 976 patients.

Panoramic diagnostic microhysteroscopy was performed in the outpatients department on 976 patients without using any type of anaesthetic. In 889 patients, that is 91%, the examination was successful, while it failed in 87 cases, that is, 9%. In 90% of the patients, the examination caused no pain whatsoever, and none of the patients suffered serious complications, either immediately after the examination of later. Comparison with the definite histological diagnosis showed 100% sensitivity and 86% specificity of microhysteroscopy. We can state that panoramic diagnostic microhysteroscopy performed in the outpatients department has proved to be a reliable examination from a diagnostic point of view, and is moreover safe and without pain for the patients.

Simple and practical technique for hysterosalpingography: results obtained in 564 cases.

About 5 years ago, we proposed a new technique for hysterosalpingography in order to make it simpler for the gynecologist and the radiologist and more readily acceptable for the patients. In our opinion, the technique is simple and practical; we have performed ISG's with it and have succeeded in 555 cases, that is, 98.4%; in 9 cases, 1.6%, we did not succeed. In 5 of these 9 cases, the failure was due to an error in the application of the technique. This technique, however, must not be used in patients with suspected didelphic uterus or septum or with an unsuitable portio. In none of the patients was the technique followed by complications.