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Background: Cataract surgery is the most common operation performed worldwide. A fixed topical corticosteroid-antibiotic combination is usually prescribed in clinical practice for 2 or more weeks to treat post surgical inflammation and prevent infection. However, this protracted schedule may increase the incidence of corticosteroid-related adverse events and notably promote antibiotic resistance. Methods: This International, multicentre, randomized, blinded-assessor, parallel-group clinical study evaluated the non-inferiority of 1-week levofloxacin/dexamethasone eye drops, followed by 1-week dexamethasone alone, vs. 2-week gold-standard tobramycin/dexamethasone (one drop QID for all schedules) to prevent and treat ocular inflammation and prevent infection after uncomplicated cataract surgery. Non-inferiority was defined as the lower limit of the 95% confidence interval (CI) around a treatment difference >–10%. The study randomized 808 patients enrolled in 53 centres (Italy, Germany, Spain and Russia). The primary endpoint was the proportion of patients without anterior chamber inflammation on day 15 defined as the end of treatment. Endophthalmitis was the key secondary endpoint. This study is registered with EudraCT code: 2018-000286-36. Results: After the end of treatment, 95.2% of the patients in the test arm vs. 94.9% of the control arm had no signs of inflammation in the anterior chamber (difference between proportions of patients = 0.028; 95% CI: −0.0275/0.0331). No case of endophthalmitis was reported. No statistically significant difference was evident in any of the other secondary endpoints. Both treatments were well tolerated. Conclusions: Non-inferiority of the new short pharmacological strategy was proven. One week of levofloxacin/dexamethasone prevents infection, ensures complete control of inflammation in almost all patients and may contain antibiotic resistance.

A recent review conducted in 2014 (Direkvand-Moghadam et al), estimated that primary and secondary female infertility, affects about 15% of the world's female population. The main cause of female infertility is the woman's age. Maximum fertility peak is reached around 25 years; a slow but constant decline of reproductive potential is observed in women aged between 30 and 35 years, then the reduction of the reproductive potential increase in the women over 35 years. Therefore, age of the woman, is the main risk factor for infertility as well as the most important prognostic factor for the ART cycles. The outcome of the data recorded about the impact of different factors of infertility by the ART National Registry are: • Male infertility: 29.3%; • Female infertility: 37.1%; • Male and female infertility: 17.6%; • Idiopathic infertility: 15.1%; • Genetic factor: 0.9%. The main causes of female infertility are: uterine or cervical abnormalities, ovulation disorders, endometriosis, as well as factor tubal / peritoneal, immunological alterations and idiopathic causes. With regards to the causes of infertility and the ART outcomes, we have evaluated three different lines of research: 1. Environmental pollution related to fertility 2. Diagnostic Approach to anovulation in patients with Polycystic ovarian syndrome 3. The role of Genetic Polymorphisms of FSH Receptor in the ART prognosis Several lines of evidence suggest that exposure to environmental contaminants is involved in the pathobiology of adverse reproductive health effects. A lot of studies have shown that exposure to benzene is associated to menstrual disorders, miscarriages and other disorders of the reproductive system. We performed an observational prospective pilot study to evaluate if levels of benzene in follicular fluid were correlated with response to controlled ovarian stimulation. We divided the study population in two groups: Group A with a “low” intra-follicular benzene concentration (n=19, benzene 2500 UI (group A). A control group was selected randomly (ratio 1:2) among normoresponder young patients undergoing a standard IVF/ICSI cycle, who required a cumulative dose of r-FSH

An update about oncofertility. Over the last years we are experiencing an increased incidence of cancer in young population. Chemotherapy and radiotherapy often result in reduced fertility in these patients. With increasing survival rates, fertility is becoming an important quality-of-life concern for young cancer patients. They may be interested in parenthood, but the number of patients who access fertility preservation techniques before treatment is low. There is a need for improvements in clinical care to ensure patients about infertility risks and fertility preservation options and to support them in their reproductive decision-making before cancer treatment. Nowadays, many opportunities exist for fertility preservation. Sperm cryopreservation is a well-established method in male. In female, there are several strategies such as ovarian suppression with gonadotropin-releasing hormone analogues, ovarian tissue cryopreservation, in vitro maturation or in vitro fertilization after ovulation induction. Recently, developed ovarian stimulation protocols using tamoxifen and letrozole have been applied to increase the margin of safety in breast cancer patients. This review is focused on the effect of cancer treatments on fertility and on the assisted-reproduction innovations devoted to the cancer survivors.

The preimplantation genetic diagnosis allows to identify genetic disease and chromosomal alterations in early stages of embryonic development, giving the opportunity to overcome the risk of transmitting an inherited disease and to improve the efficiency of in vitro fertilization techniques. In this paper, we provide an overview of indications and of the advantages and limits of techniques used to perform the preimplantation genetic diagnosis. We describe the multiplex-polymerase chain reaction (PCR) and the karyomapping for the genetic diagnosis of inherited disease as well as the comparative genomic hybridization array, the qualitative real-time PCR and the next generation sequencing for the screening of chromosomal aneuploidy.

It has been reported that 10% to 15% of young normogonadotrophic women show suboptimal response to standard gonadotropin-releasing hormone—a long protocol. These patients require higher doses of exogenous follicle-stimulating hormone (FSH). This phenomenon could be associated with genetic characteristics. In this study, FSH receptor polymorphism was retrospectively evaluated in 42 normoresponder young women undergoing an in vitro fertilization/intracytoplasmic sperm injection cycle; patients were stratified according to recombinant human FSH (r-hFSH) consumption. We selected 17 normoresponder young patients who required a cumulative dose of recombinant FSH (rFSH) >2500 UI (group A). A control group was randomly selected among patients who required a cumulative dose of rFSH

Wilson's disease (WD) is a disorder of copper metabolism that can cause hormonal alterations. The impact of WD and its therapies on fertility is not well defined. The aim of this study was to evaluate ovarian reserve and sperm parameters in long-term treated WD patients with hepatic onset.WD patients with hepatic onset treated for at least 5 years were compared with healthy controls. Men underwent spermiogram and sperm DNA fragmentation (SDF) analysis. Women were tested for serum FSH, anti-Müllerian hormone (AMH) and sonographic antral follicle count (AFC) in the early follicular phase. Ovulation was monitored with ultrasound and progesterone serum concentrations in the luteal phase.The WD group included 26 patients (12 males), the control group 19 subjects (9 males). All patients apart from four (one male) were responders to WD treatment. Sperm count and morphology were comparable between cases and controls. Sperm motility (total and after 1 h) was significantly lower in cases (44.78 ± 21.65%; 47.85 ± 21.52%) than controls (61.88 ± 11.03; 69.44 ± 11.02%, P = 0.03 and 0.01, respectively). The only non-responder had severe oligo-astheno-teratozoospermia. SDF values were normal in cases and controls. AMH, AFC and FSH did not differ between cases and controls. LH was significantly lower in cases (3.36 ± 1.65 mIU/ml) than controls (6.25 ± 1.03 mIU/ml, P 0.0001). A non-responder woman who developed neurological signs had a 7-year history of infertility.WD patients with hepatic onset, diagnosed early and treated, have no impairment in fertility potential even if males show reduced sperm motility and females lower LH values. Only patients with poor disease control have some evidence of impaired fertility.

Air pollution is a cause of concern for human health. For instance, it is associated with an increased risk for cancer, cardiovascular and respiratory disorders. In vitro and in vivo studies suggested that air pollutants could act as endocrine disruptors, promote oxidative stress and exert genotoxic effect. Whether air pollution affects female infertility is under debate. The aim of the present study was to conduct a systematic review of studies that evaluated the impact of air pollution on female infertility. We systematically searched the MEDLINE (PubMed) and SCOPUS databases to identify all relevant studies published before October 2017. No time or language restrictions were adopted, and queries were limited to human studies. We also hand-searched the reference lists of relevant studies to ensure we did not miss pertinent studies. The risk of bias and quality assessment of the studies identified were performed using the Newcastle-Ottawa Scale. Primary outcomes were conception rate after spontaneous intercourse and live birth rate after in vitro fertilization (IVF) procedures. Secondary outcomes were first trimester miscarriage, stillbirths, infertility, number of oocytes and embryo retrieved. Eleven articles were included in the analysis. We found that in the IVF population, nitrogen dioxide and ozone were associated with a reduced live birth rate while particulate matter of 10 mm was associated with increased miscarriage. Furthermore, in the general population, particulate matter of 2.5 mm and between 2.5 and 10 mm were associated with reduced fecundability, whereas sulfur dioxide, carbon monoxide and nitrogen dioxide might promote miscarriage and stillbirths. The main limitation of our findigns resides in the fact that the desegn of studies included are observational and retrospective. Furthermore, there was a wide heterogenity among studies. Although larger trials are required before drawing definitive conclusions, it seems that air pollution could represent a matter of concern for female infertility. Electronic supplementary material The online version of this article (10.1186/s12958-018-0433-z) contains supplementary material, which is available to authorized users.