Midwifery - Course C - ASL Viterbo

GIULIA GALATI
Gabriella Gentile
immacolata brillante
Sara Giuseppina Bracoloni
Andrea Agostini

To understand the main physiological and pathological processes of human reproduction, fertility and pregnancy, acquiring the foundations for their clinical assessment.

By the end of the course, students will be able to:
Knowledge and understanding
Know the anatomy and physiology of the female and male reproductive systems, the hormonal regulation of the ovarian and menstrual cycle, and the pathophysiological mechanisms underlying the main reproductive disorders (amenorrhea, abnormal uterine bleeding, PCOS, endometriosis, couple infertility). Know the causes of female and male infertility, the principles of preimplantation genetic testing, first-, second- and third-level assisted reproductive technologies (IUI, IVF, ICSI, surgical sperm retrieval) and their associated risks and complications, including ovarian hyperstimulation syndrome.
Applying knowledge and understanding
Be able to recognise the signs and symptoms of the main reproductive disorders and interpret their clinical significance, contribute to the nursing/midwifery care of women undergoing ovarian stimulation, ultrasound and hormonal monitoring, oocyte retrieval and embryo transfer, and promptly recognise signs of complications such as OHSS, providing appropriate care within the scope of midwifery competencies.
Making judgements
Be able to critically evaluate clinical, ultrasound and laboratory data relating to the reproductive health of women and infertile couples, distinguishing physiological from pathological conditions, and identify care priorities across the different stages of the assisted reproduction pathway, in compliance with current regulations on medically assisted procreation.
Communication skills
Be able to communicate clearly, empathetically and non-judgementally with women and couples facing infertility, providing understandable information on available diagnostic-therapeutic pathways (homologous and heterologous ART) and supporting decision-making processes, including with regard to the psychological impact of fertility treatments.
Learning skills
Be able to independently consult scientific literature, national and international guidelines (NICE, ESHRE), and official epidemiological data (Italian National ART Registry, Istituto Superiore di Sanità) on reproductive pathophysiology and assisted reproductive technologies, in order to keep up to date in a field undergoing rapid scientific and regulatory change.

Basic knowledge of the anatomy and physiology of the female and male reproductive systems, general endocrinology and reproductive biology, acquired in previous years of the Midwifery degree programme. No formal prerequisite requirements apply for access to this module; however, prior knowledge of the general principles of embryology and medical genetics is recommended for a better understanding of the topics related to preimplantation genetic testing.

Anatomy of the female genital tract
Physiology of the ovarian and menstrual cycle
Variations in cycle length and menstruation (polymenorrhea, oligomenorrhea, hypermenorrhea, menorrhagia, hypomenorrhea, metrorrhagia, spotting)
Primary and secondary amenorrhea
Infertility: definition, epidemiology
Causes of female infertility
Endometriosis and adenomyosis: aetiopathogenesis, localisation, symptoms, diagnosis and treatment
PMOS (formerly PCOS – Polycystic Ovary Syndrome): clinical presentation, oncological risk and treatment
Causes of male infertility: pre-testicular, testicular and post-testicular factors
Semen analysis (spermiogram) and WHO reference values
Assisted reproductive technologies (ART): definition and classification (homologous and heterologous ART)
First-level treatment: intrauterine insemination (IUI) – indications, procedure, success rates and risks
Second-level treatment: IVF and ICSI – stages of the process (ovarian stimulation, oocyte retrieval, sperm preparation, fertilisation, embryo development, embryo transfer)
Poor responder patients and the Bologna Criteria
Third-level surgical sperm retrieval techniques (TESA, PESA, MESA, TESE, Micro-TESE)
Cryopreservation of gametes and embryos (FER, FO) and frozen cycle transfer
Preimplantation genetic testing (PGT-A, PGT-M, PGT-SR): indications and clinical applications
Risks and complications of ART: procedural complications and ovarian hyperstimulation syndrome (OHSS) – pathophysiology, diagnosis and treatment
Obstetric complications associated with ART (multiple pregnancy, ectopic pregnancy, miscarriage, placenta previa, prematurity, IUGR, preeclampsia)
Heterologous ART: indications, types and national epidemiological data

Teaching material provided by the instructor (lecture slides and relevant guidelines).
Recommended textbook:
Talevi R., Gualtieri R., Biologia e tecnologie della riproduzione umana [Biology and Technology of Human Reproduction], Piccin-Nuova Libraria, 2019.

The course is delivered mainly through in-person lectures, supported by some lessons delivered online (synchronous and/or asynchronous), integrating and expanding on the topics covered in the classroom. Lessons make use of multimedia material (slides, clinical images, case studies) to support teaching.

Attendance at lectures is mandatory, in accordance with the Teaching Regulations for the Degree Programmes of the Health Professions at Sapienza University of Rome (Art. 5 – Attendance Requirement). To be admitted to the examination for this course, students must have documented attendance of at least 66% of the hours corresponding to the credits (CFU) assigned to the course. Attendance is verified by the instructor according to the assessment procedures established by the Degree Programme Council.

Assessment Methods
Learning is assessed through two tests, both mandatory for passing the exam:
Written examination
Multiple-choice questions and/or short open-ended questions, aimed at verifying theoretical knowledge of the topics covered in the syllabus (reproductive pathophysiology, assisted reproductive technologies, risks and complications). Passing the written examination, with a minimum grade of 18/30, is a prerequisite for admission to the oral examination.
Oral examination
Individual interview aimed at further exploring and integrating what was assessed in the written examination, with the objective of evaluating the student's ability to critically reason about the course content, to connect theoretical knowledge with midwifery care practice, and to express themselves with appropriate scientific terminology. The oral examination contributes, together with the written examination, to the final grade out of thirty within the integrated examination shared with the other modules of the course.
The final assessment takes into account both the accuracy and completeness of the answers given, and the ability to argue and draw connections between the different topics covered.

Example Questions
Example multiple-choice question (written examination)
Ovarian hyperstimulation syndrome (OHSS) recognises the following as the main mediator of increased vascular permeability:
a) Progesterone
b) VEGF (vascular endothelial growth factor)
c) FSH
d) Testosterone
(Correct answer: b)
Example short open-ended question (written examination)
List the main risk factors for developing ovarian hyperstimulation syndrome (OHSS) and briefly describe the clinical signs that characterise the severe form.
Example oral examination question
A patient undergoing ovarian stimulation for a second-level ART cycle presents on day 6 after oocyte retrieval with abdominal distension and pain, nausea and oliguria. What anamnestic and clinical elements would you investigate to guide the diagnosis, and what care management would you propose based on the severity of the condition?

• Anatomy of the female genital tract; Physiology of the ovarian and menstrual cycle; Variations in cycle and menstruation; Primary and secondary amenorrhea
  • Books: lecture slides and reference guidelines


• Infertility: definition, epidemiology; Causes of female infertility; Endometriosis and adenomyosis; PMOS (formerly PCOS): clinical presentation, oncological risk, treatment
  • Books: lecture slides and reference guidelines


• Causes of male infertility; Semen analysis; ART techniques: classification; First-level treatment (IUI); Second-level treatment (IVF/ICSI); Poor responders and the Bologna Criteria
  • Books: lecture slides and reference guidelines


• Third-level techniques; Cryopreservation; Preimplantation genetic testing; Risks and complications of ART (OHSS); Obstetric complications; Heterologous ART
  • Books: lecture slides and reference guidelines