Promoting the health and quality of life of the mother-infant dyad, parenting, and gender medicine /
Obstetric and Gynecological Emergency Room and Medically Assisted Procreation

Couple infertility
Infertility still presents many shadows in terms of causes and pathogenesis. In the face of this difficulty in clinical framing, we have witnessed an explosion of Medically Assisted Procreation (MAP) treatments in recent years. More than 3 million cycles are performed each year worldwide and, to date, have enabled the birth of about 9 million children. The procedures have evolved over a very few decades from experimental to clinical practice. In parallel with the advancement of knowledge of the mechanisms underlying couple infertility, diagnostic and treatment approaches to the issue have been progressively improving. On the other hand, we have inevitably witnessed some abuses that threaten their cost-effectiveness, equity and sustainability profile. A variety of projects are currently underway at the Center that aim to test the efficacy, efficiency and safety of traditional PMA, as well as the possibility of introducing innovative approaches derived from new molecular, technological and clinical evidence. 
In addition, a study funded by the Ministry of Health is underway with the aim of assessing the functional impact of the endometrial microbiome in predicting pregnancy rates in women undergoing PMA cycles and confirming the potential use of RNA species present in extracellular vesicles derived from uterine fluid as a noninvasive proxy for predicting endometrial transcriptional profiling. Finally, a new NRP-funded study will start soon with the aim of analyzing how particular mutations in maternal effect genes (also found in mothers of children with Beckwith-Wiedemann syndrome) and methylation profiles of specific genes may correlate with female infertility.

Endometriosis
Policlinico di Milano is an international reference center in the treatment and research of endometriosis. To date, there are a variety of research projects on this disease that can improve its knowledge and clinical management. In particular, two research projects funded by the Ministry of Health are ongoing:

• The SVIDOE study that aims to evaluate which strategy is best for infertile women with endometriosis. The research will evaluate the effectiveness of surgery versus in vitro fertilization in enabling patients to achieve pregnancy.
• A second study with the aim of evaluating a possible intrauterine origin in the development of endometriosis and the possible involvement of genital crisis. This project will involve the evaluation of the incidence of genital crisis and the possible involvement of steroid hormones and endocrine pollutants in the determination of this phenomenon in addition to an evaluation of the hormonal pattern and endocrine pollutants in the cord of female infants born to women with and without endometriosis. Finally, an assessment of the 2D-4D ratio in women with and without endometriosis as a surrogate for the extent of exposure to hormones and intrauterine factors will be carried out.

Study on cryopreservation of male and female gametes to improve the outcomes of medically assisted procreation
Over the past two decades, there has been a progressive and steady improvement in survival after diagnosis and treatment for cancer and a concomitant increase in attention to the quality of life of "cancer survivors." Current projects aim to investigate the efficacy of fertility preservation in individuals with cancer and the predictive factors for the use and success of cryopreserved gametes.