The research activity of the group led by Prof. La Marca spans multiple areas of gynecology and reproductive medicine, making a substantial contribution to the advancement of knowledge and to clinical innovation.
Reproductive Endocrine Axis
The group has extensively investigated the neuroendocrine regulation of the hypothalamic–pituitary–ovarian axis, highlighting the modulatory role of corticosteroids and dopamine in gonadotropin control and shedding light on the complexity of hormone-dependent signaling.
Polycystic Ovary Syndrome (PCOS)
Research has focused on alterations in folliculogenesis and steroidogenesis, with particular attention to the influence of insulin on ovarian function. This work has contributed to identifying new opportunities for the pharmacological modulation of ovarian insulin sensitivity.
Menopause
Clinical studies, including randomized controlled trials, have documented the effects of hormone replacement therapies on cardiovascular and osteoporotic risk, providing solid pathophysiological and clinical support for current therapeutic strategies.
Germ Cells
Investigations into folliculogenesis and spermatogenesis have consolidated advanced expertise in reproductive sciences, leading to the development of a patent on the use of recombinant FSH as a potential tool to reduce sperm aneuploidies.
Reproductive Medicine and Assisted Reproductive Technologies (ART)
Particular emphasis has been placed on ovarian reserve, stimulation protocols, and—pioneeringly—the early clinical application of AMH. The group has made a major contribution to defining the role of this biomarker in reproductive management.
Predictive Models and Therapeutic Personalization
Through the development of advanced models, the ability to predict ovarian response, the likelihood of euploid embryos, and ART outcomes has been improved, supporting increasingly personalized treatment pathways.
Transnational Oocyte Donation
An innovative model has been developed that allows embryo creation abroad with subsequent transfer in Italy, simplifying the clinical pathway and reducing the need for travel for couples.
Oncofertility
The group was among the pioneers in introducing urgent and unconventional ovarian stimulation protocols, contributing significantly to the dissemination of PPOS (Progestin-Primed Ovarian Stimulation) in oncology patients.
Obstetrics
Research has addressed maternal thyroid function, pregnancy immunology, and recurrent pregnancy loss, with particular attention to the inflammatory mechanisms characterizing the first trimester.
Gynecology
Studies on the pathophysiology and vascularization of fibroids have led to the development of a patent on the use of AMH as a potential innovative treatment. Research has also explored surgery for atresia, criteria for assessing the oncological risk of ovarian masses, and outcomes following ovarian suppression.
Preventive and Hereditary Endocrine-Oncologic Gynecology
The research activity of Prof. Grandi’s group is primarily focused on oncological prevention in gynecology, particularly in women at high familial risk, and on how different hormonal therapies (estrogens, progestins, and androgens) may modulate this specific risk.
The group has published some of the few available data on breast cancer risk in patients with known familial risk (intermediate and high) who have used combined hormonal contraceptives, reporting highly reassuring findings.
Over the past 10 years, Prof. Grandi has followed a cohort of approximately 500 women with BRCA mutations (aged 25–70 years) undergoing semiannual clinical surveillance (gynecological evaluation, transvaginal ultrasound, and other specific tests as needed). This experience has generated numerous publications on gynecological care in women at high familial risk (cancer prevention and general gynecological management in BRCA mutation carriers), and he has been selected to contribute to consensus documents for major international committees on this topic.
Of particular relevance are the originally described early ultrasound signs of stage I and II ovarian carcinoma, which can be identified in this special population only through a rigorous surveillance program.
Equally important is Prof. Grandi’s scientific output on hormonal contraceptives, with specific interest in different estrogenic components (ethinylestradiol, estradiol, estetrol) and progestins, the metabolic impact of hormonal contraception, and the benefits and risks associated with modern hormonal contraceptive therapies.
The research group is also involved in primary and secondary prevention of cervical cancer and in the conservative treatment of cervical dysplasia.
More recently, research interests have expanded to include non-hormonal treatments (laser and other modalities) for genitourinary syndrome of menopause in oncology patients.