Anatomy and the Field of Human Reproduction

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Dr. Liselotte Mettler: "At this European Conference for ESHRE, it is my pleasure as a Professor of Obstetrics and Gynecology from the University or Kiel to interview the very famous anatomy professor, Pietro M. Motta, from the very old and famous La Sapienza University in Rome. Professor Motta is also the President of the International Federation of Anatomists for the next five years. We would like to interview you, Professor Motta, on your basic input of anatomy into our field of human reproduction. Could please tell us how you started to get interested in putting basic anatomic aspects into our field?"

Professor Pietro M. Motta: "This is a relatively long story because I've been interested in reproduction for a long time but at the very beginning I was teaching human anatomy to students and my basic science was on rabbits, mice, and guinea pigs. As the social, economical, and ethical conditions changed from twenty years ago, we got access to human material and we started with embryos and fetal ovaries. Then we took advantage of the material that the clinicians gave to us so we have revisited all the micro-anatomy in dynamic fashion using the combination of scanning and transmission of electromicroscopy. In collaboration with other departments, mostly with Dr. Macab from the University of Tokyo we put together a series of images that just give the baseline in humans which is important today from the very beginning - the primo germ cell migration, colonization of the ovary, folliculargenesis, ovulation, and then with the in vitro fertilization we also staged the early stage of embryogenesis until the blastocyst."

Dr. Liselotte Mettler: "At this ESHRE Conference we're looking in some lectures at the genetic aspects. What do you think basic anatomy brings to our understanding of fertilization if we are going to the genetic structures already?"

Professor Pietro M. Motta: "I think there is a tendency to forget that as a physician we should know everything, you can't only know one part, it's a mosaic. We're not dealing with a disease but we are dealing with a diseased human being so you should not forget that we need all the parameters. I'm not speaking about the classical anatomy that is very well known because you also have technology that can let you look through the human body but we are talking about very detailed aspects that cannot be revealed by these techniques. Then it's important to combine all the genetics, biochemical, immunologic, or endocrine profiles with this new real true dimensional anatomy so it's important that you have these parameters."

Dr. Liselotte Mettler: "If we look at the production cells of the hormones at this age where FSH and LH can be acting on receptors of the granulosa and the thecal cells, can you tell us what importance the structure of those cells have for the hormonal production of steroid hormones?"

Professor Pietro M. Motta: "Of course, we have the morphologic parameters with very great details. We can create a base data today and put it in a statistical order in the computer, not from animals but from humans so when you check to have the morphological parameter, you have a bank of basis data that you can combine with your endocrine and a receptor profile or by a chemical profile or whatever you want. This is becoming truer now that we are moving to another important prospect, which is to review with these techniques the menopausal changes, in other words, the aged human being, mostly female. For example, we can review the mucosa of the uterus, of the tube, of the ovary in aged women and we could find aspects that are a very important complement to the endocrine profile, to the clinical profile, and so on. I think every physician should have this data in his bank as you'll have the profiles of hormones, genetics, biochemistry, or all the techniques. You must have the profile and this will become truer in the next year with micro three-dimensional anatomy in motion which is a sort of physiology, you just look at the picture and you combine the total stuff."

Dr. Liselotte Mettler: "Can you specify this a little bit more? Basically, we know anatomy as showing us gross pictures of the organs but you went so much into different techniques. Can you elaborate a little bit on the techniques that you're applying to show to clinicians the different structures that we're interested in?"

Professor Pietro M. Motta: "Okay, I can give you an example. We're now working on aging of the female reproductive tract, so if we look, for example, at the mucosa of the uterus in the female reproductive age, it appears one way but if we look at the same surface at eye resolution or eye level in three-dimensional micro-topography and not all in sections - the classical histology but in three-dimensional morphology, we can put these image also in a dynamic fashion so you can have a different approach. We can see that the mucosa in the normal reproductive age of the uterus, for example, the endometrium, possess ciliate cells and the glands and the secretory cell changing dramatically. This mucosa adapts itself in the aged woman to become a mechanical protective epithilium so it means that these are still there but change the function, which is related to the morphology, and the same happens in the tube, for example. So by these parameters we can go through and we can, for example, make application using hormone replacement therapy to see how this mucosa changes according to what happens in the aged human being. We think when we make this very detailed information in four-dimensions because it's also the dynamic aspect of the mucosa, for example, of the uterus in the normal reproductive age in menopause and in very aged women, then we can compare this with the hormone replacement therapy of disease and we can easily combine all this stuff with different profiles that you mentioned that you use in your everyday or routine day diagnostically or for other reasons in practice."

Dr. Liselotte Mettler: "Do you see a lot of interest of clinicians in your work or of students, of doctors in practice, or more of academics?"

Professor Pietro M. Motta: "When we give this lecture and they mostly invite us to meetings of gynecologists or endoscopists of reproduction, they come because they want to know some more so the interest that comes from the clinicians is tremendous. Anytime I give a lecture, and a lot of people offer me specimens to look at because they would like to improve and understand more because they've been trained in a way to look to the anatomy as just dissecting the body and when they see this picture they immediately realize that at this level they can combine the parameters that come from different sources with the real contemporary anatomy. Anatomy is an instrument, it's a technique but then the microscope approaches disease and describes more and more in detail these aspects so I think the interest for students is natural but we are very excited because we are mostly invited to meetings where the clinicians work and believe me, after this lecture, the clinicians come and offer me everything to look at. We don't' have the time or enough people to do that so I think that the clinicians are very enthusiastic about that."

Dr. Liselotte Mettler: "Thank you Professor Motta, I am very enthusiastic about your work too and it's always a pleasure."