[Diagnostic hysteroscopy before the first in vitro fertilization. For whom?]

For some teams, hysteroscopy, should be performed before each IVF attempt to maximize the chances of implantation because of the high cost, the investment in time and the psychological impact of each IVF cycle, but answer to the question of the systematic practice of hysteroscopy prior to IVF is far from settled. Assess the benefits of conducting a routine hysteroscopy before the first IVF / ICSI and to identify subgroups in whom this examination provides a real benefit. This is a comparative retrospective study about 334 patients, included in an IVF program with micro-injection, in the center of ART of Aziza Othmana hospital of Tunis, for a period of one year. The results of ICSI in patients with a first attempt at IVF / ICSI were compared according to the realization [HSC +] or not [HSC-] of a diagnostic hysteroscopy prior to the first IVF attempt. The implantation rate in our series was 21.62%. We got a pregnancy in 128 cases, that is a pregnancy rate per transfer of 38.32%. The rate of live births was 29.34%, including 94.89% deliveries to terms with living fetus. We found no significant difference between groups "HSC +" and "HSC -" in terms of pregnancy rates of biological or clinical pregnancy rate or in terms of live births. But, in patients aged 40 and over, we found improved results of IVF in a meaningful way in the group "+ HSC". Our study finds no benefit in terms of outcomes of IVF/ ICSI to the completion of hysteroscopy in a systematic way, despite a high incidence of abnormalities detected by intra-cavity examination. The benefit of routine hysteroscopy is significant only in women 40 and older

[Cost of medical treatment with methotrexate for ectopic pregnancy. Comparative study medical versus conservative laparoscopy. Experience of Aziza Othmana's hospital]

The ectopic pregnancy can be treated surgically [conservative or radical] or medically. Currently, the choice between medical and surgical treatment is a critical issue. One of the parameters of this choice is the total cost of management. To compare the cost of the management of ectopic pregnancy by medical treatment [methotrexate, MTX] and coeliochirurgicaux. This is a prospective, comparative, nonrandomized,unicentric study, on 39 patients who have ectopic pregnancies treated with MTX versus 16 patients treated by laparoscopic surgery with conservative treatment. This study was collected at the service of Obstetrics and Gynecology Reproductive Medicine Aziza Othmana Hospital [Tunis] for a period of two years. The average cost of hospital stay per patient was 549.38 dt for the MTX group against 268.39 dt for laparoscopic surgery group [p <0.001]. There was no statistically significant difference between the two groups. In terms of overall absenteeism, there is no statistically significant difference [16.43 vs 17.5 days]. The initial treatment with MTX costs more cost than the conservative laparoscopic treatment and this is mainly due to the long period of hospitalization

[Delivery in twin pregnancies. The experience of the obstetrics department of Aziza Othmana's hospital, about 117 cases]

The conduct and delivery of twin pregnancies are interspersed with as well as maternal fetal and neonatal complications. The obstetrician is faced with the birth of 2 children often fragile and a uterus often exposed to dynamic dystocia. To study the maternal and newborn morbidity and mortality in twins, in order to clear the optimal route of delivery in such circumstances. A retrospective study over a period of 3 years [1 January 2005 to December 31, 2007], about 117 twin pregnancies. Inclusion criteria were a term exceeding 28 weeks and fetuses alive. We analyzed maternal complications during and after delivery and neonatal complications. Maternal complications were significantly more frequent in case of caesarean section. The frequency of perinatal complications [Apgar score, respiratory distress, immediate neonatal resuscitation and neonatal intensive care unit transfer] in the first twin was not influenced by the route of delivery as opposed to the second twin which Apgar score's alters when vaginally. The newborns of low birth weight [<1,500 Kg] and those whose term was less than 32 weeks were more at risk of an Apgar score <7 [at 1 and 5 minutes], respiratory complications, need for immediate resuscitation and transfer to intensive care and that statistically significant both for the 1st and the 2nd twins. The twins pregnancies' morbidity appears to be more related to prematurity and intra uterine growth retardation] more than to the mode of delivery and hence the interest to detect and prevent its anomalies. It seems that vaginal delivery has a deleterious effect at least for the second twin but cesarean section doesn't seem to be the solution. Better learning techniques and obstetric maneuvers would reduce morbidity

[Quality of life during menstruation in women with an inherited bleeding disorder: a 31 cases study]

Menstruations, by their abundance and their duration, can be a source of impaired quality of life. Women with inherited bleeding disorders appear to be, specially at risk. Assess the impact of menstrual blood loss on the quality of life for women with inherited bleeding disorders. 31 women with various inherited bleeding disorders were interviewed. They completed a quality of life questionnaire. Von Willebrand disease was the most frequent inherited bleeding disorder in our population [38.7%]. 54.8% of patients had a menstrual period more than 6 days 61.3% of them consider their menstrual flow to be normal. The general condition apart of the menstrual period was considered medium to poor in 35.5% of patients. The average score assessing the impact of menstruation on daily life was of 5.00 +/- 3.47. Only 19.35% of patients felt that dysmenorrhea significantly affect their quality of life. Impaired quality of life was seen in 64.5% of patients according to score A and in 41.9% of them according to score B. During menstruation 22.6% of the patients didn't do to work or to school because of the menstrual flow. On the other hand, 48.4% of patients were hospitalized at least once for a heavy menstrual flow. The quality of life during menstruation, in women with an inherited bleeding disorder, according to the different scores appear altered. Although because of the small size of our study population, we could not prove correlation between the importance of menstrual blood loss and the impairment of quality of life

[Basal fsh level is only predictive of the quantitative aspect of the ovarian response]

Determination FSH and LH at day 3 of the menstrual cycle predicts the response to stimulation. To evaluate the value of FSH and LH measurements compared with women's age in predicting qualitative and quantitative ovarian response to gonadotrophin stimulation. 305 patients underwent at least one intra cytoplasmic sperm injection [ICSI] cycle. The levels of FSH and LH at day 3 were determined in an earlier cycle. A good quantitative ovarian response was defined as [3]3 oocytes retrieved and 3 embryos obtained. A good qualitative ovarian response was defined as a percentage of mature oocytes [3] 75% and immature ones²15% of the total number of oocytes retrieved with at least one top quality embryo obtained. Receiver operating characteristic [ROC] curves were generated for FSH, LH and female age. FSH is better than female age in predicting the number of oocytes retrieved [respectively ROCAUC=0.77, p=10-3 versus ROCAUC=0.73, p=10-3] and the number of embryos obtained [ROCAUC=0.69, p=10-3 versus ROCAUC=0.66, p=10-3]. LH is non predictive. None of the three tested parameters was predictive of the fertilization and pregnancy rates. An FSH cutoff was calculated and a value of 7.8mUI/ml is associated with a sensitivity of 73% and a specificity of 70% for the prediction of ovarian response to controlled stimulation. Basal FSH level predicts good quantitative rather than qualitative response. LH is non predictive. FSH and LH do not predict pregnancy rate. Patients having high FSH levels should not be excluded from IVF/ICSI treatment

Clinicals and biologicals aspects of ICSI cycles on polycystic ovary syndrome patients

To analyse clinical and biological pecularities of Polycystics Ovarian Syndrome[PCOS] patients enrolled on ICSI cycles and compare them to normo-ovulatory women. 100 controlled ovarian stimulation cycles for ICSI in women with PCOS and 200 cycles in normo-ovulatory women. There was no significant difference in term of cancellation rate [5,5% in PCOS group vs 5%;NS]. The mean number of follicles was higher in patients with PCOS [18,1 +/- 8,5 vs 9,4 +/- 5,5;p<0,05], Oocyte mature rate and fertilization rate were higher in PCOS group [67% vs 52%; p<0,05] [75% vs 63,7%; p<0,05] respectively. Grade 1 Embryo rate was significantly higher in PCOS group [69% vs 53%; p<0,05]. Implantation rate [16,6% vs 12,1%; NS] and clinical pregnancy rate per transfer [3 1,5% vs 22,2%; NS] did not differ statistically in the two groups. Miscarriage rate was higher in PCOS group but this did not reach the statistical significance [20% vs 7,1%; NS]. 11 cases of Ovarian hyperstimulation syndrome occurred in PCOS group versus 4 on normo-ovulatory group. Use of ICSI as fertilization technique was correlated with good biologic parameters on PCOS patients with better fertilization rate and embryo quality and similar pregnancy rate comparing to normo-ovulatory women. However, it still be great concern about high risk of miscarriages and Hyperstimulation ovarian syndrome