[Embryo vitrification: French clinical practice analysis for BLEFCO]. / Vitrification embryonnaire : état des pratiques en France par les BLEFCO.

Frozen thawed embryo transfer is currently an important part of present-day assisted reproductive technology (ART) aiming at increasing the clinical pregnancy rate per oocyte retrieval. Although slow freezing method has been the reference during 2 decades, the recent years witnessed an expansion of ultrarapid cryopreservation method named vitrification. Recently in France, vitrification has been authorized for cryopreserving human embryos. Therefore BLEFCO consortium decides to perform a descriptive study through questionnaires to evaluate the state of vitrification in the French clinical practice. Questionnaires were addressed to the 105 French centres of reproductive biology and 60 were fully completed. Data analysis revealed that embryo survival rate as well as, clinical pregnancy rate were increased after vitrification technology when compared to slow freezing procedure. Overall, these preliminary data suggest that vitrification may improve ART outcomes through an increasing of the cumulative pregnancy rate per oocyte retrieval.

[Serum AMH level is not a predictive value for IVF in modified natural cycle: analysis of 342 cycles]. / L'AMH sérique n'a pas de valeur prédictive en fécondation in vitro en cycle naturel modifié : analyse de 342 cycles.

The objective is to compare the IVF procedures in modified natural cycle outcomes according to serum anti-Mullerian hormone (AMH) levels. We included in this retrospective study 342 patients undergoing their first IVF in modified natural cycle. Patients were regrouped in three groups according to their serum AMH level: group 1 was defined by patients with AMH level<0.97 ng/mL (<25th percentile), group 2, patients with AMH level between 0.97 ng/mL and 2.60 ng/mL (25-75th percentile), and group 3, patients with AMH level between 2.61 ng/mL and 6.99 ng/mL (>75th percentile). The main outcomes were cancellation rate, embryo transfer rate and clinical pregnancy rate, ongoing pregnancy rate and implantation rate. No difference has been observed on cancellation rate, embryo transfer rate, clinical pregnancy rate and implantation rate. The ongoing pregnancy rate per IVF cycle was respectively: 12.8±3.6% for AMH inferior to 0.97 ng/mL versus 12.5±2.5% for AMH between 0.97 to 2.60 ng/mL and 13.4±4.2% for AMH between 2.61 ng/mL and 6.99 ng/mL. In conclusion, IVF in modified natural cycles procedures should be considered as an option for patients with an altered ovarian reserve defined by a serum AMH inferior to 1 ng/mL. Serum AMH level seems a quantitative marker of the ovary but not a quality factor. Serum AMH level does not seem to be a prognostic factor for ongoing pregnancy rated in IVF modified cycles.

[Impact of elective single embryo transfer criteria on the twin pregnancy rate in a French population]. / L'impact des critères du élective single embryo transfer sur le taux de grossesses gémellaires dans la population française.

To reduce the twin pregnancy rate and their morbidity, several recommendations have been proposed to practice the "elective single embryo transfer" in a selected population. We decided to apply the criteria that were proposed in five articles from the literature to our population to evaluate the percentage of our population concerned and the impact on our twin pregnancy rate. The result is that these criteria only concern 2,4 to 10,8% of our population with a minor reduction of our twin pregnancy rate with a potential lake of chance concerning the pregnancy rate. We should study others possibilities than the population's criteria to reduce the number of embryo transferred.

[Secrets of proportions in follicular liquid]. / Les secrets des dosages dans le liquide folliculaire.

Only 5% of oocytes lead to life birth after IVF. Currently, it is difficult to evaluate oocyte quality on the sole basis of morphology criteria. Embryo morphology is considered as a good marker of potential implantation of embryo after ET, however it is not enough. Therefore, we need to develop non invasive assessment of oocyte quality. Research performed on follicular fluid may represent a new tool of increasing interest. The presence of G-CSF in follicular fluid could predict ongoing pregnancy. Cytokines, IL-7 and IL-17 could be also a predictor of success.

[Improvement of results and optimization of quality control]. / Amélioration des résultats et optimisation du contrôle de qualité

Indispensable to developing the results obtained in an ART center, quality control concerns the material and techniques used as well as the laboratory environment. These control measures should not omit the personnel involved (technicians, biologists, and physicians), from the quality of their training to their personal involvement in the IVF/ICSI process. A control model was therefore developed at Antoine Béclère Hospital, taking into account successive series of patients undergoing the same treatment conditions and interseries periods: a preanalysis phase studying the preceding series'management and a postanalysis phase examining the clinical and biological results obtained, aiming at optimal reactivity.

[The destiny of cryopreserved embryos]. / Le destin des embryons congelés.

OBJECTIVES: To know the psychological motivations of couples who keep their embryos so long (five years and more) and do not make a decision about them. PATIENTS AND METHODS: We studied 84 couples refrained from making a decision on their cryopreserved embryos for at least five years. They were invited to fill out a questionnaire focusing on three points: the reasons of the indecision, their own representation of the cryopreserved embryos and their choice for the future: donation to another couple, to research, pregnancy or no solution for the moment. RESULTS: Mean (S.D.) women's and men's age were respectively, 38.8 (2.5)- and 41.3 (2.5)-years old. On average, three (1-9) embryos are preserved since 7.5 (5-12) years. Most of couples are parents. Four major reasons explain their attitudes: feeling of being too aged (25%), fear of a multiple pregnancy (45%), disagreement between members of couple (20%) and fear of failure (42.5%). Multiple choices were given to the future of the embryos: 25% wanted a pregnancy, 8% wanted to give them to infertile couples, 20% to research and 27.5% did not find any solution. Twenty percent were hesitating. The representation of those embryos is more symbolic than material. Most of the time, they see them like a potential child, a hope for the future or a brother or sister of their alive children. DISCUSSION AND CONCLUSION: Those embryos are symbolized. They are a proof of fertility, a hope for another child. So, whatever the legal statement, couples will be in a dilemma because it is never easy for an infertile person to renounce to embryos, and the hope for children.

[Preimplantation genetic diagnosis and its psychological effects]. / Aspects psychologiques du diagnostic génétique pré-implantatoire (DPI).

OBJECTIVE: Report our psychoanalyst experience in clinical practice of pre-implantation genetic diagnosis (PGD). METHODOLOGY: Between January 1999 and July 2001, 230 couples attended a multidisciplinary PGD consultation and the information meeting that preceded it. Eighty-six of these couples met the team's psychoanalyst during a private encounter (either as couples or individually, depending on their preference). RESULTS: The development of this technique was capital for couples at risk who, prior to PGD, had often suffered a termination of pregnancy and who may have a child who was seriously ill. Whether they were carriers or affected by the disease, PGD gave them the possibility to react to their condition. Those who have repeatedly been subjected to a painful experience were given the opportunity to play an active part in their own medical history. CONCLUSION: Beyond the scientific claims of this method, PGD contributes to the healing process of distressed couples and responds to their quest for recognition. We believe that this evolution in preventative medical practice, seen as a positive development, must necessarily lead to a number of ethical as well as psychoanalytical considerations, discussions and interrogations.

[Preimplantation genetic diagnosis experience in Paris: evaluation of first births]. / L'expérience parisienne du diagnostic génétique pré-implantatoire (DPI): bilan des premières naissances.

OBJECTIVE: To report the birth of the first fourteen infants conceived after preimplantation genetic diagnosis (PGD) in our unit. PATIENTS AND METHODS: Fifty-nine couples were enrolled between January 2000 and July 2001. They had a total of 71 oocyte pick-up cycles. The collected oocytes were inseminated by intracytoplasmic sperm injection. The resulting embryos were biopsied on the third day of development and the genetic analysis was performed on the same day. Most of the embryo transfers were carried out on the fourth day. RESULTS: The 71 oocyte pick-up cycles yielded 872 oocytes of which 731 were suitable for intacytoplasmic sperm injection. Among the 505 embryos obtained, 421 embryos were biopsied and genetic diagnosis was performed for 312 (74%) of these. 127 embryos were transferred during the course of 58 transfer procedures. There were 18 biochemical and 12 ongoing (7 singles, 4 twins and 1 triple) pregnancies. Fourteen infants have been born and 2 are expected. CONCLUSION: PGD has gained a place among the choices offered to couples at risk of transmission of a serious and incurable genetic disease.