[Systematic karyotyping before ICSI: A necessary procedure? Analysis of case studies in the Nancy University Hospital Fertility Centre]. / Le caryotype avant ICSI, une procédure à abandonner ? Étude de pratiques au centre d'AMP du CHRU de Nancy.

INTRODUCTION: A constitutional karyotype is often assayed for the couple before ICSI management. The objective of this study was to assess the prevalence of chromosomal abnormality in an infertile population, the impact on the care of couples and its cost. METHODS: A single-center retrospective study was carried out at the Fertility Center of the University Hospital of Nancy, including all infertile couples who underwent a karyotype analysis from June 2009 to December 2016. RESULTS: 1252 couples were included. 7.9% had at least one abnormal karyotype. A change in care affected 22% of these couples, i.e. 1.7% of the total population. 9% of couples with karyotype abnormality underwent PGD. In the male population, the percentage of abnormal spermograms is significantly higher in the group with karyotype abnormality compared to the control group (85.7% vs. 46.5%, P<0.001). DISCUSSION: The constitutional karyotype, due to its high economic and human cost, and limited interest, is a screening method for chromosomal abnormalities that has no place systematically before performing IVF. The future lies in the restriction of the indications for prescribing the karyotype as well as in the realization of PGS in targeted situations.

Immobilization versus immediate mobilization after intrauterine insemination: A systematic review and meta-analysis.

INTRODUCTION: The objective of this systematic review and meta-analysis was to investigate a possible association between immobilization and pregnancy rate in patients undergoing intrauterine insemination. MATERIAL AND METHODS: To ensure the quality of the methodology, the PRISMA criteria were met at all stages of the development of this meta-analysis. We searched the Cochrane Library, EMBASE, PubMed MEDLINE, ScienceDirect and reference lists of eligible studies from inception to March 2017, without any restriction. We also interviewed the ClinicalTrials.gov database for unpublished articles. Finally, we sought potentially eligible studies in meeting abstracts. Two reviewers independently extracted study characteristics and outcome data. Estimates were pooled using random effects models and sensitivity analyses. We selected studies that compared bed rest to immediate mobilization after intrauterine insemination. The primary outcome was the ongoing pregnancy rate per couple. RESULTS: Of 176 identified abstracts, four primary studies, all of them randomized controlled trials, met the inclusion criteria, including 1361 couples. The overall relative risk of ongoing pregnancy rate in bed rest versus immediate immobilization was 1.67 95% CI [0.86; 3.22]. The overall relative risk of the live birth rate was 1.11 95% CI [0.56; 2.20]. CONCLUSION: This systematic review and meta-analysis was not able to demonstrate that bed rest after intrauterine insemination effectively increases in pregnancy rate. For everyday practice, no specific strategy, bed rest or immediate mobilization, can be recommended at this time.

[Endometriosis and miscarriage: Systematic review]. / Endométriose et fausse couche spontanée. Méta-analyse et revue systématique de la littérature.

OBJECTIVES: In spontaneous pregnancies, endometriosis appears to be a risk factor of miscarriage. The aim of this study is to evaluate the association between endometriosis and miscarriage in spontaneous pregnancy. METHODS: We searched the Cochrane Library, Medline of eligible studies from inception to December 2016, without any restriction. We selected studies that compared endometriosis-affected pregnant women to disease-free pregnant women. To ensure the quality of the methodology, the PRISMA criteria have been met at all stages of the development of this meta-analysis. The primary adverse pregnancy outcomes studied was miscarriage. Three reviewers independently extracted the studies' characteristics and outcome data. RESULTS: Of 225 identified abstracts, 4 primary studies met our inclusion criteria by comparing spontaneous pregnant patients with endometriosis to disease-free women. Miscarriage rate was higher in the endometriosis group (OR 1.77 [CI 95% 1.13-2.78]). CONCLUSION: In spontaneous pregnancies, endometriosis appears to be a risk factor of miscarriages (almost 80% increased risk). Further prospective studies are needed to confirm these results in order to establish the exact impact of endometriosis on spontaneous pregnancy course.

Growth arrest specific 1 (Gas1) and glial cell line-derived neurotrophic factor receptor α1 (Gfrα1), two mouse oocyte glycosylphosphatidylinositol-anchored proteins, are involved in fertilisation.

Recently, Juno, the oocyte receptor for Izumo1, a male immunoglobulin, was discovered. Juno is an essential glycosylphosphatidylinositol (GIP)-anchored protein. This result did not exclude the participation of other GIP-anchored proteins in this process. After bibliographic and database searches we selected five GIP-anchored proteins (Cpm, Ephrin-A4, Gas1, Gfra1 and Rgmb) as potential oocyte candidates participating in fertilisation. Western blot and immunofluorescence analyses showed that only three were present on the mouse ovulated oocyte membrane and, of these, only two were clearly involved in the fertilisation process, namely growth arrest specific 1 (Gas1) and glial cell line-derived neurotrophic factor receptor α1 (Gfrα1). This was demonstrated by evaluating oocyte fertilisability after treatment of oocytes with antibodies against the selected proteins, with their respective short interference RNA or both. Gfrα1 and Gas1 seem to be neither redundant nor synergistic. In conclusion, oocyte Gas1 and Gfrα1 are both clearly involved in fertilisation.

[Evaluation of the theoretical teaching of postgraduate medical students in France]. / Évaluation nationale de l'enseignement théorique du troisième cycle des études médicales en France.

OBJECTIVES: In France, medical students regularly complain about the shortcomings of their theoretical training and the necessity of its adaptation to better fit the needs of students. The goal was to evaluate the theoretical teaching practices in postgraduate medical studies by: 1) collecting data from medical students in different medical faculties in France; 2) comparing this data with expected practices when it is possible; 3) and proposing several lines of improvement. METHODS: A survey of theoretical practices in the 3rd cycle of medical studies was conducted by self-administered questionnaires which were free of charge, anonymous, and administered electronically from July 3 to October 31, 2013 to all medical students in France. RESULTS: National, inter-regional, regional and field internship educational content was absent in respectively 50.5%, 42.8%, 26.0% and 30.2% of cases. Medical students follow complementary training due to insufficient DES and/or DESC 2 training in 43.7% of cases or as part of a professional project in 54.9% of cases. The knowledge sought by medical students concerns the following crosscutting topics: career development (58.9%), practice management (50.7%), medical English (50.4%) and their specialty organization (49.9%). Fifty-four point one percent would like to be evaluated on their theoretical training on an annual basis. CONCLUSION: The results of this first national survey give insights into the theoretical teaching conditions in postgraduate medical education in France and the aspirations of medical students.

[Evaluation of theoretical teaching of the French diploma of medical gynecology]. / Enseignement théorique du Diplôme d'études spécialisées de gynécologie médicale en France: évaluation nationale.

OBJECTIVES: As far as the reform of the "Diplômes d'études spécialisées" (DES) is approaching, a first national evaluation of the Medical Gynecology diploma was necessary. The objective was to evaluate the practices of the theoretical teaching with the whole students, by receiving their opinions and their wishes of changing, and by proposing some improving measures. PATIENTS AND METHODS: The self-evaluation form made by members of the Association of residents (AIGM) and the Teacher's College (CNEGM) was submitted to the students during the national teaching session of June 2014. RESULTS: Fifty-six results were gathered among 145 students enrolled at the DES (38.6 %). Twelve half days of national theoretical training are yearly scheduled. The accordance of the national theoretical training to the level of the students was assessed on average at 7.8 (VAS from 0 to 10). The scientific and pedagogical skills of the speakers are evaluated at 8.9 and 7.8. The theoretical training of the diploma was considered as satisfying for 76.6 % of the respondents. DISCUSSION AND CONCLUSION: Despite a globally satisfying evaluation, some points can be improved in the organization of the diploma. The introduction of courses about establishment, medical acts and imaging, the implementation of gradual progress teaching, the development of hands-on training and practical works, reciprocal evaluation of the students and the teachings/teachers, should be set up.

Endocrine disorders in Woodhouse-Sakati syndrome: a systematic review of the literature.

First described in 1983, Woodhouse-Sakati syndrome (WSS) is a rare autosomal recessive genetic disorder that leads to a spectrum of hypogonadal symptoms in adolescence. The responsible gene, DCAF17 located on chromosome 2q31.1, was discovered in 2008 and to date nine mutations have been reported in the literature. The aim of the study was to review WSS descriptively in the light of new case reports with focus on endocrine features. Phenotypic description of three patients (two females, one male) with WSS followed in the Endocrinology Department of the University Hospital of Nancy, France, and exhaustive review of the literature using the PUBMED database were performed. Of 72 patients from 29 families with documented WSS who were identified, 39 had undergone genetic testing. WSS was invariably associated with hypogonadism, decreased IGF1 and frontotemporal alopecia starting in childhood. In addition to this triad, some patients exhibited intellectual disabilities of varying severity (87 %), bilateral deafness (76 %), cervicofacial dystonia and limb pain (42 % of cases, rising to 89 % after 25 years) and diabetes (66 %, rising to 96 % after 25 years). The pathophysiology of WSS remains unclear.

[Azoospermia and 45,X/46,XY chromosomal mosaicism: a case report]. / Azoospermie et mosaïque 45,X/46,XY : à propos d'un cas.

Chromosomal abnormalities are common in patients with oligozoospermia or azoospermia. We report the case of a 32-year patient, with male phenotype, and without hormonal or morphological abnormalities, with a severely reduced spermatogenesis. It was revealed a 45,X/46,XY gonadal dysgenesis. We have reviewed the various problems inherent in the discovery of this rare gonadal dysgenesis, including genetic, cancer and fertility risks.