Choroidal thickness in healthy eyes using enhanced depth imaging optical coherence tomography and comparison with cases of retinitis pigmentosa.

INTRODUCTION: The goal of this study was to measure by spectral domain optical coherence tomography (SD-OCT) with EDI the choroidal thickness in healthy subjects and to compare these parameters with those of patients with retinitis pigmentosa (RP). METHODS: Data were obtained from 60 healthy patients without history or family history of retinal or choroidal disease or glaucoma. A case-control study was also conducted on 40 eyes of 20 patients with RP and 40 eyes of 20 healthy refraction- and age-matched controls, selected from among the 60 healthy patients. OCT was used with the EDI protocol. The primary outcome measure was choroidal thickness. RESULTS: Among healthy patients, the overall choroidal thickness was 287.7µm. Mean choroidal thickness was lower on the nasal side (236.6µm at 2000µm from the fovea) compared with the temporal side (262.3µm at 2000µm, P=0.002). It also varied according to age, being highest among 20-29-year-old patients and decreasing thereafter with increasing age. Choroidal thickness was significantly higher in healthy patients than in RP patients, regardless of the location (P<0.001). CONCLUSION: This observational study confirms that choroidal thickness varies with age and location. It decreases in subjects with RP and is related to worsening of retinal damage, independently of age-related thinning. Further studies are needed to understand whether choroidal vascular alteration is a cause or a consequence of the degenerative pathology.

[Conventional IVF versus ICSI in sibling oocytes: a French experience analysis for BLEFCO]. / FIV conventionnelle versus ICSI sur une même cohorte ovocytaire: analyse de l'expérience française pour les BLEFCO.

Assisted Reproductive Techniques (ART) separating oocytes in sibling oocytes treated either by conventional IVF or ICSI is called mid-IVF/ICSI. We sum up here 487 attempts of this kind from six French ART centers. The mid-IVF/ICSI technique was performed in 5.6% of cases. The fertilization rate by micro-injected oocytes was significantly higher (P<0.01) than oocytes inseminated conventionally, 72.6% versus 53.4%. A failure of fertilization was observed only in mid-IVF in 21.6% of cases, which prevented a complete fertilization failure when we decided to propose to the couples concerned the mid-IVF/ICSI technique. Conversely, in 75.2% of cases, fertilization was found for the two batches of oocytes. The overall pregnancy rate has improved since the use of the mid-IVF/ICSI technique (33.1% versus 28.9%, P=0.013) and the fertilization failures decreased (10.4% versus 14.3%, P=0. 019). The pregnancy rate in only mid-IVF/ICSI cases is very high at 39.8% but for a selected population. The indications for mid-IVF/ICSI remain to be clarified especially with regard to male and idiopathic indications.

[Assisted reproductive techniques in women aged 38 years or more]. / Prise en charge en Assistance médicale à la procréation des femmes de 38 ans et plus: résultats d'une enquête à propos de 84 couples.

OBJECTIVE: More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre. PATIENTS AND METHODS: A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data. RESULTS: Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered. DISCUSSION AND CONCLUSION: ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.

[Apoptosis during spermatogenesis and in ejaculated spermatozoa: importance for fertilization]. / Place de l'apoptose au cours de la spermatogenèse et dans le sperme ejaculé: relations avec la fécondation.

It has become clear in recent years that programmed cell death occurs spontaneously in the cycle of the seminiferous epithelium. Induced germ cell apoptosis occurs at specific stages of the spermatogenic cycle and the existence of supracellular control of germ cell death during spermatogenesis has been documented. If apoptosis is a key phenomenon in the control of sperm production, the existence and role of apoptosis in ejaculated sperm cells remain controversial. Apoptosis - as determined by DNA fragmentation (Tunel) and ultrastructural analysis - is abnormally frequent in the sperm cells of the ejaculate of sterile men. In this review, we discuss the possible origins of DNA damage in ejaculated human spermatozoa and the consequences of these DNA damage if the apoptotic spermatozoa is used for ICSI. Percentages of DNA fragmentation in human ejaculated sperm correlated with fertilization rates after FIV or ICSI assay. Detection of DNA fragmentation in human sperm could provide additional information about the biochemical integrity of sperm and may be used in future studies for fertilization failures not explained by conventional sperm parameters. However, the analysis of other molecular markers of apoptosis (Fas, Annexine V.) is now necessary to assess the role of apoptosis in human ejaculated sperm cells.