Circulating MMP-7 and VEGF as potential predictive biomarkers for recurrent implantation failures.

Recurrent implantation failure (RIF) is considered to be one of the major limiting factors of assisted reproductive technology (ART) programme success. The current study focused on the investigation of matrix metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs), cytokines and cell adhesion molecules in peripheral blood (PB) and follicular fluid (FF) obtained from 44 women aged between 25 and 39 years old and undergoing intracytoplasmic sperm injection (ICSI). These women were divided into two groups: 22 RIF women with embryo implantation failures after the transfer of at least four fresh or frozen-thawed good quality embryos in a minimum of three ICSI cycles, and 22 ICSI success women (controls) who achieved a clinical pregnancy at their first ICSI attempt. The PB and FF samples were obtained from each patient on the day of oocyte retrieval. MMP-1, -2, -3, -7, -9, TIMP-1, -2, vascular endothelial growth factor (VEGF), leukaemia inhibitory factor (LIF), vascular cell adhesion molecule 1 (VCAM1) and intercellular adhesion molecules 1 (ICAM1) were analyzed using enzyme-linked immunosorbent assay of PB and FF. Our results showed significant decreases in PB MMP-7 and PB VEGF in the RIF group compared with controls [281.11 (33-614) pg/ml vs 119.92 (27-441) pg/ml; P-value = 0.030] and [82.54 (25.94-210.20) pg/ml vs 30.93 (13.62-193.33) pg/ml; P-value = 0.022; respectively]. Receiver operating characteristic (ROC) curve analysis showed informative area under the curve values for PB MMP-7, as well as for PB VEGF, making them able to be proposed as biomarkers of the RIF. Therefore, circulating MMP-7 and VEGF seem to play an interesting role in embryo implantation in in vitro fertilization (IVF)/ICSI cycles and could be proposed as circulating biomarkers of the RIF. These results could be helpful for clinicians and patients to choose the best rescue strategy and treatment to minimize implantation failure in women undergoing IVF/ICSI procedures after the first attempt.

[HELLP syndrome: about 17 cases and literature review]. / Le HELLP syndrome: A propos de 17 cas et revue de la littérature.

BACKGROUND: HELLP syndrome is defined as an association of hemolytic anemia, raised liver enzymes and thrombocytopenia. It is a severe manifestation of pre-eclampsia. AIM: We tried to specify the epidemic factors and the best management of HELLP syndrome Methods: A retrospective study held during 6 years in the department of gynaecology and obstetrics in La Marsa hospital and according to a literature revue. RESULTS: The dominating symptoms included low abdominal pain and vomiting. The syndrome was discovered after 30.5 weeks of amenorrhea on average. Infant extraction was by cesarean section in 11 cases. Maternal morbidity was mainly marked by eclampsia and haemostatic disturbances while neonatal morbidity was attributable to the included prematurity. CONCLUSION: The main management consists essentially in a medical reanimation, in addition to a rapid foetal extraction.

[Indication of metformin in the management of hormonal dysfunction secondary to polycystic ovarian syndrome: prospective comparative study of 63 cases]. / La métformine dans la prise en charge de l'infertilité du sopk hors fiv Etude prospective comparative à propos de 63 cas.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is the most common hormonal dysfunction in women. It's a cause of female infertility by oligoanovulation, clinical and biochemical hyperandrogenism and polycystic ovaries. Weight loss, firstly proposed in overweight or obese patient suffering from PCOS, aims to reduce hyperinsulinism and hyperandrogenism. Recently, Metformin, an insulin sensitizer, has been proposed as an alternative first line treatment for polycystic ovarian syndrome by improving hyperinsulinemia and hyperandrogenism in these women. AIM: The aim of our study, and through a literature review, is to demonstrate if Metformin should be used as a first-line drug for infertile women with this syndrome or as an adjunction to Clomifene Citrate, the longest established treatment already used in this syndrome. METHODS: A prospective comparative study including 63 patients with PCOS has been done during 2 years. Women were randomly allocated to clomifene + Metformin (Metformin group, Metformin took during 8 weeks, 850 mg twice a day, plus Clomifene 100 mg per day during five days) or Clomifene only (100 mg per day during five days). All patients underwent a two- month's diet. RESULTS: The middle age was about 30.63 years and the body mass index (BMI) was about 29.88 kg/ m(2). We noticed a 6.2% weight loss in both groups (a non significant difference in p=0.04). The median of infertility period was about 2.49 years. The ovulation rate in the Metformin group was 53.12% (significant difference for inducing ovulation p=0.02) and 32.25% in Clomifene group (non-significant difference 0.07). There was also a significant difference for ongoing pregnancies (p=0.04). In fact, 11 on 32 patients (34%) achieved a full-term pregnancy in Metformin group versus only 4 ones on 31 patients (12.9%) in Clomifene group. CONCLUSION: Our conclusion is that Metformin is an effective addition to Clomifene Citrate in term of reestablishment of ovulation and full-term pregnancies achievement, excluding ART cycles.

[Red-cell alloimmunization: prevention and management]. / Allo-immunisation erythrocytaire: epidémiologie, prévention et traitement.

Although very rare, red-cell immunization is a main factor of hemolytic fetal anemia and severe neonatal jaundice. We emphasize on the prevention of immunization in different situations of feto maternal bleeding by early intravenous injection of 200 at 300 IU or more depending on the term of pregnancy, the circumstances and results of the Kleihauer's test. Prophylaxis corresponds a systematic intramuscular injection of 300 IU immunoglobulin (Natead ) at 28 WA, is performed in many countries. This measure implies information and rigor from Perinatal's professional. If this systematic prophylaxis was conducted, it is not necessary to repeat the IAR until the birth. But if the patient has not received the injection of 28 WA, IAR of the 8th month must be maintained.

[Role of the hysteroscopy and laparoscopy in management of the female infertility: about 200 cases]. / Intérêt de l'hystéroscopie et de la coelioscopie dans la prise en charge du couple infertile: a propos de 200 cas.

AIM: Infertility is a common disease which affects nearly 10% of women at reproductive age. The hysteroscopy and laparoscopy are becoming very important in the management of this pathology. We tried to assess the current results of both hysteroscopy and laparoscopy, to study the prognosis factors as well as operating techniques and to clarify their contribution in comparison with other therapeutic techniques. METHODS: This is a retrospective study about 200 cases of hysterolaparoscopy performed for female infertility in women admitted at the department of Gynaecology and Obstetrics in Mongi Slim's Hospital La Marsa. RESULTS: The hysteroscopy was abnormal in 75% of cases: the uterine synechias (23%), endometria hypertrophy (19%), endometrial polyps (10%), uterine fibroids (9%), atrophy (7.5%) and malformations (3.5%). The operating hysteroscopy procedure was performed in 27.3% of cases with a rate of subsequent pregnancy in 34.9%. There is different data between the hysterosalpingography and hysteroscopy in 34.8%. The operating laparoscopy was performed in 70% of cases divided between adhesiolysis (27.2%), tubal surgery (37.8%), electrocoagulation or excision of endometriosis nodule (17.2%) and ovarian drilling for PCOS (17.8%). The rate of pregnancy is 39.9% after laproscopic surgery (divided between intrauterine pregnancy 37.1% and ectopic pregnancy 2.8%). The data of the hysterosalpingography and laparoscopy are different in 21.1%. CONCLUSION: Hysteroscopy and laparoscopy are diagnosing and treating both uterine and tubal infertility as well as some ovarian abnormalities. They have, thus, the main role in diagnosis and treatment of female infertility. They permit to correct data from the HSG in more than a quarter of cases and to improve the rate of pregnancy in more than one third of cases.

[Ovarian cyst: comparison between ultrasonography, laparoscopy, and pathology of 100 cases]. / Kyste de l'ovaire: confrontation echographique, coelioscopique et anatomopathologique a propos de 100 cas.

BACKGROUND: The ovarian cysts are a common pathology in gynecology. AIM: The aim of our study is to confront ultrasound and coelioscopic data in final anatomo pathological diagnosis of ovarian cysts and to assess the efficiency and the morbidity of coelioscopic treatment. METHODS: We report a retrospective study of 100 ovarian cysts collected in CHU of Mongi Slim La Marsa from October 1st, 2003 to November 30th, 2007. RESULTS: The coelioscopic exploration coupled with the extemporany review has a sensitivity of 100%. The benefits of coelioscopy are: less esthetic desagrement, a decrease in morbidity per and post operatory and economic benefit. The risk of ignoring a malignant lesion is not zero with a risk of spread tumor. That's why it must respect strict rules and convert if malignancy is suspected. CONCLUSION: Coelioscopy has let a reliable diagnosis of malignancy with a low morbidity, it is an efficient and comfortable technic for patients.

[Transvaginal ultrasound of the cervix in the estimation of severity of premature labour]. / Apport de l'echographie endovaginale du col uterin. Dans l'estimation de la sévérité de la menace d'accouchement prématuré.

AIM: Premature labour is a frequent situation,it complicates about 6% of births, with increasing perinatal morbidity and mortality. The purpose of this study is to analyse the place of the ultrasound of the cervix in the coverage of a premature labour and the evaluation of the severity of the premature labour, being able to have therapeutic implications. METHODS: It is about a prospective study 56 patients presenting a premature labour between 28 and 34 weeks realized in the service of maternity in Momgi Slim hospital of Marsa for a period of 12 months going from January 2006 till January 2007. RESULTS: In our study 56 patients presented an ultrasonographic cervical length < or = 25mm. The funneling was found in 30 patients. The sensibility of the mesure of length of the cervix < or = 25mm to predict the delivery before 48 hours was 100% and specificity was 59%. Negative predictive value of this exam was very strong of 100% and its positive predictive value was 28%. The presence of funneling had a sensibility and a negative predictive value less important by report than that of the mesure of cervical length. The evaluation of severity of premature labour by the vaginal touch and calculation of Bishop's score, is a simple and reproducible exam having the same efficiency as ultrasonographic cervical length. CONCLUSION: Vaginal touch constitutes essential exam for the diagnosis of severity of the premature labour by basing itself on the calculation of Bishop's score. The utility of the ultrasonographic cervical length is based on its excellent negative predictive value consolidating our therapeutic strategy.

Hematocolpos with imperforate hemi-vagina and duplicated uterus: diagnosis and treatment.

OBJECTIVE: To document the means of diagnosis and treatment of the exceptional malformation hematocolpos with imperforate hemi-vagina and duplicated uterus CASES: Cases of four patients treated at La Marsa University Hospital, in the Department of Obstetrics and Gynecology between 2000 and 2004, were reported. Mean age=17.2 years (range: 15-22 years). Three left hematocolpos and a right one are observed. All patients underwent vaginal conservative surgical treatment (excision of vaginal septum) +/- radical treatment: hemi- colpohysterectomy in case of failure of conservative treatment. The clinical presentation was a primary dysmenorrhea associated with a pelvic collection. An ipsilateral renal agenesis is present in all cases. Sonography is essential to assess the diagnosis of renal anomalies. Pelvic MRI is the most important examination. It accurately localises the different collections and identifies their content. Conservative surgical management was effective in three cases out of four.

[Management of adnexal torsion]. / Prise en charge des torsions d'annexe.

Adnexal torsion is a current emergency in gynecology because it may compromises young women fertility. We have conducted a retrospective study about 26 adnexal torsion cases managed in B service of C.M.N.T during 4 years (1997-2001). Objective of our study is to improve patient fertility prognosis; we propose a diagnosis and therapeutic attitude which respect the time between diagnosis and treatment. Laparoscopy authorizes diagnosis, treatment and prognosis of this situation. It must usually be done in young woman who declare acute pelvic pain.