Transvaginal ultrasound-guided embryo transfer in IVF.

OBJECTIVES: To determine whether transvaginal ultrasound-guided embryo transfer is a technique that can be used routinely, whether it improves IVF outcomes and whether it makes difficult transfers easier and more successful. MATERIAL AND METHOD: Non-randomized retrospective study conducted between 2012 and 2016 in the fertility center of the Diaconesses-Croix St-Simon hospital group. The outcomes of 3910 transfers, performed by 5 senior operators, under transabdominal ultrasound guidance are compared with those of 800 transfers, performed by 1 senior operator under transvaginal ultrasound guidance. The criteria studied are the feasibility of the technique and the percentage of pregnancies per transfer in the two populations described, as well as in the difficult and very difficult transfer populations. RESULTS: All the transfers were feasible under transvaginal ultrasound guidance without the use of forceps or additional instruments. The percentage of pregnancies per transfer is significantly increased, when the transfer is performed under transvaginal ultrasound guidance compared with that performed under transabdominal ultrasound guidance, in the general population (38%, n=800 vs 30%, n=3910; P 0.0004) and in the reference population characterized by age <38 years and >6 oocytes collected per puncture (45%, n=490 vs 36%, n=1968; P 0.002). The percentage of pregnancies per transfer (P/T) is not significantly different in the populations of easy transfers (n 695, 38% P/T), difficult transfers (n 58, 46% P/T; P=ns) and very difficult transfers (n 47, 34% P/T; P=ns). CONCLUSIONS: Embryo transfer is a key stage in IVF, in which the quality of performance determines the outcome. In this study, transvaginal ultrasound guidance of the transfer, which is the reference procedure in gynaecological imaging, significantly increases the percentage of pregnancies per transfer, both in the general population and in the reference population, compared with transfers performed under transabdominal ultrasound guidance. Transvaginal ultrasound facilitates the performance of difficult transfers and in particular achieves outcomes in these situations that are not significantly different from those of easy transfers. Visual monitoring of transcervical passage, which is rendered more precise and less traumatic and precision of embryo deposition are the factors that probably account for the improvement in outcomes.

Anatomical causes of difficult embryo transfer during in vitro fertilization.

OBJECTIVES: Identify, define and validate through statistical analysis the anatomical causes of difficult embryo transfers (ET). MATERIALS AND METHODS: This observational study, carried out in 306 IVF candidates, compared the frequency of anatomical anomalies of the uterus and cervix in women who underwent an easy ET with that in women who underwent a difficult ET. Anatomical anomalies were detected during an assessment of the cervix and uterus including transvaginal ultrasound, hysteroscopy and a mock transfer. Ease of ET was determined during the actual transfer procedure. RESULTS: An easy ET was achieved in 151 patients, whereas difficulties occurred in 155 patients, among whom 55 patients underwent a "very difficult" ET. The most common anatomical characteristics associated with difficult ET were abnormal crypts in the cervical canal (86%) and tortuosity of the cervical canal (68%). Less frequent causes included: internal os contractions (28%) and pronounced anteversion of the uterus (26%). Very difficult ETs were associated with the presence of several causes. CONCLUSIONS: ET is the clinical step that has the most effect on IVF outcome. Difficult transfers are associated with a fall in pregnancy rates. The anatomical causes of difficult transfer identified in this study led to major changes in transfer procedure in our department and to the development of more adapted catheters.

Programa de rehabilitación en artrosis avanzada de rodilla / Program of rehabilitation in advanced degenerative osteoarthritis of knee

La Osteoartritis (OA) es una causa mayor de morbilidad, discapacidad y pérdida de la función en la población general. Una variedad de programas para OA de rodilla han sido descriptos en la literatura. Objetivo: Determinar si los efectos de un programa integral de ejercicios solo o combinado con Tens mejora el dolor, la función y la calidad de vida en mujeres con OA de rodilla avanzada. Métodos: Un ensayo clínico randomizado y controlado de 126 mujeres adultas con OA de rodilla fue conducido. Los participantes fueron estratificados según la severidad del dolor y la severidad de la enfermedad, grado 3 o más de la clasificación de Kellgren & Lawrence. Los pacientes fueron randomizados en cuatro grupos: actividad física (AF) (n = 34), Tens (n = 36), AF y Tens (n = 35) y control (n = 21); todos fueron estudiados durante 8 semanas. La función física fue medida por KOOS (Knee Injury and Osteoarthritis Outcome Score). La calidad de vida fue valorada por el cuestionario de salud general SF-36 (Short Form-36). Los pacientes fueron examinados a nivel basal y después de 8 semanas. Resultados: La edad media fue de 68 (9) años, peso 72 (11) kg, e IMC 30 (7) kg/m2. Las diferencias no fueron significativas antes y después del tratamiento en los datos demográficos. Los pacientes tratados con AF tuvieron diferencias significativas en todas las subescalas del KOOS, y ambas SF-36 y WOMAC (p <0,001). Los pacientes tratados con AF y Tens, mostraron diferencias significativas en todos los índices del KOOS, WOMAC y SF-36 (p <0,001). Los análisis del tamaño delefecto mostraron un marcado incremento en el grupo combinado, pre y post-tratamiento Koos (1,81), comparado con el grupo control (0). Conclusión: Un programa de ejercicios de corta duración y fácil aplicación, combinado con Tens, sugiere ser la mejor opción en pacientes con OA de rodilla avanzada.

Osteoarthritis (OA) is a major source of morbidity, disability and loss of function in general population. A variety of programs for knee OA have been described in the literature. Objective: To determine whether the effects of an integral exercise program alone or in combination with tens improves pain, physical function and quality of life in patients advanced Knee OA. Methods: A randomized controlled trial of 126 women older adults, mean age 68 years, with Knee OA was conducted. Participants were stratified by severity of knee pain and disease severity grade 3 or more, according to Kellgren & Lawrence criteria. The subjets were randomized to 4 groups: exercise group (n = 34), tens group (n = 36), combined group (exercise and tens) (n = 35), and control group (n = 21); all of them were studied during 8 weeks. Physical function was measured by KOOS (Knee injury and Osteoarthritis Outcome Score). The quality of life was assessed by the Short Form-36 (SF-36) questionnaire. The patients were examined at baseline and after 8 weeks. Results: Mean age was 68 (9) years, weigth 72 (11) kg, and BMI 30 (7) kg/m2; non significant differences were before and after treatment in demographic data. Patients treated with exercise had significant differences in all KOOS subscales, and both WOMAC and SF-36 (p <0.001). In the other hand, patients treated with exercise and tens, showed significant differences in all KOOS index, and both WOMAC and SF-36 (p <0.001). Size effect analysis showed a marked improvement in the combined group, pre and post treatment KOOS (1.81), compared to control group (0). Conclusion: Short duration and easy application of an exercise program, combined with Tens, suggest to be the best option in patients with advanced knee OA.

Programa de rehabilitación en artrosis avanzada de rodilla / Program of rehabilitation in advanced degenerative osteoarthritis of knee

La Osteoartritis (OA) es una causa mayor de morbilidad, discapacidad y pérdida de la función en la población general. Una variedad de programas para OA de rodilla han sido descriptos en la literatura. Objetivo: Determinar si los efectos de un programa integral de ejercicios solo o combinado con Tens mejora el dolor, la función y la calidad de vida en mujeres con OA de rodilla avanzada. Métodos: Un ensayo clínico randomizado y controlado de 126 mujeres adultas con OA de rodilla fue conducido. Los participantes fueron estratificados según la severidad del dolor y la severidad de la enfermedad, grado 3 o más de la clasificación de Kellgren & Lawrence. Los pacientes fueron randomizados en cuatro grupos: actividad física (AF) (n = 34), Tens (n = 36), AF y Tens (n = 35) y control (n = 21); todos fueron estudiados durante 8 semanas. La función física fue medida por KOOS (Knee Injury and Osteoarthritis Outcome Score). La calidad de vida fue valorada por el cuestionario de salud general SF-36 (Short Form-36). Los pacientes fueron examinados a nivel basal y después de 8 semanas. Resultados: La edad media fue de 68 (9) años, peso 72 (11) kg, e IMC 30 (7) kg/m2. Las diferencias no fueron significativas antes y después del tratamiento en los datos demográficos. Los pacientes tratados con AF tuvieron diferencias significativas en todas las subescalas del KOOS, y ambas SF-36 y WOMAC (p <0,001). Los pacientes tratados con AF y Tens, mostraron diferencias significativas en todos los índices del KOOS, WOMAC y SF-36 (p <0,001). Los análisis del tamaño delefecto mostraron un marcado incremento en el grupo combinado, pre y post-tratamiento Koos (1,81), comparado con el grupo control (0). Conclusión: Un programa de ejercicios de corta duración y fácil aplicación, combinado con Tens, sugiere ser la mejor opción en pacientes con OA de rodilla avanzada.

Osteoarthritis (OA) is a major source of morbidity, disability and loss of function in general population. A variety of programs for knee OA have been described in the literature. Objective: To determine whether the effects of an integral exercise program alone or in combination with tens improves pain, physical function and quality of life in patients advanced Knee OA. Methods: A randomized controlled trial of 126 women older adults, mean age 68 years, with Knee OA was conducted. Participants were stratified by severity of knee pain and disease severity grade 3 or more, according to Kellgren & Lawrence criteria. The subjets were randomized to 4 groups: exercise group (n = 34), tens group (n = 36), combined group (exercise and tens) (n = 35), and control group (n = 21); all of them were studied during 8 weeks. Physical function was measured by KOOS (Knee injury and Osteoarthritis Outcome Score). The quality of life was assessed by the Short Form-36 (SF-36) questionnaire. The patients were examined at baseline and after 8 weeks. Results: Mean age was 68 (9) years, weigth 72 (11) kg, and BMI 30 (7) kg/m2; non significant differences were before and after treatment in demographic data. Patients treated with exercise had significant differences in all KOOS subscales, and both WOMAC and SF-36 (p <0.001). In the other hand, patients treated with exercise and tens, showed significant differences in all KOOS index, and both WOMAC and SF-36 (p <0.001). Size effect analysis showed a marked improvement in the combined group, pre and post treatment KOOS (1.81), compared to control group (0). Conclusion: Short duration and easy application of an exercise program, combined with Tens, suggest to be the best option in patients with advanced knee OA.(AU)

Genetic analysis of the growth curve of Rous sarcoma virus-induced tumors in chickens.

White Leghorn chicks homozygous for B19 MHC haplotype were selected for 18 generations on tumor regression after inoculation in the wing web with an SR-D strain of Rous sarcoma virus (RSV) at 4 wk of age. Each chick was assigned a tumor profile index (TPI) based on age at death and size of the tumor. During 18 generations, 2,010 birds were divergently selected on TPI for either progression or regression of the tumor (P and R lines). A Brody growth curve was fitted for each bird. Brody function parameters included the asymptotic tumor volume (A), the factor for increased growth in progression phase (K1), the factor for decreased growth in regression phase (K2), age at maximum volume (Tmax), and maximum volume of the tumor (Vmax). Tumor growth curves were found to be different according to line, sex, and restriction fragment pattern Y complex Rfp-Y MHC haplotype (Yw*15, Yw*16, and Yw*17). Within the P line, birds from the Yw*16 haplotype reached Vmax at an earlier age than Yw*15 and Yw*17, but with a lower Vmax value. Within the R line, tumor growth curves of birds from Yw*16 and Yw*17 haplotypes were similar. Rank correlations between the different parameters and TPI were low (between -0.26 and 0.36). Heritability estimated by the sire component was high for Vmax (0.73). Heritabilities of Tmax and K2 were moderate (0.20 to 0.23 for Tmax and 0.18 to 0.21 for K2) allowing these traits to be used as selection criteria. Heritabilities of A and K1 were lower than 0.12. Modeling the growth curve should contribute to better distinction between progressors and regressors.

[Risks in medically-assisted procreation in case of positivity for HIV, hepatitis C virus or hepatitis B virus. The French law at the end of 2001]. / Risques de l'assistance médicale à la procréation en cas d'infection par le VIH, les virus des hépatites C ou B. Qu'apporte la loi française par l'arrêté de 2001?

Inclusion of HIV+, HCV+ or HBV+ couples in medically assisted procreation has been allowed by the French law since the publication of some legal texts dates January 12th 1999 and May 2001. This article tries to identify the viral risks of such inclusion and to analyse the answers given by the French law to eliminate these risks.

A modified RT-PCR technique to screen for viral RNA in the semen of hepatitis C virus-positive men.

BACKGROUND: Our objective was to use an adapted RT-PCR technique to assess the presence of hepatitis C virus (HCV) in semen and also in different density gradient semen fractions collected from men with chronic viral hepatitis participating in an assisted reproduction programme. METHODS: This study included 50 semen samples from 35 HCV(+) men, with active viral replication assessed by RT-PCR, collected the day of oocyte retrieval and used for assisted reproduction. These samples were subjected to standard assisted reproduction sperm preparation conditions, using density-gradient centrifugation with 45 and 90% layers. Aliquots of semen, 45 and 90% fractions, and embryo culture media were frozen at -80 degrees C for subsequent virological analyses. All aliquots were tested with a commercially available HCV RNA assay, adapted for use with semen after a number of technical changes. This assay yielded a sensitivity of 50-100 HCV RNA copies/ml and strongly diminished the effect of seminal amplification inhibitors. RESULTS: HCV RNA was detected in 7/50 (14%) semen samples tested, 5/35 (14.3%) men. HCV RNA was found in only 1/50 45% fractions but never in the 90% fraction or embryo culture media. Sera from 3/5 men contained 3.19-7.40 x 10(5) IU/ml, while the two others had 4.5 and 11.7 x 10(6) IU/ml. However, HCV RNA was quantified at <600 IU/ml in the HCV(+) semen of these five patients. The ongoing pregnancy rate was of 20% (10/50) with one delivery at the time of the present report. No anti-HCV antibody was found in any of the women or the newborn. CONCLUSIONS: Although HCV is present at low concentrations in the semen of a few HCV(+) patients, no purified sperm fraction (i.e. 90% fraction) used in assisted reproduction was HCV(+) and no seroconversion was observed in the women and the newborn, thereby suggesting a very low risk of virus transmission. Nevertheless, because the presence of HCV in semen implies a possible risk of nosocomial contamination, safety regulations must be strictly applied in assisted reproduction laboratories.