Pronuclear morphology differs between women more than 38 and women less than 30 years of age.

Pronuclear morphology has been reported as a good tool for studying embryo development and euploidy. Comparing two groups of women with different aneuploidy risk, women more than 38 years old (n = 28) known to be at high risk of aneuploidy, and women under 30 years old (n = 35), this study investigated whether pronuclear morphology could be used routinely as an alternative to preimplantation genetic screening (PGS) in countries where PGS is prohibited. Pronuclear morphology was evaluated for 301 zygotes and related to embryo quality and pregnancy outcome. For the older women, an increased frequency of zygotes with abnormal polar body and pronuclei alignment was observed, i.e. type gamma, with 93% aneuploidy risk (26.0 versus 15.1% P < 0.05) and fewer zygotes with a good development prognosis (36.4 versus 47.8%; P < 0.05). A1alpha configuration was associated with good implantation rate and was not related to day 2 embryo quality. This configuration was less frequent in the group of women more than 38 years old and among non-pregnant women under 30 years, compared with pregnant women under 30 years old. Pronuclear morphology seemed linked to age, but not associated with embryo quality. A larger study allowing correlation analysis is necessary to confirm the value of these criteria and the link to a woman's age.

Milk fat thermal properties and solid fat content in emmental cheese: a differential scanning calorimetry study.

The experiments reported in this study give deeper insight into the crystallization of milk fat in Emmental cheese, which is the most widely consumed hard cheese in France. Differential scanning calorimetry (DSC) was used to monitor the thermal properties of milk fat after the main stages involved during manufacture of Emmental cheese. By heating the samples to 60 degrees C to eliminate their thermal history and cooling them at 2 degrees C/min, the liquid --> solid phase transition of fat was investigated. Confocal laser scanning microscopy was used to characterize in situ the supramolecular organization of milk fat dispersed in the casein matrix. The destabilization of fat globules by aggregation or coalescence and the formation of free fat during the manufacture altered the thermal properties of milk fat by increasing the initial temperature of crystallization and by the formation of 2 overlapping exotherms. The melting properties of the crystalline structures formed by fat at the temperatures used for ripening (12, 21, and 4 degrees C) were examined. Differential scanning calorimetry was used to determine the ratio of solid to liquid fat; that is, the amount of fat that is crystallized, by dividing the partial enthalpy of melting of the fat for ripening temperature by the total enthalpy of melting of the same fat extracted from cheese. This study shows, for the first time, that milk fat is partially crystallized in Emmental cheese: about 55.7 +/- 3.5% of fat is solid at 4 degrees C at the end of ripening. Polymorphic phase transitions of milk fat are also suggested during ripening of Emmental cheese.

[Diagnosis and current concepts of management of advanced abdominal pregnancy]. / Diagnostic et concepts actuels de prise en charge de la grossesse abdominale avancée.

Authors report a case of abdominal pregnancy diagnosed by MRI at 17 SA with prospective follow-up and planned delivery at 37 SA. The diagnosis is clinically suspected when extra-uterine pregnancy risk factors or history of uterine trauma are present. This is confirmed by MRI, which may be considered as the gold standard. A conservative management may be proposed when the diagnosis is made after 20 weeks and under the following conditions: absence of fetal growth malformation, placental implantation remote from the upper abdomen, good maternal condition, close management in a hospital setting of the patient previously informed of the risks and outcomes. Placental location on the uterus seems to be a major positive factor of outcome for these pregnancies. Materno-fetal follow-up is based on physical examination, repeated ultrasonic investigations with Doppler imaging and daily fetal heart rate monitoring. In the absence of complications, a laparotomy should be planned at 34 weeks. The placenta may not be removed when a serious risk of hemorrhage is feared.

Relationship between phosphatidic acid level and regulation of protein transit in colonic epithelial cell line HT29-cl19A.

Colonic epithelial HT29-cl19A cells are polarized and secrete proteins among which alpha(1)-antitrypsin represents about 95%. Secretion occurs via a constitutive pathway, so that the rates of secretion directly reflect the rates of protein transit. In this paper we have demonstrated that: 1) in resting cells phospholipase D (PLD) is implicated in the control of apical protein transit; 2) phorbol esters stimulate apical protein transit (stimulation factor 2.2), which is correlated with a PLD-catalyzed production of phosphatidic acid (PA) (2.45-fold increase); 3) the stimulation of cholinergic receptors by carbachol results in an increase (stimulation factor 1.45) of apical protein transit which is independent of protein kinase C and PLD activities, but related to PA formation (1.7-fold increase) via phospholipase(s) C and diacylglycerol kinase activation; 4) an elevation of the cAMP level enhances apical protein transit by a PA-independent mechanism; 5) a trans-Golgi network or post-trans-Golgi network step of the transit is the target for the regulatory events. In conclusion, we have shown that PA can be produced by two independent signaling pathways; whatever the pathway followed, a close relationship between the amount of PA and the level of secretion was observed.

Does hydrosalpinx reduce the pregnancy rate after in vitro fertilization?

OBJECTIVE: To determine the effect of hydrosalpinges on the pregnancy rate in an IVF program. DESIGN: Multicentric retrospective analysis of clinical and laboratory data. SETTING: Two assisted reproductive technology centers in university hospitals. PATIENT(S): Four hundred forty-three women, under 38 years of age, with pure tubal infertility. The patients were classified into the following five groups: bilateral hydrosalpinges (n = 37), unilateral hydrosalpinx (n = 54), bilateral tubal occlusion (n = 207), unilateral tubal occlusion (n = 55), and severe tubal disease without complete occlusion (n = 90). MAIN OUTCOME MEASURE(S): Pregnancy and implantation rates. RESULT(S): The pregnancy and the implantation rates per transfer (12.3% and 5.4%) obtained by women with bilateral hydrosalpinges are significantly lower than the rates (means = 23.1% and 12%) for all other tubal infertility groups. CONCLUSION(S): Bilateral hydrosalpinges have a deleterious effect on the outcome of IVF program.

Endometrial cathepsin D immunostaining throughout ovulatory and anovulatory menstrual cycles.

The results of histological examination of the endometrium are normal in most patients with unexplained sterility. Cathepsin D is a ubiquitous lysosomal protease regulated by progesterone in the endometrium. Assays of concentrations of cathepsin D might be useful in determining the functional responses of the endometrium to progesterone. To examine this possibility, we quantified immunostaining of endometrial cathepsin D using an image analysis system in women with regular menstrual cycles. An endometrial sample was obtained during the proliferative and luteal phases from 17 women with ovulatory menstrual cycles and at the beginning and during the last 14 days of a cycle from 15 women having anovulatory menstrual cycles. In endometrial glands of ovulatory women, cathepsin D protein immunostaining increased during the cycle and was significantly higher during the luteal than during the proliferative phase [51 +/- 38.1 arbitrary units (AU) versus 118.2 +/- 58.9 AU; P < 0.01]. This increase was also observed in stromal cells, although to a lesser extent (28.6 +/- 26.9 versus 41.5 +/- 43.1 AU; P = NS). In the endometrium of women with anovulatory menstrual cycles, cathepsin D staining was high both for the proliferative and the luteal biopsies in glands (respectively 95 +/- 43 and 104 +/- 51.3 AU) and stromal cells (respectively 61.8 +/- 33.8 and 75 +/- 32.6 AU). In women with ovulatory cycles, cathepsin D staining was localized in the apical part of glandular cells during the proliferative phase and diffused throughout the cytoplasm during the luteal phase. In contrast, in women with anovulatory cycles, cellular localization of cathepsin D remained apical in glands, regardless of the day of biopsy. In conclusion, this study shows that the cytoplasmic localization of cathepsin D might be a qualitative biological indicator of endometrial gland responses to progesterone. This could be a useful tool for evaluating cell function, which is poorly tested by histology alone.

Efficacy and safety of recombinant follicle stimulating hormone (Puregon) in infertile women pituitary-suppressed with triptorelin undergoing in-vitro fertilization: a prospective, randomized, assessor-blind, multicentre trial.

The objective of this study was to compare the efficacy and safety of a recombinant follicle stimulating hormone (FSH) preparation (Org 32489, Puregon) with a urinary FSH preparation (Metrodin) in infertile women undergoing in-vitro fertilization (IVF and embryo transfer and who were pituitary-suppressed with triptorelin. In an assessor-blind, group-comparative, multicentre study, 60 women were randomized to Org 32489 and 39 to urinary FSH. An evaluation of the main parameter, the mean total number of oocytes recovered, indicated a similar efficacy for the two preparations: 9.7 with Org 32489 versus 8.9 with urinary FSH. In addition, there were no significant between-group differences with respect to other efficacy variables such as the total dose used, the duration of the treatment, the number of follicles > or = 17 mm in diameter and embryo quality. The ongoing pregnancy rates per attempt (30.2 versus 17.4%) and per transfer (34.0 versus 18.8%) were higher with Org 32489, but this difference was not statistically significant. No clinically relevant differences between Org 32489 and urinary FSH were seen with respect to safety variables. Serum antibodies were not detected in any of the subjects. It is concluded that Org 32489 compares favourably with urinary FSH in the treatment of infertile pituitary-suppressed women undergoing IVF and embryo transfer.

[The treatment of sterility due to retrograde ejaculation, using implantation of a pericervical sphincter prosthesis. Apropos of a case]. / Traitement d'une stérilité par éjaculation rétrograde, par l'implantation d'une prothèse sphinctérienne péri-cervicale. A propos d'un cas.

The authors report the case of a 26 year old man consulting for primary sterility due to retrograde ejaculation, which was associated with urinary incontinence secondary to repeated surgery to the bladder neck for neurogenic bladder in a patient with incomplete spina bifida. Pericervical implantation of an AMS 800 artificial sphincter restored perfect continence and normal ejaculation followed by a pregnancy for his wife.

[Contribution of applied cytogenetics to medically assisted procreation]. / Apports de la cytogénétique appliquée aux procréations médicalement assistées.

The cytogenetic studies of gametes and embryos reveal the incidence of chromosomic abnormalities in medically assisted pregnancies. When extended to natural fecundation, these data enable a better comprehension of the place and the role of the selection in the quality of the conceptus.

[Technical and biological evolution of medically assisted procreation (MAP)]. / Evolution technique et biologique des procréations médicalement assistées (PMA).

Compared to IUI (to which one knows that an ovulation induction must not be associated and where 6 cycles must not be exceeded), in vitro fertilization has undergone an important evolution. It has now become ambulatory. Its evolution has been marked by the use of LH-RH agonists, the vaginal route for the echographic puncture and freezing of the embryos. The two progresses expected are: in the short term, the mastering of the retrograde catheterization of the tube, to enable the embryo replacement in sterilities of healthy tubes and, in middle term, a better assessment of the quality of the conceptus to carry out a selective embryo transfer and to reduce the rate of multiple pregnancies.

[Preliminary study of the use of intranasal buserelin in the long-term protocol of ovarian stimulation with the view toward fertilization in vitro]. / Etude préliminaire de l'utilisation de la busereline par voie nasale dans le protocole long de stimulation ovarienne en vue de fécondation in vitro.

A study conducted in 22 patients who used intranasal buserelin, in a long-term protocol for IVF, showed that pituitary desensitization is obtained between 14 days and 1 month. Analysis of the trials in this series, where the results were not satisfactory, suggests that the bioavailability of the product used intranasally, may be in question. A better distribution of nasal sprays causes more discomfort than when used subcutaneously.

[Evaluation of ultrasonography. Apropos of a continuous series of 1,000 pregnancies]. / Evaluation de l'échographie. A propos d'une série en continu de 1,000 grossesses.

2,648 sonograms were performed in a continuous series of 1,000 patients, all of whom had delivered in the department between March 1, 1988 and September 1, 1988; pregnancies resulting in a spontaneous miscarriage, extra-uterine pregnancy, therapeutic abortion as well as invasive sonographies, are excluded. Most patients underwent two or three sonograms during their pregnancy. 74 per cent of the requests come from specialists. The main indications are either systematic (67.7%) or result from early manifestations (25.1%). 12.6 per cent of the sonograms are performed before 12 weeks of amenorrhea, including 36.7 per cent performed systematically, and could be performed at a later date. 90 per cent of the term modifications were correctly indicated, and there were early manifestations in 60 per cent of the cases. 45.1 per cent of intra-uterine growth delays were detected and there were early manifestations in 50 per cent of the cases. 41.6 per cent of the malformations were diagnosed on sonograms. Renal malformations are easily recognized; this is not true of cardiac malformations. 96 per cent of the patients were justifiably reassured or worried. Ultrasonography presents a good sensitivity for term modifications, macrosomia, placental insertion anomalies. The sensitivity is less for intra-uterine growth delays and fetal malformations.

[Study of the choice between sampling of the chorionic villi and the amniotic fluid in prenatal diagnosis]. / Etude du choix entre prélèvement de villosités choriales ou de liquide amniotique dans le diagnostic prénatal.

We are reporting the results of a 21-month study during which 653 couples were seen in consultation at the prenatal diagnostic center of the University Hospital in Amiens, referred by their physician. 171 patients presented a theoretical term under 11 weeks of amenorrhea, for whom the choice between chorionic villi biopsy or amniotic fluid tap was possible. The different situations and results are compared for each method. The rate of fetal death was 5.4 per cent for chorionic villi biopsy and 1.5 per cent for amniotic fluid tap.

[Maternal complications of cesarean section. Results of a multicenter study. I]. / Les complications maternelles des césariennes. Résultats d'une étude multicentrique (première partie).

The authors report a study they have made of 7,216 case histories designed to show the type and the number of the various maternal complications of the caesarean operation and compare these results with those found in the literature and those that occur after vaginal delivery. The maternal mortality rate directly associated with the operation is 1.38/000, which is between 5 and 25 times greater than those for vaginal delivery. The pre-operative anaesthetic and surgical complications are rare and are usually not very serious. They depend on the experience of the operators. The post-operative complications tend to be mainly due to infections and thrombo-embolic phenomena. If the most minor infections are included, the infection rate for caesarean operations rises to 20.6%, whereas thrombo-embolic complications are rare at 0.52%.

[Prevention of the risk of infection and thromboembolism following cesarean section. 2. Results of a multicenter study]. / Prévention du risque infectieux et thrombo-embolique après césarienne. Deuxième partie: Résultats d'une étude multicentrique.

The amount of infection following caesarean operations changes according to the indication for the caesarean and the length of time the membranes have been ruptured. Antibiotics should be prescribed according to these parameters. It does not seem that the numbers of thrombo-embolic complications in this series were reduced by using heparin prophylactically in the usual doses. It does seem to us that women with real factors for this risk should receive heparin in high doses to lower blood coagulation.

[Our experience of the detection of latent pericardial effusions in the 3d trimester of pregnancy]. / Notre expérience du dépistage des épanchements péricardiques latents au troisième trimestre de la grossesse.

Following the paper published by Haiat, in which he reported the ultrasonographic detection of latent pericardial effusions in the third trimester of pregnancy, the authors conducted a study of 129 cases: 99 hospitalized patients (series I) and 30 patients seen in the consulting rooms (series II). Pericardial effusions were detected in 15% of cases in series I and in 20% of cases in series II, despite a more sophisticated apparatus. In general, these effusions were quite small. Hypertension of pregnancy was an aetiological factor observed in a significant number of cases. The presence of such effusions does not require aspiration, even when they are large, because of their perfect functional tolerance.

[Study of fertility after extrauterine pregnancy]. / Etude de la fécondité après grossesse extra-utérine.

Out of a total of 139 cases of extra-uterine pregnancy operated between 1979 and 1983, 78 patients were regularly followed. In 47 women wanting to become pregnant, 18 remained sterile, 8 had a further extra-uterine pregnancy and 21 obtained an intra-uterine pregnancy. The results are analysed in terms of the past history and the treatment of the first extra-uterine pregnancy. These results are compared with the data in the literature.

[The effects of bromocriptine in normoprolactinemic anovulation and dysovulation: followed by pregnancy in 11 cases]. / Etude de l'action de la bromocriptine dans les anovulations et dysovulations normoprolactinémiques: suivi de 11 grossesses.

The authors report the results of a study of 40 patients with normal serum prolactin levels who were treated with bromocriptine for sterility secondary to ovulatory disturbances. This therapy restored normal ovulatory cycling in 62.5% of cases with subsequent pregnancy in 27.5% of cases, in particular in patients with primary infertility of long duration. The course of "latent" hyperprolactinemia (peak of TRH, repeated dosages of PRL) was discovered in only one out of two patients who responded to treatment. In patients with "non-latent" normal serum prolactin levels, bromocriptine's mechanism of action is not always clear.

[Prognosis of decidual hematomas or ovular detachments discovered by echography during the 1st trimester of pregnancy]. / Pronostic des hématomes déciduaux ou décollements ovulaires de découverte échographique au premier trimestre de la grossesse.

A prospective study conducted over a period of 20 months revealed 76 cases of ovular detachment during the first trimester (0.9% of the obstetric ultrasound examinations performed during this period). In the 57 cases which were followed up, a poor outcome was observed essentially in the group of patients with a past gynaeco-obstetrical history (endometrial infection, intra-uterine operations). Factors of poor prognosis are therefore the presence of such a history, in particular patent endometrial infection immediately prior to the pregnancy in which the decidual haematoma is detected. The prognosis is not affected by the extent of the haematoma, nor its volume nor the length of time it persists.