[Acceptability and value of autoinjection of gonadotropins for ovarian stimulation in intrauterine insemination]. / Acceptabilité et intérêt de l'auto-injection de gonadotrophines pour la stimulation en vue d'une insémination intra-utérine.

OBJECTIVES: To evaluate the acceptability, the personal and economic benefit of subcutaneous self-injections of recombinant FSH within mono-ovulating stimulation for Intra Uterine Insemination (IUI). PATIENTS AND METHODS: Women aged < 42 years' old, enrolled for a series of three IIU associated with ovarian stimulation with FSH. All had an infertility > 2 years, at least one patent fallopian tube, and normal FSH and estradiol levels at day three of the cycle. In the male partner, the migration test yielded > 10(6) mobile spermatozoa with survivals > 10% after 24 h. Once entered in the study, the patients (with or without their partners) were informed and shown how to administer the injection. After each cycle, they filled up a questionnaire evaluating the training and the possible difficulties they had with their infertility treatment. RESULTS: Forty women were treated. 103 cycles were achieved (including 40 first cycles, 35 second cycles and 28 third cycles) 99 IUI were performed and ten pregnancies were obtained. Four cycles were cancelled: Premature fall of estradiol levels (n = 2), multiple pregnancy risk (n = 1) and spontaneous ovulation (n = 1). Three pregnancies occurred spontaneously between treatment cycles. All the patients appreciate to perform subcutaneous self-injections (themselves or by the partner) without any deleterious effect on stimulation cycles results and they expressed their will to continue for the next treatment cycles. CONCLUSION: After a quick initiation to subcutaneous injections, and its use, women appreciated their active involvement in the treatment and the self-sufficiency so achieved. By planning an educational program, medical staff could participate to improve the stress experienced by the women and their partners through the infertility treatment.

[Management of HELLP syndrome before 32 weeks of amenorrhea. 22 cases]. / Prise en charge du hellp syndrome avant 32 semaines d'aménorrhée. 22 observations.

OBJECTIVES: Assess expression and management of HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) occurring before 32 weeks gestation. METHODS: Among 50 patients presenting HELLP syndrome from 1990 to 1994, 22 (44%) who developed the syndrome before 32 weeks gestation were evaluated retrospectively. RESULTS: Most of the patients were primiparous and HELLP syndrome recurred in 2 during a second gestation before 32 weeks gestation. Only three cases began during the post partum period. All patients had severe pre-eclampsia before discovery of the HELLP syndrome. Episodes of eclampsia also occurred in 6. The most frequent clinical manifestation was epigastric pain. Ten patients had acute severe renal failure. The 3 post partum patients had severe complications (eclampsia, renal failure, subcapsular hepatic hematoma). Obstetrical intervention was required in all cases. Cesarean section was performed within 48 hours of diagnosis. Pregnancy had to be terminated in 3 cases between 24 and 29 weeks gestation. There was one fetal death in utero and one during the neonatal period. Seventeen live infants were delivered. In the group of 11 infants born after 30 weeks gestation, only 1 had hyalin membrane disease which developed in all those born before 30 weeks, including 2 with broncho-pulmonary dysplasia. CONCLUSION: Based on the physiological mechanisms involved in HELLP syndrome, criteria for obstetrical extraction and the possibilities for conservative management in very premature pregnancies, we propose a management protocol for HELLP syndrome developing before 32 weeks gestation. Corticosteroid therapy may be given for 48 hours in cases without maternal or fetal complications in order to accelerate fetal maturation before extraction.