[Pregnancy by micromanipulation in a case of excretory azoospermia associated with a natural spermatocele]. / Grossesse obtenue par micromanipulation dans un cas d'azoospermie excrétoire associée à la présence d'une spermatocèle naturelle.

Microinjection of capacitated sperm into the perivitelline space of oocytes has been performed in a case of male infertility attributed to excretory azoospermia. In this particular case, a spermatocele detected five years ago was observed, which provide motile spermatozoa. These sperm collected by direct puncture into the cyst, were capacitated using discontinuous Percoll gradient. After ovarian stimulation, seventeen oocytes were collected. Nine of them were used for classical IVF whereas the other eight were submitted to microinjection. Only one oocyte of the second group fertilized and cleaved 48 hours later. A clinical pregnancy was achieved after embryo transfer and a normal, healthy boy delivered at term.

[Therapeutic approach for nasal sinus polyposis]. / Approche thérapeutique de la polypose naso-sinusienne.

The multiple etiologies of bilateral naso-ethmoidal polyposis (PNE) make a precise and regulated therapeutic decision difficult. The treatment is chosen after a clinical history, radiology and complete biological investigation. Medical and surgical treatments share the indications. Medical treatment is dominated by local corticotherapy. Its failures and recurrence following its end may suggest general corticotherapy, an efficacious remedy but which carries well known risks. The choice of treatment is guided by whether the characteristics of the polyposis are invalidating or not. The localised forms often respond to local medical treatment. Invalidating polyposis continues to be difficult to treat, especially where there is intolerance to aspirin. Corticotherapy by the general route, even sequential, remains insufficient to be sure of long asymptomatic periods. We suggest for these patients a clear ethmoidal once or twice under local anaesthetic with diazanalgesia. The local treatments associated with corticotherapy and anti histamines help the healing of the operated cavity. Crenotherapy is an useful aid after having obtained clean, permeable nasal fossae. The choice remains empirical and is a function of the group, but it must not include iatrogenic risks greater than those of the illness itself. We report our actual experience.

Transvaginal sonographically controlled follicle puncture for oocyte retrieval.

Transvaginal sonographically guided follicle aspiration under local anesthesia was performed on more than 100 patients and compared favorably with the other techniques that have been proposed to retrieve oocytes for in vitro fertilization. Sonography employs a sector scanner placed on the abdomen, and the needle is introduced through the posterior fornix of the vagina into the cul-de-sac and the ovary. In case of a high ovary, a transvaginal-transvesical variation may be used. The method is not painful and is easy to learn and perform. The sole adverse incidents have involved inadvertent venous puncture with no sequelae. The number and quality of recovered oocytes are good, and five normal children conceived after this method of retrieval were recently born. The technique permits substantial simplification of egg recovery for in vitro fertilization, which can now be performed in an outpatient setting without the risk and expense of laparoscopy and general anesthesia or the discomfort of transabdominal-transvesical ultrasound-guided aspiration.