[The experiences of patients and the maternal representations throughout the different steps of an oocyte donation]. / Le vécu des patientes et les représentations maternelles au fil des étapes d'un don d'ovocytes.

This research aims to study the experiences and the maternal representations of infertile women throughout the different steps of a medically assisted procreation (MAP) with oocyte donation. The analysis of collected data (interviews and questionnaires) shows that the resort of egg donation creates psychic adjustment (particularly in terms of maternal representations) that appear specific to this type of procreation.

Pregnancies, growth and development of children conceived by subzonal injection of spermatozoa.

Subzonal injection of spermatozoa (SUZI) was one of the first micromanipulation techniques efficient in treating male factor infertility and unexplained in-vitro fertilization failures. The aim of this retrospective study was to evaluate the in-vitro development of embryos conceived by SUZI, the obstetric outcome, the rate of congenital malformations and subsequent follow-up in children. Fifty-five pregnancies were obtained between 1991 and 1994 (54 after fresh embryos were transferred and one after cryopreserved embryos were transferred). Among the 50 clinical pregnancies, there were seven miscarriages (14%) and two ectopic pregnancies (4%). Among the 41 resulting evolutive pregnancies, the discovery of one anencephaly led to a medical abortion. Forty deliveries including six twin pregnancies occurred, leading to the births of 45 live neonates and one stillbirth. The gender distribution of the offspring included 17 males and 29 females (ratio 0.59:1). Birth weight, length and head circumference were within the expected ranges. Two children presented a malformation: the first one had one thumb with congenital shelf and the second a polymalformative neurological syndrome. Growth curves were normal for all these children except one (weight above the 2 SD curve). Medical follow-up detected no pathological features in these children apart from a physical disability in one girl. In this small series a 4.2% rate of malformation was observed, particularly affecting the neural tube, in SUZI offspring. However, no firm conclusions can be drawn since the study was carried out on a small cohort. SUZI is no longer performed but these observations suggest that it is necessary to collect extensive data about children conceived by microfertilization.

[Death in utero of a fetus in multiple pregnancies (author's transl)]. / La mort in utero d'un des foetus au cours des grossesses multiples.

Six intrauterine deaths which occurred in the course of our survey of 160 multiple pregnancies are reported here. The way of handling them obstetrically is discussed, taking note of the facts given in the literature. When prevention is possible it rests on consecutive clinical and paraclinical observation. Ultrasound tomography is of the greatest possible value to diagnose poor intrauterine growth in one fetus. When one has died and this has been confirmed, routine Caesarean section seems to be indicated to allow the remaining twin to escape, as much from the risk of chronic fetal distress as from the added risks that follow on the retention of a dead fetus.