[The role of the semi natural cycle as option of treatment of patients with a poor prognosis for successful in vitro fertilization]. / La place du cycle semi-naturel dans la prise en charge de patientes ayant un mauvais pronostic en fécondation in vitro.

OBJECTIVE: To evaluate the efficacy of semi natural cycle as option of treatment for the patients who have a poor prognosis to controlled ovarian hyperstimulation (COH). PATIENTS AND METHODS: Prospective study. Sixty-six patients with an ovulatory cycle who presented either altered ovarian status (AOS) or implantation failure (IMF) and had carried out a total of 133 semi natural IVF cycles were included. Once follicular dominance was established, the growth of this follicule was controlled by administration of the GnRH antagonist with exogenous gonadotrophins. RESULTS: Groups AOS (n = 47) and IMF (n = 19) were similar with regard to oocyte pickup rate (81.2% and 81.1%), the oocyte recovery rate (61.4% and 64.8%) and clinical pregnancies per oocyte pickups rate (15.4% and 16.6%), respectively. CONCLUSIONS: The semi natural cycle appears as option of treatment for patients who have a poor prognosis for successful in vitro fertilization.

Detectable levels of interleukin-18 in uterine luminal secretions at oocyte retrieval predict failure of the embryo transfer.

BACKGROUND: Most implantation failures after successful in vitro fertilization-embryo transfer (IVF-ET) result from inadequate uterine receptivity. There is currently no way to predict this receptivity. METHODS: We investigated whether the detection of interleukin-(IL)18 by ELISA in uterine luminal secretions might predict implantation failure. Secretions of 133 patients enrolled in our IVF-ET program were sampled by uterine flushing immediately before oocyte retrieval. We assessed the following outcomes: pregnancy rate, multiple pregnancy rate, and implantation rate per embryo transferred. RESULTS: Interleukin-18 was detected in the flushing fluid of 38 patients (28.6%). Although the two groups were comparable for all other characteristics (age, etiology, ovarian reserve, number of embryos transferred, quality of embryos), all outcome variables differed significantly. The pregnancy rate was 37.9% in the IL-18 - ve group and 15% in the IL-18 + ve group, the multiple pregnancy rate 27.7% and 0%, and the implantation rate per embryo transferred 19.4% and 6.7% (all comparisons, P=0.02). Only embryos meeting good quality criteria were transferred to 65 patients: 50 IL-18 - ve and 15 IL-18 + ve. The pregnancy rate was 51% for the IL-18 - ve group and 20% for the IL-18 + ve group, the multiple pregnancy rate 36% and 0.0%, respectively, and the implantation rate 29% and 8.3% (P = 0.02). CONCLUSION: This non-invasive and simple method predicted inadequate uterine receptivity, independent of embryo quality.

Fetal growth and Doppler assessment in patients with a history of bilateral internal iliac artery embolization.

BACKGROUND: Pregnancy occurring after pelvic arterial embolization for postpartum hemorrhage is rare. The harmlessness of this procedure for subsequent pregnancies is poorly documented. MATERIALS AND METHODS: Eight pregnant women with a history of arterial embolization were followed up with fetal growth and Doppler assessment. RESULTS: Fetal growth and umbilical Doppler findings remained normal in all cases. CONCLUSION: Embolization, a life-saving and fertility-preserving procedure, does not seem to affect subsequent pregnancies.

[Ovarian drilling for surgical approach of polycystic ovary syndrome]. / La place du drilling ovarien dans la prise en charge du syndrome des ovaires polykystiques.

OBJECTIVES: Show the different surgical approaches for the treatment of polycystic ovarian syndrome (SOPK). PATIENTS AND METHODS: Seventy-one patients treated by ovarian drilling by laparoscopy and 47 by hydrolaparoscopy. The main inclusion criterion was the absence of response after 6 months of stimulation by clomifene citrate for oligo-amenorrheic patients. RESULTS: After a review of surgical series published of ovarian drilling, we found 73% pregnancy rate after laparoscopic treatment and 61 % after hydrolaparoscopy. DISCUSSION AND CONCLUSION: Ovarian drilling appears as an alternative to ovarian hyperstimulation with intra-uterine insemination after failure of clomifène citrate and/or metformine. Surgical treatment decreases multiple pregnancies and miscarriages. Hydrolaparoscopy is more efficient than laparoscopy with less morbidity in particular in obese patients.

[Uterine contractility and reproduction: new perspectives]. / Contractilité utérine et reproduction humaine: nouvelles perspectives.

The contractile activity of the nonpregnant uterus plays an important role in the human reproduction process. Noticeable variation in uterine contractility occurs during the menstrual cycle to meeting some physiologic requirements of the female reproductive system. During the follicular phase, stimulation of uterine contractions by estrogens fosters sperm transport toward the fertilization site. After ovulation, contractility decreases in response to progesterone, a phenomenon that is probably involved in the embryo implantation mechanism. The comprehension of uterine contractility regulation and physiologic roles has been considerably extended during recent years by the development of direct and noninvasive assessment tools, in particular, ultrasound. Today, not only the artificial stimulation of uterine contractions, aiming at promoting sperm transport during the pre-ovulatory phase, but also their attenuation to provide optimum conditions for embryo implantation during the luteal phase, represent innovating, promising issues in the optimization of assisted reproduction treatments.

[Impact of systematically freezing embryos on ovum donation]. / Retentissement de la congélation embryonnaire systématique dans l'exercice du don d'ovocytes.

In France, all embryos obtained after ovum donation have to be frozen. We present a brief background on this policy and expose our results, then discuss the rationale of such a policy in order to upgrade knowledge on the mechanism of vertical HIV transmission.

[Contribution of diagnostic ultrasonography in cases of repeated embryonic implantation failure in fertilization in vitro]. / Apport du diagnostic échographique en cas d'échecs répétés d'implantation embryonnaire en fécondation in vitro.

INTRODUCTION: To assess ultrasonic data in the context of repeated failure of implantation in assisted reproduction medicine. MATERIALS AND METHODS: We reviewed ultrasonic data (uterine score at follicular and luteal phase). The same ultrasound exploration was repeated for two consecutive cycles to assess the changes in abnormalities observed and compare findings in 16 patients with repeated failure of implantation and in 14 controls. The controls were women who became pregnant within the three months following the exploration. We then introduced acetylsalicylic acid and prednisolone as first line treatment and nitroglycerin as second line treatment to measure the effects induced in 14 pathological uterine scores. RESULTS: The score obtained under hormonal treatment was representative of other cycles (r = 0.812, p < 0.0014). The score was significantly lower and the luteal uterine artery pulsatility index was significantly higher in the repeated failure group than in the control group (p < 0.0001 and p = 0.008 respectively). For the 14 patients, treatment improved the uterine score in 8 with acetylsalicylic acid and prednisolone and in 4 with nitroglycerin. Two patients did not respond to treatment. Concerning the effect of therapy, of 14 patients, 8 had an improved uterine score with A + P, and with T; 2 patients did not respond to any treatment. CONCLUSION: The uterine score and luteal artery pulsatility index may be valuable tools for patients with implantation failure who all do not respond to the same therapy.