Sperm chromatin condensation defects, but neither DNA fragmentation nor aneuploidy, are an independent predictor of clinical pregnancy after intracytoplasmic sperm injection.

PURPOSE: The impact of sperm DNA damage on intracytoplasmic sperm injection (ICSI) outcomes remains controversial. The purpose of the study was to evaluate the prognostic value of several types of sperm nuclear damage on ICSI clinical pregnancy. METHODS: Our retrospective study included a total of 132 couples who consulted for male or mixed-factor infertility that benefited from ICSI cycles from January 2006 to December 2015. All infertile males presented at least one conventional semen parameter alteration. Sperm nuclear damage was assessed using the Motile Sperm Organelle Morphological Examination for sperm head relative vacuolar area (RVA), aniline blue staining for chromatin condensation, terminal deoxynucleotidyl transferase dUTP nick-end labeling for DNA fragmentation, and fluorescence in situ hybridization for aneuploidy. RESULTS: Infertile males who achieved pregnancy after ICSI had fewer chromatin condensation defects than did males who did not achieve any pregnancy (15.8 ± 12.0% vs. 11.4 ± 7.9%, respectively, P = 0.0242), which remained significant in multivariate regression analysis (RR = 0.40 [0.18 to 0.86], P = 0.02). RVA, DNA fragmentation, and aneuploidy were not predictive factors of ICSI outcomes. The pregnancy rate was significantly decreased by number of progressive motile spermatozoa with normal morphology after migration (P = 0.04). In female partners, 17ß estradiol of less than 2000 pg/mL on the day of ovulation induction significantly reduced the occurrence of clinical pregnancy (P = 0.04). CONCLUSION: Sperm chromatin condensation defects were more frequently observed in couples with ICSI failure and should be considered a negative predictive factor for the occurrence of clinical pregnancy.

In vitro fertilization outcomes after ablation of endometriomas using plasma energy: A retrospective case-control study.

OBJECTIVE: Ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy, because it could spare underlying ovarian parenchyma resulting in high spontaneous and overall pregnancy rates. After initial postoperative decrease, anti-mullerian hormone (AMH) level progressively increases several months after ablation. The aim of our study was to assess the outcomes of in vitro fertilization (IVF) in women managed for ovarian endometriomas by ablation using plasma energy, when compared to those in women free of endometriosis. METHODS: Retrospective preliminary case-control study, enrolling women undergoing IVF or IntraCytoplasmic Sperm Injection (ICSI), from July 2009 to December 2014. Cases were infertile women with previous ovarian endometrioma ablation using plasma energy and were matched by age, AMH level and assisted reproductive technique with controls presumed free of endometriosis. IVF/ICSI response (type of protocol, dose of gonadotrophin, number of oocytes, fertilization rate) and outcomes were compared between the two groups. RESULTS: In all, 37 cases were compared to 74 controls. Age (30.9±4.4 years vs. 31.7±4.2 years), AMH level (2.8±2ng/mL vs. 2.8±1.7ng/mL) and ART procedures (ICSI in 24.3% vs. 27%) were comparable between the two groups. Of the 37 cases, previous surgical procedures on right and left ovaries were performed in 27% and 21.6% of patients respectively, 81% of patients were nullipara. AFSr score was 73±41, while deep endometriosis infiltrated the rectum and the sigmoid colon in respectively 40.5% and 27% of patients. Despite a lower number of oocytes retrieved, cases presented better implantation rate, pregnancy and delivery rates per cycle, oocyte retrieval, transfer, and embryo, as well as superior cumulative birth rate per transfer. CONCLUSION: Ovarian endometrioma ablation using plasma energy is followed by good IVF/ICSI outcomes, suggesting that surgical procedure spares underlying ovarian parenchyma. These results consolidate those of previous studies reporting high spontaneous conception rate. Hence, ovarian endometrioma ablation using plasma energy appears to be a valuable alternative to cystectomy in patients presenting with endometriosis and pregnancy intention.

[Double-balloon device and intravaginal dinoprostone for cervical ripening in women with unfavourable cervix]. / Maturation cervicale par double ballonnet et dinoprostone en cas de col utérin très défavorable.

OBJECTIVES: To compare the efficiency of a double cervical ripening (mechanical agent and dinoprostone) to a dinoprostone-only ripening in women with an unfavourable cervix. METHODS: In a retrospective study from January 2008 to October 2013, 96 patients were included with the following criteria: pregnancies over 37 weeks, singleton, vertex presentation, medical indication for induction of labor, no premature rupture of membranes and very unfavourable cervix (Bishop score ≤ 3). Patients were classified into 2 groups: intravaginal dinoprostone for 24h (prostaglandin group, n=38) and double-balloon device for 12h followed by intravaginal dinoprostone for 24h (balloon+prostaglandin group, n=58). RESULTS: There was no difference in vaginal delivery rates between the 2 groups (balloon+prostaglandin group 51.7%, prostaglandin group 50%, P=0.87). The Bishop score after cervical ripening was significantly higher in the balloon+prostaglandin group (4.4 versus 2.4, P<0.0001), but the interval between the induction and the delivery was longer (33.6h versus 24.9h, P=0.0044). There was no significant difference for maternal and neonatal complications. CONCLUSION: A double cervical ripening (with mechanical agent and dinoprostone) allows the Bishop score to be improved without increasing the rate of vaginal delivery, for patients with a Bishop score ≤ 3.

[Colonic Crohn's disease: diagnostic and therapeutic problems. Apropos of 11 cases]. / Maladie de Crohn colique: problèmes diagnostiques et thérapeutiques. A propos de onze observations

The authors report a few unusual cases of Crohn's disease of the colon and discuss the diagnostic problems which are raised in such cases. They then review the various colonic diseases liable to be considered in a differential diagnosis, and which may be linked to colonic Crohn's disease, e.g. ulcerative colitis, intestinal tuberculosis, carcinoma of the colon, colonic diverticulosis and sarcoidosis. In a chapter on treatment, they emphasize the favourable effect of acexamic acid and the necessity for very wide colonic resection, and they note a complication which they encountered during surgery for Crohn's disease: lymphatic peritonitis on the 8th day after right colectomy.

[Crohn's disease after administration of oral contraceptives. Report of a case (author's transl)]. / Maladie de Crohn iléo-colique après emploi d'un contraceptif oral

PIP: The case of a 20-year-old female patient is which ileo-colic Crohn's disease developed after repeated attempts at contraceptive treatment (no rgestrel-ethinyl estradiol) had resulted in periods of diarrhea, which ceased after stopping treatment, is reported. As a consequence of the severity of the disease, after the 3rd attempt at using oral contraceptives (OCs) a partial removal of the ileum and colon had to be performed. The relation between Crohn's disease and other acute ulcerative colitis in patinets receiving OCs and the role of these drugs as a triggering factor in Crohn's disease are discussed. It is conclude d that, while their causative role is unproven, in view of studies on th e relation between pregnancy and this disease, OCs may favor the development of the disease, and intestinal disorders during OC treatment should be carefully monitored.^ieng