[EUGIC (Extension of the Use of Gametes in Intra-Conjugal): New uses of gametes within the couple]. / EUGIC (Extension de l'Utilisation de Gamètes en IntraConjugal) : les nouveaux usages des gamètes au sein du couple.

OBJECTIVE: New possibilities for using gametes within a couple were created by the French law of August 2, 2021 related to bioethics by opening Assisted Reproductive Technics (ART) to all women. It concerns previously self-preserved gametes, thus avoiding the need for gamete donation. The objective of our study is to evaluate the perception of these new uses by ART practitioners. METHOD: A questionnaire of twelve short questions was sent to professionals concerned with gamete donation. RESULTS: One hundred and ten professionals answered the questionnaire. The majority of them approve of the Reception of Oocytes from the Partner (ROPA), notably if there is a medical indication. Requests are rarer for the care of trans* people, and raise more questions. Although less favorable to the use of eggs from trans* men, more of them support the practice when it is an alternative to oocyte donation. CONCLUSION: The acronym EUGIC (Extension of the Use of Gametes in Intra-Conjugal) makes it possible to group together these new situations generated by the change in the French law.

[Comparative survey of French oocyte donor's profile and motivations between nulliparous and multiparous donors, 2017-2018]. / Profils et motivations des donneuses d'ovocytes en France en 2017­2018 : comparaison entre les nullipares et celles qui ont déjà procréé.

OBJECTIVES: Since the authorization of French nulliparous women to donate oocytes, who are the new donors? What are the similar and differential points with the initial donors who have already procreated? METHODS: Retrospective multicenter cohort study using a questionnaire. RESULTS: The return rate is 90.7% with 248 donor files from 5 French assisted reproductive technology (ART) centers, included between 1 January 2017 and 31 December 2018. The average age is 31,0 years. More than two thirds of women have a higher educational level than the license. Donation is spontaneous or relational in 69% and 25% of cases, respectively. Among nulliparous donors, 37% don't know the possibility of self-preservation but after information, 80% wish to benefit from it versus 32% of multiparous women if they were given the opportunity. CONCLUSIONS: This study by the Study Group for Egg Donation (GEDO) highlights the particularities of French oocytes donors. The 2015 decree allowed to diversify the origin of the donation, which remains mainly altruistic but the possibility of self-preservation for nulliparous donors also seems to motivate women. This link between donation and self-preservation poses an ethical problem that needs to be approached and resolved in the next Bioethics Law framing Assisted Reproductive Technologies (ART).

[Legislative and regulatory situation of oocytes donation in France]. / Situation législative et réglementaire du don d'ovocytes en France.

In France, medically assisted procreation (MAP) activities and gamete donation are strictly regulated by the bioethics law. The main ethical principles applied to the donation--no remuneration, anonymity, and the requirement for free and informed consent--aim to protect donors. In the same spirit, since MAP with oocytes donation is recognized as a healthcare activity, receiving couples benefit from exemption from co-payments by the health insurance system. Thus, it is widely accessible to couples presenting medical infertility requiring oocytes from a donor, but availability is insufficient to cover needs. This shortage in supply results in moving the demand abroad where this particular MAP is exercised at varying levels of supervision.

[Procreation in Turner's syndrome: which recommendations before, during and after pregnancy?]. / Procréation et syndrome de Turner: quelles recommandations avant, pendant et après la grossesse?

Turner's Syndrome (TS) is characterized by an ovarian failure which occurs in most cases before puberty and leads to infertility. In less than 10% of women with TS, puberty may occur and spontaneous pregnancies are possible with a high risk of fetal loss, chromosomal and congenital abnormalities. Fertile women with TS should therefore be counselled with regard to these increased risks and be offered prenatal diagnosis testing. For all the other women with TS, in vitro fertilization with oocyte donation (OD) has dramatically transformed the prognosis of infertility. However, in the same time, it has become obvious that pregnancies in TS either spontaneous or obtained after oocyte donation are at very high risk of possible sudden death. Miscarriages are very frequent probably linked to uterine abnormalities. The most specific risks lie in cardiovascular complications involving aortic root dissection, severe hypertension (HTA) or ventricular insufficiency. In fact pregnancies in TS women cumulate the risk of congenital heart defects and HTA associated to TS, the risk of preeclampsia associated to oocyte donation and the increased cardiac work necessary for pregnancy. It is therefore absolutely necessary for all women with TS to undergo a full cardiological assessment before seeking to become pregnant including echocardiography, thoracic magnetic resonance imaging (MRI) to verify aortic root, cardiac valves and left ventricular function, hypertension monitoring and treatment. Single embryo transfer must definitively be considered. Cardiovascular surveillance during pregnancy has to be enhanced especially at the third trimester and during the peripartum period, most women requiring caesarean section for delivery because of cephalopelvic disproportion and/or aortic root dilatation risk.

[Current practices of oocyte donation in France and Europe]. / Etat des pratiques du don d'ovocytes en France et en Europe.

This review aims to evaluate, in France, oocyte donation, an assisted reproductive technique (ART), for which 25 years of experience have shown its efficacy for the palliative treatment of infertility caused by ovarian exocrine failure. Its indications have since been expanded to cover certain genetic diseases and document failures of other ART attempts. Oocyte donation is performed within the framework of French legislation - bioethics laws 94-653 and 94-654 of 29 July 1994, and the revised bioethics law 2004-800 of 6 August 2004. Its main fundamental principles are: voluntary, free, anonymous donation, for which regulated confidentiality is assured and now - judicial decree 2004-606 of 24 June 2004 - and the synchronization of donor-recipient cycles with fresh embryo transfer in accordance with established safety procedures. According to the 2004 results of the French Group for the Study of Oocyte Donation (GEDO) for French centers actively involved in ART, the chance of pregnancy was increased to 43.4% for synchronized cycles with fresh embryo transfers versus 18.7% for deferred cycles with frozen-thawed embryos (P<0.01). In addition, follow-up studies reported the excellent family relationships and physical and psychological development of these children. The major difficulties encountered in the daily practice of oocyte donation concern the recruitment and management of donors, but also, and above all, the lack of optimal means to exercise this medical specialty, due to the lack of recognition of the organizational duties incurred, which are the cornerstone of the character-specific functioning of this type of ART. In comparison, we foresee that the discrepancies of this ART practice in Europe, with it differential facets, will lead to medical nomadism for those couples financially able to do so, when national conditions of access fail because of prohibitions but also as a consequence of insufficient means to perform the inherent tasks. Today, it seems essential to provide information on the particularity and practice of oocyte donation required for the comprehension of its obligations for the different players with the aim of obtaining the means necessary for the perpetuation of its practice.

[Spontaneous pregnancies and premature menopause]. / Grossesses spontanées et ménopause précoce.

Hypoestrogenic hypergonadotrophic amenorrhea occurring before the age of 40 years is generally considered irreversible. The term "premature menopause" used to define this condition seems a misnomer, and "premature ovarian failure" (POF) is preferred on both a psychological and a physiological basis. POF is not uncommon considering the incidence rate of 1-2% of women during their theoretically reproductive life. These circumstances are particularly painful when a child is desired. However, since a long time the notion of permanent cessation of ovarian function is challenged and intermittent and transient return of ovarian function has been described with 5-10% chance of pregnancy often more than 12 months after the beginning of the amenorrheic status. A multicentric retrospective study conducted by the GEDO reports 27 pregnancies out of 518 patients waiting for an in vitro fertilization with oocyte donation because of POF or occult ovarian insufficiency. Considering this work and a literature review, we try to propose part of understanding of the basic POF physiopathology, and to examine the factors which could act on the prognosis and the clinical management.