[Interest of selective progesterone receptor modulators in endometriosis]. / Intérêt actuel des selective progesterone receptor modulators (SPRM) dans l'endométriose.

The SPRM (selective progesterone receptor modulators) are agonists and/or antagonists of progesterone receptor. They are responsible for anovulation, amenorrhea and a lower prostaglandin levels, which leads to an improvement in pain and regression of lesions in endometriosis. On the endometrium, a particular aspect, the progesterone receptor modulator-associated endometrial changes (PAEC), raises additional studies to verify its harmlessness. However, due to the lack of hypoestrogenism and metabolic effects with these drugs, it is very likely that the SPRM will in the near future an important place in the treatment of endometriosis.

[Granulosa cell tumor: difficulty of diagnosis and contribution of imaging]. / Tumeur de la granulosa : difficultés diagnostiques et apport de l'imagerie.

Granulosa tumors (GT) are rare neoplasms, difficult to diagnose in a preoperative stage. We report a set of seven patients affected by GT admitted in Amiens University Hospital, collated with a review of the literature (n=379). Our aim was to report the clinical and radiological characteristics of GT, in order to improve preoperative diagnosis. The average age of the subjects was 50.8 years old among the bibliographical search, and 37years old for the observations reported in Amiens. The principal circumstances of diagnosis were vaginal bleeding, abdominal pain and infertility. Ultrasound was the most frequently investigation, revealing GT as a large unilateral solid and cystic mass. The computed tomodensitometry (CT) allowed to precise the locoregional extension. Magnetic Resonance Imaging (MRI) appeared to be interesting to clarify lesions, showing GT as a solid mass with a cystic component or as a multicystic mass. Hormonal assays (inhibin B and/or anti-Müllerian hormone) can provide valuable assistance in diagnosis, despite their cost and lack of availability. In view of the clinical and radiological presentation of the reported and literature review cases, we suggest hormonal assays among perimenopausal women presenting with an unusual radiological aspect of an annexial mass.

[Should a laparoscopy be necessary in case of infertility with normal tubes at hysterosalpingography?]. / Peut-on réellement se passer de la cœlioscopie en cas d'infertilité a trompes normales en hystérosalpingographie ?

The aetiological assessment of an infertile couple includes several complementary biological and morphological examinations. Initial exploration of the female genital tract requires the performance of pelvic ultrasound and hysterosalpingography. The value of systematic laparoscopy in infertility assessment is still subject to debate. The aim of the present review is to evaluate arguments against the systematic use of laparoscopy and to define the place of the other tests as Chlamydia Trachomatis serology, hysterosalpingosonography and MR-IRM. In our opinion, laparoscopy is of course indicated in infertility assessments not only when anomalies are revealed by hysterosalpingography but also in the following circumstances: past history of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant risk of adhesions), unexplained secondary infertility, unexplained infertility after the age of 38 (when choosing between artificial insemination and direct enrolment in an IVF programme) and failure of 3 cycles of good-quality intra-uterine inseminations (with ovarian stimulation and a sufficient number of spermatozoids).

[Coasting and ovarian stimulation protocols in high-responder patients undergoing assisted conception]. / Le coasting et les protocoles de stimulation chez les hyperrépondeuses en AMP.

Over-responsive patients are at risk of ovarian hyperstimulation, which may lead to severe complications. The choice of ovarian stimulation protocol or the use of a coasting (gonadotrophins suspension) with its associated risk of too strong ovarian response will be discussed herein. As for in vitro fertilization stimulation protocols, the best are probably those which use steadily increasing low doses of gonadotrophins, associated to GnRH agonists (low-dose protocols) or those which complete a double hypophyseal inhibition (estro-progestative association and GnRH agonists). GnRH antagonists may also reduce the risk of ovarian hyperstimulation, by estradiol drop. Outside the context of in vitro fertilization GnRH continuous administration or low -dose gonadotrophin stimulation are the best options. A coasting will be performed when an excess follicle response is documented. Under strict hormonal follow-up and within four days it allows achieving a high rate of pregnancy with a lower risk of hyperstimulation. Compared to other therapies of hyperstimulation syndrome, the coasting allows to avoid cycle cancellation or freezing of all embryos.