Blastocyst stage transfer: the real benefits compared with early embryo transfer.

With the development of commercially available sequential media it is now possible to grow human embryos to the blastocyst stage without feeder cells. The transfer of blastocysts offers several advantages, the most important being synchronization of the embryos with the uterine endometrium and selection of the best quality embryos with a high implantation potential. This study was conducted to compare the efficiency of day 2 and day 5 transfer in a prospective randomized trial involving patients for whom embryo selection was possible (i.e. those with more than three embryos on day 2 following insemination). We obtained equivalent clinical pregnancy rates per cycle for day 2 (41.7%) and day 5 (38.8%) transfer, but fewer embryos were transferred on day 5 (2.24 versus 3.03). The implantation rates were 18.9% on day 2 and 24.1% on day 5. Selected patients with a good response to gonadotrophins (at least eight good quality metaphase II oocytes) may therefore benefit from blastocyst transfer by a reduction in the multiple pregnancy rate, provided no more than two (or even one) blastocyst is transferred.

[Comparative randomized controlled study between human follicle- stimulating hormone (FSH-HP) and human menopausal gonadotropins (hMG) in in vitro fertilization]. / Essai contrôle randomisé comparatif entre l'hormone folliculostimulante humaine (FSH-HP) et les gonadotrophines ménopausiques humaines (hMG) en fécondation in vitro.

We present the results of a prospective randomized trial comparing the issue of IVF-ET and of ICSI when either highly purified human folliculostimulin (FSH-HP) or human menopausal gonadotrophin (hMG) is used. There seems to be a trend to a better rate of ongoing pregnancies when FSH-HP is used although not statistically significant. The study has been stopped due to the lack of hMG.

Role of laparoscopy in the management of pelvic adhesions and pelvic sepsis.

Operative laparoscopy in pelvic sepsis is useful in acute cases: (a) for diagnosis, as there are 20-30% false positive and false negative diagnoses based on clinical and laboratory data alone; and (b) for treatment in severe cases and mainly in tubo-ovarian abscesses, laparoscopy allows aspiration of purulent discharge and, in recent cases, removal of fresh adhesions. In most cases, rapid and complete recovery is associated with treatment with an effective polyvalent antibiotic. Fertility is also preserved in most cases as assessed by a small series of bilateral abscesses with long-term follow-up. In CS associated with infertility, laparoscopic treatment is limited to velamentous adhesions or to dense adhesions of small extent. If performed after the completion of the inflammatory episode, laparoscopic surgery can give results comparable to those of microsurgery. A full bacteriological investigation and appropriate antibiotic treatment are necessary in order to stop or reduce the inflammatory condition which is usually associated with the development of adhesions and is a possible cause of their recurrence.

[The role of Chlamydia trachomatis in the infectious etiology of extra-uterine pregnancy]. / La place de Chlamydia trachomatis dans l'étiologie infectieuse des grossesses extra-utérines.

The study was carried out in two different hospital centres on a series of 55 women who had ectopic pregnancies compared with 2 control groups. The study concerned taking samples from cells in the pelvis to culture for Chlamydia trachomatis and to estimate the levels of anti-Chlamydia antibodies. The cultures were positive in 30% of the cases and the serology was positive in 52% of the cases. This difference is significant when compared with the control groups (p less than 0.001). There was no significant statistical difference as far as positive cultures were concerned between the groups of women who had or had not had previous tubal infertility or a history of salpingitis. It seems that Chlamydia trachomatis can itself therefore be a direct cause for the development of an ectopic pregnancy.

Cryopreservation of human embryos and oocytes.

The success rate of human embryo cryopreservation depends on technical and embryonic parameters. First of all, the cryoprotectant can affect embryo survival as we found by comparing two freeze-thaw procedures using propanediol (PROH) (1.5 mol) alone or with sucrose (0.1 mol). Embryo survival was significantly enhanced with sucrose (62 versus 32%). Embryo quality is another major parameter involved in the success of freezing; the rates of positive survival were found to be 67% for morphologically normal embryos versus 49% for embryos with fragments (P less than 0.001). The efficiency of embryo cryopreservation in an IVF programme could be estimated in 1986: a woman with extra embryos, stored after transfer of 3-4 fresh embryos (16% of all cycles), can expect a 22% pregnancy rate per transfer of fresh embryos and a 32% pregnancy rate per collection after transfer of the stored eggs. A comparative study of the cryopreservability of immature or mature oocytes was performed in humans. Human oocytes have a low survival rate (36%) whatever the cryopreservation protocol or the initial maturation stage. Immature human oocytes could survive freezing and thawing, mature and be fertilized in vitro, but with a very low efficiency.

[The value of an antiprogesterone steroid in the treatment of extra-uterine pregnancy. Preliminary results]. / Intérêt d'un stéroïde à action antiprogestérone dans le traitement de la grossesse extra-utérine. Résultats préliminaires.

The aim of this work is to study the effects of an antiprogesterone drug (RU 486) on extrauterine pregnancy and to draw from it possible inferences for therapy. The study was carried out on 28 patients presenting an extrauterine pregnancy, the levels of plasma chorionic gonadotrophins of whom were higher than or equal to 250 mIU/ml. Different modes of administration were employed and a coelioscopic salpingotomy was carried out for a pathological study.

[Tuboscopy]. / Tuboscopie.

Tuboscopy permits the observation of the tubal mucosa and the discernment of two types of lesions: synechiae and mucosal "plates". The coincidence of the interpretation of hysterography and the results of tuboscopy does not exceed 1 case in 2. Experience shows that intrauterine pregnancies which develop beyond the first trimester only survive when tuboscopy shows us a normal mucosa, whatever may be the salpingographic picture. It is better to abandon the idea of a plasty when the tubal mucosa is in a bad condition.

Endoscopy of the tube (= tuboscopy): its prognostic value for tuboplasties.

A tuboscopy was performed during tuboplasties, in 131 cases; this method gives the surgeon a direct, panoramic view of the ampullary mucosa; the lesions observed differ in 50% of cases from what was expected according to the hysterosalpingography. A 2 year follow-up shows that normal uterine pregnancies occurred only in women with at least one tube with normal mucosa according to the tuboscopy, whichever the lesions or the results of the hysterosalpingography; the other cases only had ectopic pregnancies or spontaneous abortions.

[A comparative study of salpingotomies with or without suture. An experimental microsurgical research carried out on rabbits' tubes (author's transl)]. / Etude comparée des salpingotomies avec ou sans suture. Recherche microchirurgicale expérimentale sur la trompe de lapine.

Two techniques of salpingotomy have been compared in two series of rabbit experiments with the aim of finding out whether, when carrying out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate following the two methods. On the other hand, implantation is less good when the tube is left open than when the salpingotomy is sewn up. In the first series there was a significant difference between the side that was operated on and the control side, whereas the second series there was very little difference. In spite of the fact that the scar seemed to be apparently of the same type, the eggs were able to descend more easily in the oviduct when it had been sutured.