[Impact of thyroid function on the result of intrauterine insemination among fertile women]. / Impact de la fonction thyroïdienne sur le résultat des inséminations artificielles avec sperme de donneur chez des femmes fertiles.

This retrospective study compares the impact of TSH level on the result of intrauterine insemination (IUI) with donor sperm in fertile women. There is no difference in women characteristics and their fertility. Despite the fact that the thyroid hormones influence fertility, this study shows that TSH before IUI doesn't influence pregnancy and live birth rates. However, thyroid hormones are important for the foetal brain development and pregnancy. Therefore, it is important to evaluate the thyroid function and prescribe a treatment if needed, (if TSH superior to 2.5 mUI/l) as the pregnancy is a stressful factor for thyroid and an infraclinical hypothyroidism can evolve into a clinical hypothyroidism in pregnant women.

Cette étude rétrospective, incluant 526 patientes, s'intéresse à l'effet de la fonction thyroïdienne sur le résultat des inséminations artificielles avec sperme de donneur chez des patientes a priori fertiles. Il n'existe aucune différence significative dans les caractéristiques des patientes et leur bilan de fertilité. Bien que la fertilité soit influencée par la fonction thyroïdienne, cette étude montre que les taux de grossesse et de naissance obtenus ne sont pas influencés par le taux de TSH dosé avant le début des inséminations. Toutefois, les hormones thyroïdiennes jouent un rôle dans le bon déroulement de la grossesse et le développement cérébral fœtal. Il est donc important d'évaluer la fonction thyroïdienne en début de grossesse et d'instaurer un traitement substitutif si nécessaire (si TSH sup�rieur a 2,5 mUI/l). En effet, la grossesse est considérée comme un stress pour la thyroïde et une fonction thyroïdienne limite avant la grossesse peut décompenser pendant celle-ci.

Impact of follicular G-CSF quantification on subsequent embryo transfer decisions: a proof of concept study.

BACKGROUND: Previous experiments have shown that granulocyte colony-stimulating factor (G-CSF), quantified in the follicular fluid (FF) of individual oocytes, correlates with the potential for an ongoing pregnancy of the corresponding fertilized oocytes among selected transferred embryos. Here we present a proof of concept study aimed at evaluating the impact of including FF G-CSF quantification in the embryo transfer decisions. METHODS: FF G-CSF was quantified with the Luminex XMap technology in 523 individual FF samples corresponding to 116 fresh transferred embryos, 275 frozen embryos and 131 destroyed embryos from 78 patients undergoing ICSI. RESULTS: Follicular G-CSF was highly predictive of subsequent implantation. The receiving operator characteristics curve methodology showed its higher discriminatory power to predict ongoing pregnancy in multivariate logistic regression analysis for FF G-CSF compared with embryo morphology [0.77 (0.69-0.83), P < 0.001 versus 0.66 (0.58-0.73), P = 0.01)]. Embryos were classified by their FF G-CSF concentration: Class I over 30 pg/ml (a highest positive predictive value for implantation), Class II from 30 to 18.4 pg/ml and Class III <18.4 pg/ml (a highest negative predictive value). Embryos derived from Class I follicles had a significantly higher implantation rate (IR) than those from Class II and III follicles (36 versus 16.6 and 6%, P < 0.001). Embryos derived from Class I follicles with an optimal morphology reached an IR of 54%. Frozen-thawed embryos transfer derived from Class I follicles had an IR of 37% significantly higher than those from Class II and III follicles, respectively, of 8 and 5% (P < 0.001). Thirty-five per cent of the frozen embryos but also 10% of the destroyed embryos were derived from G-CSF Class I follicles. Non-optimal embryos appear to have been transferred in 28% (22/78) of the women, and their pregnancy rate was significantly lower than that of women who received at least one optimal embryo (18 versus 36%, P = 0.04). CONCLUSIONS: Monitoring FF G-CSF for the selection of embryos with a better potential for pregnancy might improve the effectiveness of IVF by reducing the time and cost required for obtaining a pregnancy.