[Outcomes of cumulative transfers of fresh and frozen embryos in in vitro fertilization in women infected by hepatitis B virus]. / Issues des transferts cumulés d'embryons frais et congelés en fécondation in vitro chez les femmes infectées par le virus de l'hépatite B.

OBJECTIVE: To assess the impact of hepatitis B virus (HBV) infection in women on in vitro fertilization (IVF) outcomes. METHODS: An observational monocentric case-control cohort study conducted between 2012 and 2019 compared the outcomes of the first cycle of IVF between 64 woman infected with HBV and 128 seronegative controls. Frozen embryos transfers made within 18 months of the puncture were included. The exclusion criteria were severe infections, viral co-infection in women, any viral infection in their spouse, or lack of fresh embryo transfer. The matching was performed according to age, primary infertility or secondary, conventional or intracytoplasmic injection IVF technique and date of attempt. The main analysis focused on cumulative live births rates (LBR). RESULTS: The clinical and ovarian stimulation characteristics were comparable except for a longer period of infertility in the HBV group. The LBR in the HBV group, when compared to controls, was not different after transfer of fresh (14.06 vs. 25.00% P=0.08) or frozen embryos (4.17 vs. 18.92% P=0.08), but significantly decreased in cumulative analysis (15.63 vs. 35.94% P=0.003). HBV infection was negatively associated with LBR in multivariate analysis OR=0.38 (95% CI 0.14-0.92) P<0.05. The implantation rate was lower in the HBV group versus controls, in fresh (14.89 vs. 27.72% P=0.02) and frozen (3.03 vs. 21.65% P=0.01) embryo transfers. CONCLUSION: This study suggests a negative impact of HBV infection in women on the cumulative LBR after IVF.

Serum progesterone level and ongoing pregnancy rate following frozen-thawed embryo transfer after artificial endometrial preparation: a monocentric retrospective study.

INTRODUCTION: In some studies, early pregnancy loss (EPL) rate is higher with artificial cycle (AC) endometrial preparation for frozen-thawed embryo (FET) transfer than with other protocols, even though pregnancy rates are similar. An inadequate luteal phase support could explain these findings. The aim of this study was to compare, among the patients who had a pregnancy after FET with AC endometrial preparation, serum progesterone (PG) levels between those who experienced an EPL or an ongoing pregnancy. MATERIAL AND METHODS: A monocentric retrospective cohort study, conducted at a University affiliated fertility center, studied 130 FET cycles with AC endometrial preparation between June 2016 and July 2017. Serum PG rates were compared according to reproductive outcomes and to endometrial preparation protocol on day 10 or 12 after FET (PG0) according to the embryo stage, and every 48h in case of pregnancy (i.e. PG1; PG2). RESULTS: Among patients who had a pregnancy after FET with AC (n=33), serum PG levels were higher in case of an ongoing pregnancy than EPL, only significantly at PG1 (PG0 12.4ng/mL [7.5-14.6] vs 8.2ng/mL [6.0-13.0], p= 0.320; PG1 15.0 ng/mL [14.0-15.9] vs 8.5ng/mL [5.9-13.8], p= 0.048). DISCUSSION: We found that serum PG level was lower in women experiencing early pregnancy loss after FET with AC endometrial preparation, potentially reflecting a lack of appropriate luteal phase support with PG. A cycle AC test, monitoring serum PG levels after its steady state, could detect this lack of PG, allowing physicians to adapt PG supplementation.

[Adverse obstetric and perinatal outcome with in vitro fertilization technology: A French nationwide population-based study]. / Risques de morbidité maternelle et périnatale en fécondation in vitro : une étude nationale de cohorte française.

OBJECTIVES: The objective of this study was to quantify the risk of maternal and perinatal morbidity with in vitro fertilization (IVF) technology compared to non-IVF pregnancies in a recent French national cohort. METHOD: The data was extracted from the hospital information data system, including all pregnancies with a delivery from 2013 to 2016. The risks of preterm birth, maternal morbidity (venous and arterial thrombosis, gestational diabetes, vascular disorders, placenta previa, placenta abruption), hypotrophy and congenital malformation were compared in both groups in univariate and multivariate analysis after adjustment on the characteristics of women (age, parity, obesity, tobacco dependence, history of diabetes or high blood pressure), multiple deliveries and sex of children. RESULTS: In all, 2,875,662 pregnancies and 2,922,712 births were analyzed, of which 49,224 were derived from IVF (1.7%). In multivariate analysis, all risks were significantly higher in IVF: premature deliveries (ORajusted=1.28; CI95%=1.24-1.32), maternal morbidity (ORajusted=1.24; CI95%=1.21-2.28), (mainly for thrombosis venous, placenta previa and placenta abruption). The risks of hypotrophy (ORajusted=1.13; CI95%=1.10-1.16) and congenital malformations (ORajusted=1.11; CI95%=1.05-1.17) were slightly increased. CONCLUSION: The results of this study on a large cohort of recent births in France confirm that there was an increased risk of maternal and perinatal morbidities in IVF. These risks were similar to those published in the international literature. This study is the starting point for a forthcoming surveillance.

[Assisted reproductive technologies in HIV patients: Which results and which strategy in France in 2019?] / Prise en charge des couples porteurs du VIH en assistance médicale à la procréation : quels résultats et quelle stratégie en France en 2019 ?

With the use of antiretroviral therapy, HIV transmission from mother to fetus and between sexual partners has been significantly reduced, successively allowing pregnancy, then assisted reproductive technologies, and targeted unprotected sex among couples living with HIV. Since first French Morlat report in 2013, natural procreation is now possible under certain conditions for these couples living with HIV and the use of assisted reproductive technologies is increasingly limited to the treatment of infertility. While the results of intrauterine insemination seem satisfactory for serodiscordant couples living with HIV, in vitro fertilization results appear to be unfavorable when the woman is infected with HIV. In vitro fertilization results appear to be comparable to those in general population when only the man is infected with HIV. It can be assumed that ovaries are impacted by the treatment and/or the HIV in infected women.

Decreased antibiotic susceptibility of Enterobacteriaceae causing community-acquired urinary tract infections in French Amazonia.

OBJECTIVES: Urinary tract infections (UTIs) have rarely been studied in the Amazon region. We aimed to describe the epidemiology of bacteria causing UTIs in French Guiana. PATIENTS AND METHODS: We performed a monocenter retrospective study of adults consulting at the emergency department of Cayenne Hospital in 2014 with a diagnosis of UTI. The bacterial species and resistance profile were described. RESULTS: Two-hundred-and-eighty-nine patients presenting with UTI were included: 82 (28.4%) presented with cystitis, 166 (57.4%) with pyelonephritis, and 41 (14.2%) with male UTI. E. coli was predominant (74.1%), and had decreased susceptibility to ampicillin, amoxicillin-clavulanic acid, fluoroquinolones, co-trimoxazole, and furans compared with data from metropolitan France. Extended-spectrum beta-lactamases (ESBL) was isolated in 3.1% of E. coli and 31.6% of K. pneumoniae. CONCLUSIONS: Antibiotic susceptibility in UTI is lower than reported in metropolitan France without evidence for an excessive consumption of antibiotics.

[An update on adenomyosis and implantation]. / Adénomyose et implantation : mise au point.

Adenomyosis is an enigmatic disease whose impact on implantation and fertility outcome is still controversial. A negative effect on IVF outcome was already observed, but it is mainly explained by an increase in early spontaneous miscarriages. We reviewed scientific data in order to bring relevant information about adenomyosis and endometrial receptivity for patient counselling and to precise if screening of adenomyosis is indicated before IVF treatment.

[Cultural diversity in gamete and embryos donation]. / Diversité culturelle et dons de gamètes et d'embryons.

Through gamete and embryo donation have successively emerged new ways of designing individuals who, in turn, have generated mutations in the concept of parenthood. A debate is open to the society, which often raises ideological cleavages. Indeed, donation practices mobilize the conflicting interests of donor of gametes, the recipient couple, child, whose origins are complex, although his filiation is legally clear. Its place in the family genealogy can be examined in relation to other societies, which admit plural concepts called "classificatory" kinship. They set up role partition between parents and educators. Setting anthropological perspective provides a broadening of the reflection to answer questions from the donation practices, including genealogical questions of revelation to the child of his conception, his incorporation in family and social group and the importance of compensation of donation.

[Diagnosis and treatment of pelvic splenosis during exploration of infertility]. / Diagnostic et traitement de splénose pelvienne au cours d'un bilan d'infertilité.

Splenosis is the heterotopic autotransplantation of splenic tissue that usually follows traumatic splenectomy. Rare pelvic localizations are reported. We report here a case of a 36-year-old woman, followed for secondary infertility. On transvaginal ultrasound pelvic scanning hypervascular paracervical nodules were demonstrated. Pelvic splenosis was suspected regarding the patient's medical past (post-traumatic splenectomy). Surgical exploration and resection were decided considering the nodule localization, the risk during ovarian punction for IVF, and the hypothetical risk of bleeding at delivery. Generally, it is recommended to leave in place the splenic tissue, which may be immunologically functional.

[Targeted screening for HTLV-1 in couples requesting medically assisted reproduction]. / Dépistage ciblé HTLV1 des couples demandant une AMP.

Currently there are no guidelines for the targeting of HTLV-1 screening of couples requesting inclusion in an assisted fertility programme. These can be drawn up only if there is a multidisciplinary input allowing for specialist advice on the quantification of risk in the target populations offered help with fertility both in mainland France and the Antilles or French Guyana.In units offering Assisted Reproductive Technics (ART) targeted screening which might reveal a requirement for specific medical management, presents the opposing problems of the need for exhaustive questioning of the couple and that of non-discrimination. If screening is arranged to take place before the couple is taken on for assisted reproduction, then the good practice which is currently recommended and applied for HIV, is a suitable reference model. It remains to define the expected benefits in this branch of medicine where medical responsibility in assisted conception is already highly regulated. Moreover, if any measures are applied in the context of assisted reproduction, this would suggest that similar guidelines should be established for natural conception.

[Post-ART follow-up for women]. / Suivi des femmes après AMP.

The follow-up of women after ART is for the most part related, over the short and long term, to the follow-up of the child born through ART. What is important to know is the possible repercussions of treatment on women's health over the short and long term. To date, no study has proven that menopause comes on earlier after ART treatments. Similarly, none of the international studies has demonstrated a significant increase in breast, ovary, uterus, or colon cancer related to ovulation-inducing treatment. However, for reasons of safety, vigilance is required. Large-scale follow-up of this nature essentially involves crossing registries (cancers, ART), but must respect the desires of women not to be indefinitely reminded of their past infertility. In addition, a study is reported on pursuing the parental project in a cohort of 1200 women who delivered at least one child conceived through MAP more than 3 years before.

[Diethylstilbestrol exposure in utero. Polemics about metroplasty. The cons]. / Utérus DES. Polémiques sur l'hystéroplastie d'agrandissement. Arguments contre.

Uterine malformations in DES-exposed women are not the only aetiologies for infertility, miscarriages, and other problems in their reproductive life. A global screening of fertility factors of the couple may, for instance, show in them vascular uterine abnormalities which reduce their reproductive potential. Furthermore, these abnormalities are not always predictive of losses of pregnancy, and many exposed women with patent uterine abnormalities can carry a pregnancy to term. Metroplasty for uterine enlargement is a surgical procedure suggested for restoring the size and shape of the uterine cavity. There are no comparative studies for assessing efficacy and safety of metroplasty. Therefore, metroplasty should not be performed routinely, but should only be considered after the couple has undergone a full fertility workup, and the best possible level of fertility has been achieved.

[Children born of ICSI]. / Les enfants de l'ICSI.

Studies on children born as a result of IVF or ICSI present significant methodological differences and have been conducted on highly heterogeneous populations. Regarding perinatal data, there is a consensus of opinion on the increased risk of prematurity, growth retardation and perinatal mortality, even after maternal factors and the presence or absence of multiple pregnancies have been taken into account. There is no significant difference in the studies between ICSI and IVF, which are often not individualised. The results of birth defects following IVF treatment are contradictory in the literature. The risk of birth defects following ICSI can be caused by male infertility (chromosome abnormality rate, microdeletion of the Y chromosome, genetic fingerprint) or by the technique used (no selection of the fertilising spermatozoon, disturbance of the meiotic spindle, risk of introduction of foreign materials, risk of infection). Analysis of the literature is complicated because of methodological biases. Thus, according to the studies, the risks of defects following ICSI are identical or increased compared with those following IVF. In the long term, synthesis of the studies does not allow any certainty regarding the growth of children, their cognitive or psychomotor development, the risk of cancers or epigenetic diseases. The current data is more reassuring than worrying, but the good current studies on child development should be developed in terms of number, cohort size and monitoring period.

ICSI outcomes in obstructive azoospermia: influence of the origin of surgically retrieved spermatozoa and the cause of obstruction.

BACKGROUND: Spermatozoa can be retrieved from the testis and epididymis of men with obstructive azoospermia (OA) and used for ICSI. However, it is unknown whether the outcome of ICSI depends on the cause of obstruction or the origin of surgically retrieved spermatozoa. METHODS: A cohort of 171 men with OA and normal spermatogenesis were included in this retrospective study. They were divided into three groups according to the site and origin of obstruction: 83 men had congenital bilateral absence of vas deferens; 55 and 33 had acquired epididymal and deferent duct obstructions, respectively. The outcome of 368 ICSI cycles was determined and compared according to the origin of spermatozoa: epididymal (n = 253) or testicular (n = 115). RESULTS: Fertilization and clinical pregnancy rates did not differ between spermatozoa of different origin (58.9% versus 51.9% and 22.1% versus 24.3% with epididymal and testicular spermatozoa, respectively). However, the miscarriage rate was significantly higher for testicular spermatozoa (35.7% versus. 12.5% P < 0.05, chi2 test). Findings were similar whatever the aetiology of the OA. CONCLUSION: This study suggests that the use of testicular spermatozoa, even those generated during normal spermatogenesis, alters embryonic development and that epididymal spermatozoa should be preferentially used, irrespective of the aetiology of OA.

[What are the health scheme's responses to "out of the ordinary" requests in ART?]. / Quelles réponses aux demandes "hors normes" en AMP?

This communication reviews some ethical considerations concerning debated indications for ART (Assisted Reproductive Therapy). Several case reports are discussed concerning the risks of IVF for women presenting severe pathology, the ethical responsibilities of investigators, social control of IVF.

[Early prophylactic cervical cerclage for hypoplastic cervix following exposure to DES in utero]. / Technique de cerclage prophylactique précoce des cols hypoplasiques après exposition au DES in utero.

AIM: Presentation of a prophylactic cerclage technique, placed in the beginning of second trimester of the pregnancy, derived from McDonald cerclage and adapted to hypoplastic cervix following exposure to DES in utero. MATERIALS AND METHODS: Prospective study including 20 pregnant patients exposed to DES in utero and presenting a hypoplastic cervix. Study of the location of the cerclage tape in the cervix and of changes in cervical length (before and after cerclage) assessed by physical examination of the cervix and by transvaginal ultrasonography. RESULTS: The cervix was longer after cerclage as shown by physical examination and by ultrasound. The tape was localized near the internal cervical os, its posterior portion nearer the internal cervical os than its anterior portion. CONCLUSION: This easy-to-perform technique of cerclage of hypoplastic cervix allows the tape to be localized near the internal cervical os without colpotomy and without use of the transabdominal approach, while allowing vaginal delivery.

[Indications and modalities of assisted reproductive techniques in infertile women with cystic fibrosis]. / Mucoviscidose féminine et projet d'enfant: spécificités des indications et résultats de l'aide médicale à la procréation.

OBJECTIVE: To treat cystic fibrosis women who failed to conceive. PATIENTS AND METHODS: Multidisciplinary coordinated approach in 20 infertile women affected with cystic fibrosis. Advisability of pregnancy was based on the assessment of pulmonary and nutritional status, risks of maternal health deterioration, infertility factors, risk of cystic fibrosis in the offspring. Assisted reproductive techniques in moderately affected women are described. RESULTS: Three patients requested only information, three were discouraged, two are still evaluated, 12 were treated and three delivered healthy children. The pulmonary status of each patient remained unchanged 36 months after delivery, and all three children remain healthy. DISCUSSION AND CONCLUSION: Assisted reproductive techniques are an option in moderately affected infertile cystic fibrosis women. Advisability and management of pregnancy should be provided by a coordinated team of healthcare professionals with knowledge and experience in cystic fibrosis.