RESUMO
OBJECTIVE: Many studies in the literature have found an association between geographic origin and poorer IVF outcomes in African American and Asian minority populations compared with Caucasian populations. The limitations of these studies are multiple (inconsistencies in the characterization of ethnic groups, mostly multicenter studies with large variability in success rates between centers, minorities having more limited and delayed access to care). Thus, socioeconomic status may have been an important bias in judging environmental or "genetic" factors. The objective of our study is to determine whether geographic origin would influence IVF response and outcomes in a French university hospital center with equal access to care. MATERIAL AND METHODS: This was a retrospective single-center observational study from January 2013 to January 2020 comparing IVF response in 3 populations of similar size at our Medically Assisted Reproduction center, with all charges covered by Medicare. The primary objective was ovarian response to IVF, and the secondary objectives were clinical pregnancy rate and live birth rate per cycle started. RESULTS: We analyzed 1669 cycles of first IVF attempt in women from Europe (525), Sub-Saharan Africa (649) and Maghreb (495). The SSA and Maghrebi women had a higher BMI. SSA women were more often affected by tubal or uterine infertility, HIV or HBV infection, and were less often nulliparous. The indication of male infertility was more frequent in Maghrebi women with a higher ICSI rate. There was no significant difference in the duration of stimulation, endometrial thickness at induction, number of oocytes collected, fertilization rate, number of embryos transferred and frozen. Nevertheless, the cancellation rate was higher in SSA and Maghrebi women and the total dose of gonadotropins was higher in SSA. No significant difference was found between Maghrebi and European women on IVF outcomes except for a lower number of total embryos in Maghrebi women (3.33 vs. 4.13 on average, P<0.001). The SSA had a lower rate of mature oocytes per puncture (66 % vs. 73 %, P<0.001), a lower number of total embryos per puncture (3.56 vs. 4.13 on average, P<0.016), a lower rate of clinical pregnancies per cycle (11.7% vs. 20.4%, P<0.001), a lower rate of live births per cycle (6.9% vs. 15.2%, P<0.001). CONCLUSION: There was no significant difference between European and Maghrebi women at the end of IVF, but the results were lower for those from SSA.
Assuntos
Fertilização in vitro , Infertilidade Masculina , Idoso , Estados Unidos , Gravidez , Masculino , Feminino , Humanos , Fertilização in vitro/métodos , Estudos de Coortes , Estudos Retrospectivos , Medicare , Taxa de Gravidez , Europa (Continente) , Infertilidade Masculina/terapia , África Subsaariana/epidemiologia , Indução da Ovulação/métodosRESUMO
Iodine deficiency during pregnancy. Iodine is a necessary element to thyroid hormones synthesis, and is essential in neurological development. Iodine needs increases during pregnancy. In developed countries, iodine deficiency is the second cause of mental delay avoidable after foetal alcoholization syndrome. In France, there is a moderate iodine deficiency, according to World Health Organization (WHO) thresholds. The marker used in studies is 24h urinary iodine excretion, but this marker is not applicable at the individual level. European substitution policy is hard to establish considering alimentary customs for each population. Salt fortification has a limited impact because its use has to be limited during pregnancy. Prophylaxis is recommended systematically by WHO in moderate deficiency areas like in France: 150 µg/ day for women of childbearing-age and 250 µg/ day during pregnancy and breast feeding. Side effects may seem bearable considering benefit/ risk ratio providing not exceeding 500 µg/day.
Carence en iode pendant la grossesse. L'iode est un élément essentiel à la synthèse des hormones thyroïdiennes, qui ont un rôle démontré dans le développement neurologique foetal. Les besoins sont accrus au cours de la grossesse. Dans les pays développés, la carence iodée est la deuxième cause de retard mental évitable après le syndrome d'alcoolisation foetale. En France, il existe une carence iodée modérée selon les seuils définis par l'Organisation mondiale de la santé (OMS). Le marqueur utilisé dans les études est l'iodurie des 24 heures, mais il n'existe pas de moyen de dépistage à l'échelle individuelle. Une politique européenne de substitution est difficile à mettre en place compte tenu des habitudes alimentaires de chaque population. La fortification du sel a un impact limité car sa consommation doit être limitée pendant la grossesse. Une prophylaxie est recommandée de manière systématique par l'OMS dans les zones de carence modérée comme la France : 150 µg/j pour les femmes en âge de procréer et 250 µg/j pendant la grossesse et l'allaitement. Les effets secondaires apparaissent tolérables en regard du rapport bénéfice-risque à condition de ne pas dépasser le seuil de 500 µg/j.
RESUMO
OBJECTIVES: To describe the surgical technique of transcorporal artificial urinary sphincter (AUS) implantation. To assess the efficacy of the AUS on continence and erectile function. PATIENTS AND METHODS: A prospective evaluation was conducted between December 2007 and October 2012 at a tertiary referral centre of all male patients treated by transcorporal AUS (AMS800™, AmericanMedicalSystems, Minnetonka, MN, USA) implantation for stress urinary incontinence (SUI) recurrence, after failure of previous anti-incontinence surgery. Functional urinary outcomes were assessed according to daily pad use, the Urinary Symptom Profile questionnaire, and International Consultation on Incontinence Questionnaire - Short-Form. Erectile function was evaluated using the five-item International Index of Erectile Function (IIEF-5) questionnaire and patient satisfaction was assessed by Patient Global Impression of Improvement questionnaire. Data were collected by telephone interview. RESULTS: A total of 23 patients were included. Their mean (sd; range) age was 70 (7; 60-85) years. Of these, 18 patients had urethral atrophy and/or erosion after placement of AUS (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiation therapy. The implantation of the AUS with transcorporal cuff placement was successful in all patients, with no peri-operative complications. Follow-up data over 1 year were available for 17 patients. After a median (sd; range) follow-up of 20 (15; 2-59) months, eight patients were perfectly dry (no pad use and no symptoms), five achieved social continence (less than one pad/day), and four still had SUI (required two or more pads/day). Among six patients who had good preoperative erectile function and were sexually active, four had no decrease in their IIEF-5 score. CONCLUSIONS: Transcorporal AUS cuff placement is a useful alternative for challenging cases of male SUI after failure of previous surgical treatment, urethral atrophy or erosion. Erectile function can be maintained despite dissection of the corporal body.
