[Oocyte cryopreservation : medical and social indications]. / La cryoconservation d'ovocytes : indications médicales et sociétales.

The increasing survival rate in cancer patients and the global tendency to delay motherhood are two distinct phenomena leading to an increased demand for fertility preservation. Currently, fertility preservation is possible to be achieved with less hormonal exposure and without delaying oncological treatments. Based on this knowledge, any patient with an oncological diagnosis should be referred to a fertility specialist to consider gamete cryopreservation. In addition, the indication for fertility preservation have been extended to many benign pathologies. Awareness of age-related fertility decline coupled with a tendency to delay motherhood is leading more and more women to consider social egg freezing. For these women, oocyte cryopreservation allows them to maintain their reproductive lifespan until an age when they feel ready to become mothers.

L'augmentation de la survie des patientes atteintes de cancer et la tendance à retarder la première maternité sont deux phénomènes distincts menant à une hausse de la demande de préservation de fertilité. Actuellement, une préservation d'ovocytes est possible chez les patientes avec une exposition hormonale légère et sans retarder les traitements oncologiques. Ainsi, toute patiente recevant un diagnostic oncologique devrait être orientée vers un spécialiste de la fertilité. De plus, les indications de préservation de fertilité se sont élargies à de nombreuses pathologies bénignes. La conscientisation de la diminution de fertilité liée à l'âge, couplée à une tendance à retarder la première grossesse, pousse de plus en plus de femmes à faire appel à l'AGE Banking (Anticipation of Gamete Exhaustion), technique qui leur permet de maintenir leur potentiel reproductif jusqu'à l'âge où elles désireront devenir mères.

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.

[Retrospective study--pregnancy after assisted medical reproduction from 2001 to 2009 at the Central Hospital of Luxembourg (first section)]. / Etude retrospective--suivis de grossesses après Procréation Médicalement Assistée (PMA) de 2001 à 2009 au Centre Hospitalier de Luxembourg (1re partie).

Retrospective study on a nine year ART practice focusing on pregnancy outcomes and multiple pregnancies, their complications, the gestational duration, delivery options, the new born weights and health statements til the age of two. Post ART pregnancies seem to have an increased complication rate; multiple births are more frequent than with spontaneous conception. The first chapter deals with the entire group. The second chapter analyses several sub-groups according to the ART method employed. The results are compared to publications in PubMed and Medline.

[Anti-ovarian antibodies and in vitro fertilization: cause or consequence?]. / Anticorps anti-ovaires et fécondation in vitro: cause ou conséquence?

OBJECTIVES: To assess anti-ovarian antibodies (AOA) in serum samples at various times of in vitro fertilization (IVF) attempts to determine whether ovarian stimulation could result in the production of such autoantibodies in women. PATIENTS AND METHODS: Prospective study on 134 patients and 138 IVF cycles using a classical long protocol. For each attempt, four serum samples were obtained, respectively, at the onset of downrelation (S1), end of downregulation (S13), after 7 days of follicular stimulation (S21) and the day of follicular puncture (SP). Five hundred and fifty two samples were tested with an enzyme-linked immunosorbent assay for three isotypes (IgG, IgA, IgM) of AOA. RESULTS: In the whole group, mean concentrations of AOA for each isotype were compared group by group: S1-S13, S1-S21, S1-SP, S13-S21, S13-SP, S21-SP. Not any significant difference was observed whatever the isotype considered. DISCUSSION AND CONCLUSION: This study shows the absence of influence of endogenous or exogenous ovarian stimulation by gonadotropins on anti-ovarian autoimmunity.

Twin pregnancy obtained with frozen-thawed embryos after in vitro maturation in a patient with polycystic ovarian syndrome.

PURPOSE: A twin pregnancy was obtained in a patient with polycystic ovary syndrome after the transfer of three in vitro maturation-derived day 3 embryos that has been frozen and thawed. METHODS: The patient had received mild hMG stimulation followed by hCG injection. After culture for 24-48 h, mature oocytes were fertilized by ICSI. Embryos were cultured until day 3; supernumerary embryos were cryopreserved using a slow protocol. RESULTS: Among 15 nonatretic oocytes, 9 matured, 8 were fertilized. Four embryos were transferred but they did not implant. The subsequent transfer of three frozen-thawed embryos resulted in the delivery of two healthy girls. CONCLUSIONS: These results indicate that a pregnancy could be obtained with in vitro maturation-derived day-3 frozen-thawed embryos.

[Successful PMA. Review of the activities of the Center for Medically Assisted Procreation of University of Liege, 1985-1997]. / La PMA qui réussit Bilan d'activité du Centre de Procréation Médicalement assistée de l'ULg, 1985-1997.

Assisted reproductive treatments (ART) hold an increasing place in the field of female infertility but also of male infertility with the development of new micromanipulative technologies. From January 1985 to December 1997, more than 3,000 ovarian punctures were achieved at the CPMA of the University of Liege and more than 40,000 oocytes were recovered. Global results show a take home baby rate of 23% per ovum pick-up and 27% per embryo transfer. Embryo cryopreservation offers an efficient solution to the problem of supernumerary embryos and opens the way for IVF-derived procedures such as oocyte or embryo donation, surrogate mother. The transfer of frozen-thawed embryos increases the total ongoing pregnancy rate per cycle of 31%. One of the aims of our Centre in the near future is the development of new technologies such as control of chromosomal abnormalities or genetic defect in preimplantation embryos and clinical applications of oocyte or ovarian tissue freezing.

Determination of thiamin and its phosphate esters in cultured neurons and astrocytes using an ion-pair reversed-phase high-performance liquid chromatographic method.

A sensitive method, based on fluorescence detection, for the determination of thiamin derivatives after precolumn derivatization is described. The separation is achieved on a PRP-1 column using ion-pair reversed-phase HPLC. This method is especially well adapted to the detection of thiamin triphosphate in complex mixtures such as tissue extracts. The detection limit for TTP is 50 fmol. The contents of thiamin derivatives were determined in primary cultures of rat cerebellar granule neurons and cerebral astrocytes. The amount of TTP is about five times higher in neurons than in astrocytes. Thus in rat brain TTP seems to be essentially associated with neurons and the intracellular concentration is estimated to be about 0.2 microM. Our results suggest the existence, in nerve cells, of specific regulatory mechanisms not related to the blood-brain barrier and responsible for the maintenance of thiamin homeostasis in brain.

Pregnancy rates after transfer of embryos obtained from different stimulation protocols and frozen at either pronucleate or multicellular stages.

After in-vitro fertilization, 2161 supernumerary embryos were frozen with 1,2-propanediol and sucrose as cryoprotectants at either pronucleate or multicellular (2-6 blastomeres) stages. By the end of March 1990, 494 pronucleate stage embryos and 492 multicellular stage embryos had been thawed and 54 and 47% of them, respectively were considered suitable for transfer. Ongoing pregnancy and implantation rates were 17.9 and 10.7%, respectively for embryos frozen at the pronucleate stage and 5.5 and 4.7% for embryos frozen at the multicellular stage. Ovarian stimulation with human menopausal gonadotrophin (HMG) after pharmacological hypophysectomy with a gonadotrophin releasing hormone agonistic analogue (GnRHa) using a long protocol permitted us to freeze significantly more embryos per cycle (7.2 +/- 4.1) than stimulation with HMG and GnRHa in a short protocol (4.7 +/- 3.4) or stimulation with clomiphene citrate (CC) and HMG (2.7 +/- 1.9). Ongoing pregnancy rates after transfer during the stimulated cycles were similar for the three types of treatment (27.1, 27.3 and 32.1%, respectively). However, ongoing pregnancy rates after frozen-thawed embryo transfers were significantly higher when originating from GnRHa + HMG treatments (14.3 and 14.8%, respectively for long and short protocols) than when originating from CC + HMG treatment (5.6%). Embryo cryopreservation has permitted the ongoing pregnancy rate to increase from 28.4 to 36.9% (P less than 0.01) even though more than half of the embryos have not been thawed. We conclude that embryos obtained after stimulation with GnRHa + HMG and frozen at the pronucleate stage are more likely to result in a pregnancy.

[Chronic lymphocytic leukemia, acute anergic tuberculosis, multiple caseous adenitis (author's transl)]. / Leucose lymphoïde chronique, tuberculose aiguë anergique, adénites caséeuses multiples.

The authors report an exceptional case of hematopoietic tuberculosis complicating a chronic lymphocytic leukemia, developing at first an acute tuberculous septicemia then a caseous disease of lymph glands. The usual difficulties of the diagnosis were increased by the underlying blood disease and it was done mainly thanks to an osteo-medullary biopsy and to the results of the specific proof treatment.