Does early morphology provide additional selection power to blastocyst selection for transfer?

Routine early developmental parameters are widely used in IVF centres to evaluate embryo development and fresh single-blastocyst transfer currently seems superior to single-embryo transfer. Would early morphological parameters help to choose the single blastocyst to be transferred, thereby improving the chances of implantation and live birth rate? This prospective observational study analysed the individual outcomes of 2617 embryos from 511 IVF couples scheduled for a single-blastocyst transfer. Embryo and blastocyst scores were constructed. There was a clear relationship between the kinetics and morphology of blastocysts and further implantation and live birth rate. There was a limited predictive value of embryo score with regard to blastocyst development and growth kinetics. Implanted and non-implanted blastocysts showed similar embryo scores. Thus usual morphological parameters on days 1 and 2 seem to have no additional value in indicating the right blastocyst to transfer. Non-invasive approaches might be helpful to increase the chances of implantation in the future.

Serum antimüllerian hormone is not predictive of oocyte quality in vitro fertilization.

OBJECTIVES: The assessment of the ovarian reserve is mandatory in women undergoing assisted reproduction. Antimüllerian hormone (AMH) produced by granulosa cells from preantral and early antral follicles, is a promising indicator of ovarian reserve. However, few studies have evaluated the predictive value of AMH on oocyte quality. MATERIAL AND METHODS: A retrospective study was undertaken at the Bretonneau University Hospital of Tours. A total of 559 women undergoing in vitro fertilization treatment between January 2007 and December 2007 were included in the study. Serum AMH levels were determined by using an ultrasensitive ELISA test. Total number of oocytes, rate of mature oocytes, fertilization rate, embryo quality and clinical pregnancy rate were recorded. RESULTS: Serum AMH was significantly lower in groups of patients with few oocytes collected. However, serum AMH was not predictive of nuclear maturity of oocytes, fertilization rate and quality of early embryos. Additionally, low levels of AMH do not preclude clinical pregnancy, in in vitro fertilization. CONCLUSION: At the moment, serum AMH is a relatively predictive indicator of the ovarian reserve, in terms of quantity but not in terms of quality. Moreover, it is still not possible to determine serum AMH cut-off value to predict clinical pregnancy in IVF programmes.

Single Day 2 embryo versus blastocyst-stage transfer: a prospective study integrating fresh and frozen embryo transfers.

BACKGROUND: Whether extended culture allowing selection of embryos with high development potential has any advantage over cleavage-stage embryo transfer remains a matter of debate. Among the currently unsolved questions, the cumulative delivery rate resulting from fresh and frozen embryo transfers needs to be taken into account in both strategies. The aim of our study was, therefore, to compare the efficacy of single embryo transfer either on Day 2 or on Day 5/6 combining fresh and frozen embryo transfers. METHODS: A prospective study including 478 couples assigned on a voluntary basis to undergo elective single embryo transfer (eSET, n = 243) on Day 2 or single blastocyst transfer (SBT, n = 235) on Day 5/6 was performed. The primary outcome measurement was the cumulative delivery rate including fresh and frozen-thawed cycles in both groups. RESULTS: The delivery rate per cycle following fresh embryo transfer was significantly higher in the SBT group compared with the eSET group (P < 0.01). Conversely, frozen embryo and/or blastocyst transfers tended to result in a higher number of deliveries in the eSET compared with the SBT group. Altogether, the cumulative delivery rate per couple, including fresh and frozen embryo transfers, was similar between the two groups (37.9% versus 34.2% in the SBT and eSET groups, respectively). CONCLUSIONS: The observed cumulative delivery rates in this study do not allow us to take a position in favor of SBT or eSET. An improvement in blastocyst cryopreservation may change this attitude.

[Posterior approach to the elbow preserving the extensor apparatus. Its value in the osteosynthesis of humerus plate fractures]. / Voie d'abord postérieure du coude respectant l'appareil extenseur. Son intérêt dans la synthèse des fractures de la palette humérale.

The authors describe a median posterior approach of the elbow with preservation of the triceps mechanism in continuity. Such an approach provides an excellent exposure of the elbow and of the lower part of the humeral shaft which can be used for the osteosynthesis of complex supra and intercondylar fractures. This approach can also be extended to the midshaft of the humerus, the radial head and the ulnar shaft. The repair is easy and strong enough to allow a rapid rehabilitation.

[Prevertebral lesions of the subclavian artery: long-term results of reconstructive surgery and percutaneous angioplasty]. / Lésions pré-vertébrales de l'artère sous-clavière: résultats à distance de la chirurgie reconstructrice et de l'angioplastie percutanée.

Short and long-term results were compared after reconstructive surgery and percutaneous transluminal angioplasty (PTA) of aortic arch trunks and subclavian arteries in 2 groups of patients (10 after dilatation and 12 after surgery). The technique used for treatment was selected as a function of distribution of lesions, their number and their appearance. Gruntzig's method was applied for PTA, while surgery consisted of either reimplantation of subclavian arteries into the main carotid artery or prosthetic by-pass procedures. Immediate and long-term (mean: 14 months) review examinations were by Doppler velocimetry and digital subtraction angiography. Thromboembolic complications secondary to PTA were not observed and there were no cases of recurrence of stenosis in the 10 patients after follow up for 13 months. Complications after surgery were one case of recurrence of stenosis requiring a repeat operation after 20 months, one case of thrombosis of carotid-axillary shunt after 19 months and one case of repeat surgery for lymphorrhea. Long-term results were very good in this series of 12 patients. It is difficult to compare results of the two techniques, patients treated by surgery having multiple lesions requiring combined procedures, and the number of cases treated being too low. However, PTA appears to be effective therapy for localized, non-ulcerated stenosis, and surgery for long or ulcerated stenosis, complete thrombosis and multiple lesions of aortic arch trunks justifying associated procedures.