[Fertilization failure in IVF and ICSI]. / Les échecs de fécondation en FIV et en ICSI.

OBJECTIVES: To assess male and female clinical and biological parameters that may explain fertilization failure in vitro fertilization (IVF) and IVF with intra-cytoplasmic sperm injection (ICSI). MATERIAL AND METHODS: Retrospective case-control study including 1282 IVF or ICSI cycles at the centre hospitalier universitaire of Nantes from September 2010 to February 2012. The "Fertilization Failure" group, showing no sign of fertilization, has been compared with the "Control patients" group, getting at least one embryo. RESULTS: Several significant differences were noted as, in the "Fertilization Failure" group, lower values of antral follicles (P<0.05), of inseminated oocytes (P<0.001) and active sperm (P<0.001) in IVF, and a lower quantity and quality of oocytes (P<0.001) in ICSI. The correlation tests have confirmed a significant association with these parameters. However, the logistic regression tests did not identify explanatory or predictive factor in IVF or ICSI. CONCLUSION: In our study, in accordance with literature data, impaired sperm parameters were mainly involved in complete fertilization failure in IVF, and a lower oocyte quality in ICSI.

[Interest of 3D ultrasound in the follow-up of tubal sterilizations: case report of a rare tubal perforation]. / Intérêt de l'échographie en 3 dimensions dans le suivi des stérilisations tubaires : à propos d'un cas rare de perforation.

The Essure™ system's effectiveness is based on the follow-up at three months. The challenge is to find a minimally invasive imaging technique to locate the devices. Therefore, many authors recommend three-dimensional ultrasound in first-line. We report here an exceptional case of tubal perforation for which ultrasound failed to diagnose. Until then, only three cases have been reported in the literature, noting the difficulty to diagnose this complication. Indeed, although ultrasound is described as reliable, reproducible and non-radiating, it is a dynamic examination, operator dependent, exposing to the risk of misinterpretation.

[Facial coloboma: report of an exceptional prenatal case and interest of three-dimensional ultrasonography]. / Colobome facial: à propos d'une observation anténatale précoce exceptionnelle; apport de l'échographie en 3-dimensions.

We report a rare case of Tessier no. 4 craniofacial cleft diagnosed by ultrasound imaging at 10 weeks' gestation. Tessier no. 4 craniofacial cleft is a very rare and complex congenital abnormality, characterized by an oblique orbitomaxillary facial cleft. Prenatal diagnosis of orofacial clefting is usually done at midtrimester of pregnancy, based on careful sonographic examination of the fetal face. However conventional 2D ultrasound is limited in screening isolated cleft palate and defects of the secondary palate. Thus, 3D ultrasound shows a greater sensitivity in a referred population and antenatal evaluation of facial clefs.

[Is there still any interest of x-ray pelvimetry for women with a scarred uterus]. / Reste-t-il une indication pour la radiopelvimétrie en cas d'utérus cicatriciel?

OBJECTIVES: To revalue the interest of X-ray pelvimetry and analyse our current management of patients with a previous caesarean delivery. PATIENTS AND METHODS: Case-control retrospective study reviewing 418 case records of women with a scarred uterus: a study group of 206 parturients who delivered in 2002, when X-ray pelvimetry was the rule, compared with a control group of 212 parturients who delivered in 2007, without any X-ray pelvimetry. Outcomes of labour, influence of X-ray pelvimetry, indications of caesarean sections, rates of uterine rupture and neonatal well-being have been analysed. RESULTS: There was no significant difference between both groups concerning the outcomes of labour. The transverse pelvic diameter is positively correlated with an eutocic delivery and inversely correlated with the rate of caesarean section performed during labour because of obstructed labour. Measurements of the pelvis were unrelated neither to the risk of uterine rupture nor to the neonatal outcome. The risk of uterine rupture is significantly higher when an emergency caesarean section is required. CONCLUSION: Our study brings to light a complementary point of view about X-ray pelvimetry. Indeed, our results show that it could be useful in the following of a caesarean section for obstructed labour.