Pregnancies and obstetrical prognosis after oocyte donation in Turner Syndrome: A multicentric study.

INTRODUCTION: Turner syndrome is one of the most frequent chromosomal abnormalities in women, with a prevalence estimated to be 1 of 2500 live birth. Pregnancy in women with Turner syndrome is known to be at high risk, whether it is spontaneous or after oocyte donation, because of miscarriages and potential cardio-vascular complications which can be life-threatening. All of these patients should therefore be screened with a comprehensive cardio-vascular assessment before pregnancy, and have a close follow-up during and after pregnancy. PATIENTS AND METHODS: It is a retrospective study, conducted in 10 of the 27 French oocyte donation centers between 2012 and 2016, on all the patients presenting with Turner syndrome included in an oocyte donation program. RESULTS: 151 embryo transfers were realized in 73 patients, resulting in 39 pregnancies. Among these pregnancies, 24 children were born healthy, 11 spontaneous miscarriages, 3 voluntary abortions, 1 extra-uterine pregnancy and 1 maternal death from non-cardio-vascular origin occurred. Pregnancies were complicated by gravid arterial hypertension in 28.2% of cases, preeclampsia in 10.3% of cases, and gestational diabetes in 7.7% of cases. CONCLUSION: This study bring out obstetrical complications of the same magnitude than the ones described in the literature. Lead over a period of 4 years, in 10 French oocyte donation centers, it doesn't reveal any cardio-vascular complications, conversely to other studies published before French and American recommendations. This study reinforces the usefulness of specific recommendations for the care of these particular patients.

Transvaginal repair of stage III-IV cystocele using a lightweight mesh: safety and 36-month outcome.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess the 36-month safety and efficacy of a lightweight polypropylene mesh used for the transvaginal repair of stage III-IV cystocele. METHODS: A multicenter prospective cohort study was performed. Preoperative assessment included an interview and evaluation with the Pelvic Organ Prolapse Quantification (POP-Q) system. Inclusion criteria were stage III-IV cystocele and no contraindications for mesh use. A lightweight (28 g/m(2)) four-arm transobturator polypropylene mesh was used for the study. Pre- and postoperative symptoms and quality of life were assessed using the Urinary Symptoms Measurement (MHU), Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The main endpoint was mesh safety. Secondary endpoints were anatomic (Ba point ≤ -1) and functional success. RESULTS: In all, 111 patients with a mean age of 67 ± 9 years (range 47-89) were included in the study, and 94 (84.7%) were included in the analysis. Two intraoperative complications occurred (one bladder and one rectal injury, 2.2%). Medium-term analysis of 79 patients (84%) after 36 months showed a satisfaction rate of 98.7% (78/79), a mesh contraction rate of 5.1% (4/78), only one case of vaginal mesh exposure (1.3%), no cases of chronic pelvic pain, and a postoperative dyspareunia rate of 2.8% (1/36). The anatomic success rate of cystocele repair was 75/79 (94.9%) and a highly significant improvement was noted for symptoms and on quality of life questionnaires. Overall, 7/79 patients (8.9%) were reoperated, including 1 for hemorrhage, 1 for vaginal mesh exposure, 3 for stress urinary incontinence, and 2 for cystocele recurrence (2.5%). CONCLUSION: Transvaginal cystocele repair using a lightweight transobturator polypropylene mesh was safe and efficient in the medium term. Long-term data and comparative studies are needed.

Programming in vitro fertilization retrievals during working days after a gonadotropin-releasing hormone antagonist protocol with estrogen pretreatment: does the length of exposure to estradiol impact on controlled ovarian hyperstimulation outcomes?

OBJECTIVE: To verify whether a variable number of days beyond the menses of estrogen (E) pretreatment may impact on controlled ovarian hyperstimulation (COH) outcomes and birth rate using a GnRH antagonist protocol. DESIGN: Single center, prospective, nonrandomized study. SETTING: Nonacademic fertility unit. PATIENT(S): A total of 1,080 women, aged 25-38 years, consecutively included (1,603 cycles). INTERVENTION(S): Given 4 mg/d E(2) valerate, started 3 days before the theoretical date of the next menses up to the first day of stimulation (S1). MAIN OUTCOME MEASURE(S): Hormone serum levels, drug exposure, and main IVF outcomes. RESULT(S): The cancellation rate was similar in the six similarly sized groups according to the number of days with E(2) pretreatment beyond the menses (1-8 days). The mean serum E(2) and LH levels at S1 gradually increased along with E(2) exposure, whereas the mean serum P level decreased. The mean serum E(2) level on the day of hCG administration gradually increased along with E(2) exposure. Serum LH level at S1 correlated significantly and positively to the length of E(2) exposure and to E(2) level on the day of hCG administration. No significant difference was observed for the number of oocytes retrieved and the number of embryos obtained. Women exposed the longest to exogenous E(2) tended to have higher pregnancy rates (PR). CONCLUSION(S): Extending E(2) pretreatment beyond the menses had no deleterious effect on the main COH outcomes and proved to be slightly beneficial.