MAR dataset

Burden of Medical Assisted Reproduction: French Surve

Tumeurs épithéliales de l’ovaire : préservation de la fertilité. Article rédigé sur la base de la recommandation nationale de bonnes pratiques cliniques en cancérologie intitulée « Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire » élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY sous l’égide du CNGOF et labellisée par l’INCa

International audienceObjectivesTo study the methods and strategies of fertility preservation in young women with stage I epithelial ovarian cancer (EOC), in order to provide recommendations for clinical practice.MethodsThe PubMed database was searched for english and french language articles, between 2005 and 2001, according to predefined search equations.ResultsYoung patients with stage IA EOC willing to conceive should be informed that conservative treatment (contralateral ovary and salpinx, uterus) is possible (Grade C), associated with a 6 % to 13 % recurrence risk (Grade C) on the remaining ovary. This conservative surgical treatment includes adnexectomy, peritoneal and lymph node staging for all subtypes, and additional endometrial curettage for endometriosis and mucinous subtypes (Grade C). In case of positive staging conservative treatment is not possible. In case of mucinous EOC with an infiltrative pattern, lymph node staging is not necessary. Multidisciplinary analysis (including oncologists and reproductive medicine specialists) of the risk-benefit balance for a conservative surgery is recommended and must rely on a complete final pathology report (Grade C). No recommendation on bilateral adnexectomy and uterine conservation to allow pregnancy using egg donation can be provided in case of low-grade stage IA EOC, in the absence of data. Bilateral adnexectomy and uterine conservation to allow pregnancy using egg donation can be offered in case of serous, mucinous or endometrioid high-grade FIGO stage IA or low-grade FIGO stage IC1 or IC2 EOC (Grade C). Preservation of the uterus and contralateral ovary and Fallopian tube can be discussed with a specialized rare ovarian tumors multidiciplinary staff in case of clear cell stage I EOC.ObjectifsÉtudier les modalités et stratégies de préservation de la fertilité pour une femme jeune en cas de cancer de l’ovaire stade I en vue d’émettre des recommandations à l’usage des praticiens.MéthodesRecherche bibliographique en langue française et anglaise effectuée par consultation de la base de données PubMed entre 2005 et 2017, selon les équations de recherche prédéfinies.RésultatsIl est recommandé d’informer les patientes atteintes d’un cancer de l’ovaire de stade IA en âge de procréer sur les possibilités d’un traitement conservateur (Grade C), cette stratégie étant associée à un risque de récidive compris entre 6 % et 13 % au niveau de l’ovaire controlatéral. Un traitement chirurgical conservateur de l’utérus et de l’annexe controlatérale après annexectomie unilatérale peut être proposé pour un cancer de l’ovaire stade IA de bas grade chez une femme en âge de procréer, à la condition d’une stadification négative (péritonéale et ganglionnaire complète pour toutes les histologies et associée à un curetage utérin pour les sous-types histologiques endométrioïde et mucineux) (Grade C). Pour le cas particulier du cancer ovarien mucineux expansif, la stadification ganglionnaire n’est pas nécessaire. Une information sur le risque de récidive compris entre 6 % et 13 % au niveau de l’ovaire controlatéral est recommandée en cas de souhait de préservation de la fertilité (Grade C). Une évaluation de la balance bénéfices/risques d’une chirurgie conservatrice est recommandée sur une anatomopathologie définitive de façon multidisciplinaire entre oncologues (médical et/ou chirurgical) et un médecin de la reproduction (Grade C). En l’absence de données, aucune recommandation ne peut être formulée sur la stratégie d’annexectomie bilatérale avec préservation de l’utérus en vue d’un don d’ovocytes dans le cadre des cancers épithéliaux de l’ovaire de stade 1A de bas grade. Une annexectomie bilatérale avec préservation utérine peut être proposée afin d’envisager ultérieurement une grossesse par don d’ovocyte pour un cancer séreux, mucineux ou endométrioïde de l’ovaire de stades FIGO IA de haut grade ou FIGO IC1 ou IC2 de bas grade (Grade C). La préservation utérine et annexielle controlatérale peut être discutée au cas par cas en réunion de concertation pluridisciplinaire de tumeurs rares pour un cancer à cellules claires de stade I

Should we better inform young women about fertility? A state-of-knowledge study in a student population

International audienceObjectives. - To assess midwifery students' knowledge in the field of female fertility and to study their decision if they had diagnosis of diminished ovarian reserve (DOR). Subjects and methods. - A prospective observational study by self-administered questionnaire was conducted among female midwifery students of seven French schools from June to December 2013. The questionnaire had three parts: (1) questions designed to gather information on the study population; (2) a questionnaire consisting of 10 items to test knowledge about female fertility and ovarian reserve; (3) a self-administered questionnaire simulating a DOR diagnosis and quantifying the decision that students would make using a Likert scale of 5 points. Results. - The participation rate was 72.5% (n = 285/393). The average age was 22, 6 years +/- 1.9. Among the 285 participants, the ovarian reserve concept was known by 93% of them (n = 265) thanks to the midwifery studies (77%, n = 204), the media (9%, n = 24) and other sources of information. In total, 83.5% of midwifery students (n = 238) were interested in assessing their ovarian reserve, and 48.3% Of them were interested in evaluating it immediately (n = 115). Among midwifery students, 22.5% of them (n = 64) reported that female fertility began to decline from the age of 35 years old; 85.6% (n = 244) thought that in vitro fertilization allowed women to conceive if fertility is related to a diminished ovarian reserve; 43.9% (n = 125) answered that physical activity and a healthy diet had a beneficial effect on the ovarian reserve. If a DOR was diagnosed to them, 76.8% of students (n = 219) would be likely to conceive their first child earlier than expected. Among them, 57.9% (n = 165) would agree to have oocyte freezing in this context. Conclusion. - This study is the first in France that assessed students' knowledge on fertility. We observed: (I) gaps and misconceptions about female fertility despite a medical training in midwifery students; (2) a belief that in vitro fertilization is effective to overcome infertility related to age; (3) that some of these young students would be favorable to oocyte social freezing (technique not allowed in France); (4) that an adequate information on the decrease of fertility with age could lead some students to anticipate their first pregnancy. Specific information regarding the decrease of fertility with age should be offered to all reproductive-aged young women. (C) 2015 Elsevier Masson SAS. All rights reserved

Methotrexate treatment for ectopic pregnancy after assisted reproductive ă technology: A case-control study

International audienceObjectives. - Ectopic pregnancy (EP) occurs in 2% to 5.6% of ă pregnancies achieved by assisted reproductive technology (ART). EP ă treatment options include medical treatment by uses of methotrexate ă (MTX) systemic injection. The objective of this study was to compare MTX ă treatment effectiveness for EP occurring spontaneously or following ART. ă Methods. - A case-control study performed in the department of ă obstetrics and gynecology at a tertiary health care center in France. ă Twenty EP achieved by ART (ART group) and 60 spontaneous EP (SEP group) ă received MTX treatment between January 2002 and May 2012. The main ă outcome measures were MTX treatment failure rates, number of MTX ă injections administered and recovery time. ă Results. - MTX treatment failure rates observed in ART and SEP groups ă were similar (3/20 [15%] versus 10/60 [17%]: OR = 0.88 ă [0.22-3.58]). Mean duration of recovery time in patients with ă successful MTX treatment did not differ between ART and SEP groups (33 ă 14 days versus 28 13 days, P = 0.39). A second MTX injection was ă required more frequently in ART group than in SEP group (10/20 [50%] ă versus 10/60 [17%]: OR= 5 [1.65-15.15]). ă Conclusions. - It is concluded that MTX treatment is equally effective ă for spontaneous EP and EP achieved by ART, two injections of MTX being ă more frequently required in case of ART. (C) 2016 Elsevier Masson SAS. ă All rights reserved