Echecs répétés de fécondation in vitro (anomalies retrouvées sur le bilan diagnostique)

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Comparaison des catheters souples de transfert embryonnaire Frydman Classic 4.5 et Elliocath au cours du test de transfert et du transfert réel d'embryons en fécondation In Vitro (étude prospective randomisée)

BORDEAUX2-BU Santé (330632101) / SudocFORT-DE-FRANCE-CHRU-BU (972332102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Attitude thérapeutique en cas de menace d'accouchement prématuré après 48 heures de traitement efficace (grossesses uniques et gémellaires)

OBJECTIF : Décrire l'attitude thérapeutique après 48 heures de traitement efficace, en cas de MAP, pour les grossesses uniques et gémellaires. PATIENTES ET METHODE : Etude de cohorte prospective, observationnelle, unicentrique, au CHU de Bordeaux, incluant les patientes hospitalisées entre le 1er novembre 2009 et le 1er octobre 2010 pour MAP, entre 25 et 34 semaines d'aménorrhée, avec des contractions utérines régulières, ressenties et une longueur cervicale échographique inférieure à 25 mm. RESULTATS : Nous avons inclus 73 grossesses simples et 20 grossesses gémellaires. Pour les singletons, 6,8 % des patientes ont accouché dans les 48 premières heures, et 60,2 % ont accouché à terme Après 48 heures de traitement, la tocolyse a été efficace pour 86,3 % des patientes. La tocolyse a été poursuivie dans 54 % des cas. La comparaison des groupes "maintien" et "arrêt" de la tocolyse n'a mis en évidence aucune différence statistiquement significative pour le délai entre l'hospitalisation et l'accouchement, pour le terme de l'accouchement et pour la morbi-mortalité néonatale. Pour les grossesses gémellaires, 10 % des patientes ont échappé à la tocolyse et ont accouché dans les 48 heures suivant l'admission, et 10 % des patientes hospitalisées ont accouché à terme. Après 48 heures de traitement, la tocolyse a été efficace pour 85 % des patientes. La tocolyse a été poursuivie pour 50 % d'entre elles. CONCLUSION : Plus de 50 % des patientes hospitalisées pour MAP ont reçu une tocolyse d'entretien alors qu'elle s'était avérée efficace. Aucune différence statistiquement significative entre les groupes "maintien" et "arrêt" de la tocolyse concernant le terme de l'accouchement et la morbi-mortalité néonatale n'est retrouvée.OBJECTIVE : To describe the therapeutic attitude in the case of preterm labor, after 48 hours of effective tocolysis, in single and twin pregnancies. PATIENTS AND METHOD : Prospective, observational and unicentric study, in Bordeaux university teaching hospital, including the patients taken into hospital for preterm labor, between 25 and 34 weeks of gestation, experiencing regular uterine contractions and with a cervical length less than 25 mm, between the 1st November 2009 and the 1st October 2010. RESULTS : We included 73 singleton gestations and 20 twin gestations. Concerning the singleton gestations, 6,8 % of the patients delivered in the first 48 hours, and 60,2 % delivered at full term. After 48 hours of treatment, tocolysis was effective for 86,3 % of the patients. Tocolysis was pursued in 54 % of the cases. The comparison of "maintenance" and "stop" groups brought to light no statistically significant difference to the period between hospitalization and delivery, to the delivery date and to neonatal morbidity and mortality. Concerning twin gestations, tocolysis was ineffective for 10 % of the patients, they delivered within the first 48 hours, and 10 % delivered at full term. After 48 hours of treatment, tocolysis was effective for 95 % of the patients. Tocolysis was pursued for 50 %. CONCLUSIONS : Over 50 % of the patients, admitted for preterm labor, received maintenance tocolysis, even although it had been effective. There was no statistical significant difference between the two "maintenance" and "stop" froups concerning the delivery date and neonatal morbidity and mortality.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process.

peer reviewedInternational guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification-in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP

Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process

International audienceInternational guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP.All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalizedcounseling for FP

Prise en charge de première intention du couple infertile : mise à jour des RPC 2010 du CNGOF

Objective: To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples.Materials and methods: Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts.Results: The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery.Conclusion: Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples