Intérêt des marqueurs biologiques dans le suivi des patientes traitées médicalement par Methotrexate pour les grossesses extra-utérines

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Transvaginal ethanol sclerotherapy for an endometrioma in 10 steps

International audienc

Transvaginal ethanol sclerotherapy for an endometrioma in 10 steps

International audienc

Endometrioma ethanol sclerotherapy could increase IVF live birth rate in women with moderate-severe endometriosis

International audienceObjectiveTo examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis.MethodsThis retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate.ResultsSeventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13–6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage.ConclusionsEST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women

Unexplained infertility: live-birth’s prognostic factors to determine the ART management

International audienceBACKGROUND: The purpose of this retrospective observational study was to identify prognostic factors that lead to alive birth (LB) in couples with unexplained infertility in order to define the best assisted-reproductive technique (ART)strategy.METHODS: Prognostic factors of couples with unexplained infertility managed initially with gonadotropin intrauterineinseminations (IUI) at a single university fertility center were analyzed. Infertility was not considered “unexplained” incase of mild male infertility and suspicion of diminished ovarian reserve (FSH>10 IU/L). ART management consisted tostart with IUI cycles and then, if failure, to propose in vitro fertilization (IVF). Couples were compared according to theresults of IUI cycles in terms of LB.RESULTS: Between January 2011 and July 2015, 133 couples with unexplained infertility were included (320 IUI cycles).The average age of women was 31.6±4.6 years and the average number of IUI per couple was 2.4±1.2. The IUI livebirth rate (LBR) was 37.6%, with an average of 2 cycles to obtain a pregnancy. For 63 couples, no pregnancy occurredafter IUI cycles. The prognostic factors of the two groups “LB after IUI” vs. “no LB after IUI” were not statistically different.The remaining 20 couples had a spontaneous pregnancy with a LB. Cumulative LBR, including spontaneous andART pregnancies, was 65.7 %. Of the 63 couples with no LB after IUI, 33.3% dropped-out from infertility treatmentsbefore starting IVF.CONCLUSIONS: To avoid couple’s drop-out, we advise to start infertility treatment for unexplained infertility with twoIUI before undergoing IVF if IUI failure

Unexplained infertility: live-birth’s prognostic factors to determine the ART management

International audienceBACKGROUND: The purpose of this retrospective observational study was to identify prognostic factors that lead to alive birth (LB) in couples with unexplained infertility in order to define the best assisted-reproductive technique (ART)strategy.METHODS: Prognostic factors of couples with unexplained infertility managed initially with gonadotropin intrauterineinseminations (IUI) at a single university fertility center were analyzed. Infertility was not considered “unexplained” incase of mild male infertility and suspicion of diminished ovarian reserve (FSH>10 IU/L). ART management consisted tostart with IUI cycles and then, if failure, to propose in vitro fertilization (IVF). Couples were compared according to theresults of IUI cycles in terms of LB.RESULTS: Between January 2011 and July 2015, 133 couples with unexplained infertility were included (320 IUI cycles).The average age of women was 31.6±4.6 years and the average number of IUI per couple was 2.4±1.2. The IUI livebirth rate (LBR) was 37.6%, with an average of 2 cycles to obtain a pregnancy. For 63 couples, no pregnancy occurredafter IUI cycles. The prognostic factors of the two groups “LB after IUI” vs. “no LB after IUI” were not statistically different.The remaining 20 couples had a spontaneous pregnancy with a LB. Cumulative LBR, including spontaneous andART pregnancies, was 65.7 %. Of the 63 couples with no LB after IUI, 33.3% dropped-out from infertility treatmentsbefore starting IVF.CONCLUSIONS: To avoid couple’s drop-out, we advise to start infertility treatment for unexplained infertility with twoIUI before undergoing IVF if IUI failure

Lower Pregnancy Rates After IVF in Women Working as Occupational Cleaners A Preliminary Longitudinal Study

International audienceOBJECTIVE: To assess clinical, biological, and environ­ mental factors influencing pregnancy rates (PRs) after in vitro fertilization (IVF), and to study the influence of occupational, lifestyle, and domestic exposure on PR.STUDY DESIGN: A longi­ tudinal cohort study was performed in women who started an IVF cycle with a self­administered question­ naire concerning their envi­ ronmental and occupation­ al exposure. Medical data were obtained from medical files.RESULTS: Among 534 cycles, we showed a variety of factors that had an impact on PR: age, infertility du­ ration, number of mature oocytes and embryos. After multivariate analysis, women with "elementary" occu­ pations had a significantly lower PR (OR 5.6; 95% CI 1.3-23.7). Among them, 82% were cleaners.CONCLUSION: This preliminary result leads us to focus on a socio­professional category that is already rec­ ognized in the literature as at risk for congenital abnor­ malities during pregnancy. Further cohort studies are needed to study the influence of socio­professional cate­ gory on PR

Sperm donor conception and disclosure to children: a 10-year retrospective follow-up study of parental attitudes in one French center for the study and preservation of eggs and sperm (CECOS)

International audienceObjective: To evaluate the percentage of parents in one French center for the study and preservation of eggs and sperm who disclose their use of donated spermatozoa to their children.Design: A questionnaire survey of couples who had a child using donated spermatozoa.Setting: University hospital laboratory.Patient(s): One hundred five couples.Intervention(s): Questionnaire sent by mail.Main Outcome Measure(s): The percentage of parents who disclose their use of donated spermatozoa to their child.Result(s): Among the 157 questionnaires sent, 105 couples answered, which corresponded to 138 children. There were 40 (38%) couples who had already disclosed the donor origin to their child and 65 (62%) who had not. Of the 40 couples who disclosed the donor origin, 37 (93%) had intended to do so before making use of assisted reproductive techniques (ART), but two (5%) had not wanted to do so before ART. Among the 65 couples who did not inform their child, 42 (65%) planned to inform their child soon, but 20 (31%) wanted to keep the sperm origin secret. Of the 20 couples who wanted to keep the origin secret, nine couples had told other persons about the gamete donation but had not informed their child and do not intend to inform their child in the future.Conclusion(s): This first report about disclosure attitude in a large cohort of parents of donor-conceived offspring in France showed that most parents had already disclosed their use of donated spermatozoa to their children or intended to disclose it soon and had an attitude after birth consistent with their intentions prior to ART

Loss of Calmodulin- and Radial-Spoke-Associated Complex Protein CFAP251 Leads to Immotile Spermatozoa Lacking Mitochondria and Infertility in Men

International audienc

Women and health professionals’ perspectives on a conditional cash transfer programme to improve pregnancy follow-up: a qualitative analysis of the NAITRE randomised controlled study

Objectives Women of low socioeconomic status have been described as having suboptimal prenatal care, which in turn has been associated with poor pregnancy outcomes. Many types of conditional cash transfer (CCT) programmes have been developed, including programmes to improve prenatal care or smoking cessation during pregnancy, and their effects demonstrated. However, ethical critiques have included paternalism and lack of informed choice. Our objective was to determine if women and healthcare professionals (HPs) shared these concerns.Design Prospective qualitative research.Setting We included economically disadvantaged women, as defined by health insurance data, who participated in the French NAITRE randomised trial assessing a CCT programme during prenatal follow-up to improve pregnancy outcomes. The HP worked in some maternities participating in this trial.Participants 26 women, 14 who received CCT and 12 who did not, mostly unemployed (20/26), and - 7 HPs.Interventions We conducted a multicentre cross-sectional qualitative study among women and HPs who participated in the NAITRE Study to assess their views on CCT. The women were interviewed after childbirth.Results Women did not perceive CCT negatively. They did not mention feeling stigmatised. They described CCT as a significant source of aid for women with limited financial resources. HP described the CCT in less positive terms, for example, expressing concern about discussing cash transfer at their first medical consultation with women. Though they emphasised ethical concerns about the basis of the trial, they recognised the importance of evaluating CCT.Conclusions In France, a high-income country where prenatal follow-up is free, HPs were concerned that the CCT programme would change their relationship with patients and wondered if it was the best use of funding. However, women who received a cash incentive said they did not feel stigmatised and indicated that these payments helped them prepare for their baby’s birth.Trial registration number NCT0240285