Greffe de tissu ovarien humain cryopréservé (à propos de trois cas et revue de la littérature)

LIMOGES-BU Médecine pharmacie (870852108) / SudocSudocFranceF

Ovarian reserve and response to stimulation in women undergoing fertility preservation according to malignancy type

International audienc

A pilot study comparing corifollitropin alfa associated with hp-HMG versus high dose rFSH antagonist protocols for ovarian stimulation in poor responders

International audienceDoes corifollitropin alfa associated with hp-HMG protocol from the beginning of ovarian stimulation perform better than high dose rFSH alone for ovarian stimulation with GnRH antagonist in poor responders? This retrospective, monocentric, case-control pilot study was conducted in 65 poor responders (Bologna criteria) undergoing 2 consecutive IVF cycles. All patients underwent a first ovarian stimulation cycle with high dose rFSH (≥300 IU/day) alone in antagonist protocol, unfortunately leading to poor ovarian response and no pregnancy. The following cycle was performed with 150 μg of corifollitropin alfa associated with daily injections of hp-HMG from the beginning of the cycle. The primary outcome was the number of mature oocytes retrieved. The secondary outcomes were ovarian stimulation cancellation and embryo transfer rate per initiated cycle. The number of mature oocytes was not significantly different between the 2 groups. However, cycle cancellation rate was significantly lower and the proportion of cycles with embryo transfer was significantly higher with corifollitropin + hp-HMG protocol, leading to an encouraging clinical pregnancy rate of 24.1% per oocyte retrieval. This pilot study based on corifollitropin alfa associated with hp-HMG from the onset of stimulation appears to be promising for ovarian stimulation in poor responders

Association between early βhCG kinetics, blastocyst morphology and pregnancy outcome in a single-blastocyst transfer program

International audienceObjective(s): Beta human chorionic gonadotrophin (b-hCG) is secreted by placenta and detectable in maternal serum a few days after embryo implantation. The evolution of b-hCG serum levels is commonly used to confirm early pregnancy and differentiate normal pregnancies from others, either in spontaneous pregnancies or after IVF. However, little is known on the eventual link between blastocyst quality in IVF, pregnancy outcome, and bhCG kinetics. The objective was to evaluate the association between early bhCG rise, blastocyst morphology and pregnancy evolution in a single-blastocyst transfer program Study design: This retrospective cohort study was conducted in a University-affiliated IVF center in 441 couples undergoing 455 single blastocyst transfer cycles leading to a positive pregnancy test 12 days afterwards. The rate of rise of ß-hCG (ß-hCG kinetics) was calculated in each cycle and its association with blastocyst quality and pregnancy clinical outcome was evaluated. Results: b-hCG kinetics was significantly different according to blastocyst expansion, but with considerable overlap between groups. b-hCG kinetics was also significantly different according to clinical outcome, with higher values in clinical pregnancies than in other groups. This remained true in subgroups' analysis according to blastocyst expansion and in top quality blastocysts. Conclusion(s): Early b-hCG kinetics after single-blastocyst transfer is different according to pregnancy outcome and is only slightly influenced by blastocyst quality. These results confirm the interest of b-hCG follow up in IVF pregnancies, and do not support the interest of building blastocyst-specific b-hCG ranges in IVF cycles

Is low anti-Mullerian hormone (AMH) level a risk factor of miscarriage in women <37 years old undergoing in vitro fertilization (IVF)?

International audienceAnti-Mullerian Hormone (AMH) is considered to be one of the most relevant markers of ovarian reserve. However, its association with oocyte quality, pregnancy occurrence and evolution remain to be further investigated. The objective of this study was to compare miscarriage rate after fresh blastocyst(s) transfer in young women (<37 years old) with or without diminished ovarian reserve (DOR), as reflected by low serum AMH levels. This monocentric retrospective study was conducted in 669 women undergoing 1,891 blastocyst transfers. Patients were divided into 2 groups: (1) 190 transfers performed in 106 women with a 'low' serum AMH (< 10th percentile) (i.e. AMH < 0.85 ng/mL); and (2) 961 transfers performed in 563 patients with a 'normal' serum AMH (25th-75th percentile) (i.e. AMH 1.4-4 ng/mL). Miscarriage rate was comparable in both groups (9.5 and 6.8% respectively; p = 0.2) as well as implantation rate, pregnancy rate, live birth rate per transfer (p = 0.4, p = 0.07 and p = 0.6, respectively). After multivariate analysis, no significant association was found between serum AMH level and miscarriage rate (p = 0.22). In women <37 years, low serum AMH level is not associated with an increase in miscarriage rate after fresh blastocyst transfer

Apport de l'épidémiologie moléculaire pour l'amélioration de la maîtrise des infections mammaires à Streptococcus uberis des vaches laitières

Ce travail avait pour objectif d’évaluer la capacité d’une méthode de typage moléculaire pour décrire la dynamique des infections à Streptococcus uberis (Str. uberis) dans les troupeaux et plus précisément pour distinguer les troupeaux selon leur voie majoritaire de transmission des infections. Dans 19 troupeaux de l’Ouest de la France à problèmes récurrents de mammites liées Str. uberis, cinq séries de prélèvements aseptiques d’échantillons de lait de quartier ont été effectuées toutes les six semaines, sur toutes les vaches en lactation. Après identification bactériologique de l'espèce, un génotypage des souches de Str. uberis a été effectué par la technique MLVA et a permis de préciser que de nombreuses souches de Str. uberis étaient présentes dans les élevages (203 souches différentes, soit de 5 à 30 souches par troupeau). Par contre, même si l’approche MLVA est à même de caractérisersans ambiguïté le modèle épidémiologique des infections en élevage (contagieux, environnemental ou mixte), il est inenvisageable, pour des raisons financières, de procéder en routine à ce type d’approche.Une diminution marquée de ce coût, rendue possible par une automatisation d’une ou toute partie de l’analyse, permettrait d’associer cette approche par MLVA aux outils actuellement disponibles pour la réalisation d’un diagnostic des mammites par les intervenants de terrain. Le typage basé sur l’étude de la variabilité de séquence d’un des gènes de virulence que nous avons mis en évidence pourrait également constituer une alternative moins coûteuse

Impact of the duration of oestradiol treatment on live birth rate in Hormonal Replacement Therapy cycle before frozen blastocyst transfer

International audienceAlthough the duration of progesterone administration in Hormonal Replacement Therapy (HRT) cycles before frozen embryo transfer is standardized, the optimal duration of oestrogen treatment remains controversial. In this monocentric retrospective study conducted in all single frozen blastocyst transfer (FBT) performed with HRT between January 2016 and July 2019, we evaluated the association between the duration of oestradiol treatment before FBT and live birth rate (LBR) in HRT cycles. Cycles were gathered in 3 groups according to quartiles of duration of oestrogen treatment. LBR was compared across the 3 groups and multivariate analysis was performed. We included 2235 single FBT cycles; 507, 1257 and 471 with E2 treatment below 23 days, 23-30 days (reference) and more than 30 days respectively. After multivariate analysis and adjustment, no significant difference in LBR was found between below 23 or more than 30 days and reference groups (OR = 0.93 [0.68-1.27] and OR = 1.29 [0.88-1.89] respectively). Complementary sensitivity analysis led to a non-significant adjusted OR = 1.66 [IC 0.9-3.1]. In conclusion, our study showed that the duration of E2 treatment in HRT cycles before FBT is not associated with LBR

Epidémiologie des infections intramammaires à Streptococcus uberis : premiers résultats

National audienceOn constate depuis quelques années une augmentation de la prévalence des mammites dues à Streptococcus uberis qui peuvent persister dans la mamelle et ainsi contribuer à une augmentation des niveaux cellulaires des laits. Un travail a été engagé depuis plus de 2 ans par l’UMT Maîtrise de la santé des troupeaux bovins et l’INRA afin de mieux connaitre grâce au typage moléculaire MLVA, l’épidémiologie des infections à Streptococcus uberis au sein des troupeaux et ainsi permettre de mieux cibler les actions de maîtrise à recommander. Cet article a pour objectif de décrire les premiers résultats concernant la dynamique des infections (prévalence, incidence, taux de guérison, proportion de contagion) dans dix neuf troupeaux de l’ouest de la France (Bretagne et Pays de la Loire) à problèmes récurrents de mammites liées Streptococcus uberis

Epidémiologie moléculaire des infections intramammaires à Streptococcus uberis dans des troupeaux laitiers français

National audienceThe aim of this study was to describe the infection dynamics of Streptococcus uberis (Str. uberis) in dairy herds, in order to assess a molecular-based method to determine the transmission routes of Str uberis infections on the herds. Milk samples were taken aseptically every quarter from every lactating cow in 17 herds in the west of France with an accute Str. Uberis mastitis problem. The sampling took place five times with a six-week interval. The samples were analysed for bacteriological identification and the isolated strains were genotyped by MLVA. Str. uberis was found in 693 samples out of 13 796. Mean infection prevalence was 5.3%, with significant variations according to the herd, from 2.1% and 15.9%. MLVA allowed identifying 203 strains (from 5 to 30 strains on one herd). The major source of new infections was contagion from another quarter (56%), followed by environmental transmission (44%). The part of contagious contamination varied between the herds from 0 to 78%, without any link with risk factors. Fifty-three percent of the sub-clinical infections disappeared spontaneously, while 71% of the subclinical infections disappeared when they were cured by antibiotics. This study emphasizes the mixed origin of Str. uberis mammary infections and confirms that measures targeting both contagious and environmental sources have to be considered to manage this pathogen in infected herds.Cet article a pour objectif de décrire la dynamique des infections à Streptococcus uberis (Str. uberis) dans les troupeaux afin d’évaluer la capacité d’une méthode de typage moléculaire à distinguer les troupeaux selon leur voie majoritaire de transmission des infections. Dans 17 troupeaux de l’ouest de la France à problèmes récurrents de mammites liées Str. uberis, 5 séries de prélèvements aseptiques d’échantillons de lait de quartier ont été effectuées toutes les 6 semaines, sur toutes les vaches en lactation. Après identification bactériologique, un génotypage des souches de Str. uberis a été effectué par la technique MLVA. Sur les 13796 échantillons réalisés, 693 prélèvements étaient positifs à Str. uberis. La prévalence moyenne de l’infection était de 5,3% des quartiers avec des variations importantes suivant les troupeaux, de 2,1% à 15,9%. L’analyse MLVA a permis d’identifier 203 souches différentes, soit de 5 à 30 souches par troupeau. Les nouvelles infections sont issues pour 44% de contaminations par l’environnement et de 56% des contagions à partir d’un autre quartier. Selon les troupeaux, la part des contagions variait de 0 à 78%, sans que l’on puisse identifier clairement des pratiques d’élevage à risque. Le taux de guérison spontanée des infections subcliniques en lactation était de 53% alors que celui des traitements antibiotique de mammite clinique était de 71%. Cette étude confirme l’origine mixte des infections à Str. uberis et doit conduire à recommander des actions visant à limiter les contaminations par l’environnement et les contagions entre vaches dans les élevages confrontés à ces infections