La congélation des embryons obtenus par fécondation in vitro (bilan de six années au CHU de Marseille)

Nous avons analysé rétrospectivement 6 années de congélation embryonnaire au CHU de Marseille afin de rechercher les facteurs prédictifs de l'obtention d'une grossesse clinique (GC) lors d'un transfert d'embryons congelés (TEC). 12,5% des tentatives de Fécondation In Vitro (n=403) aboutissent à une congélation. Le nombre moyen d'embryon congelé est de 2,9. 254 cycles de décongélation aboutissant à 223 TEC ont été étudiés. Le taux de GC/TEC est de 25,1% pour un nombre moyen d'embryons transférés de 1,8. Les facteurs prédictifs de l'obtention d'une GC sont : le jeune âge des patientes (<30 ans) lors de la congélation et de la décongélation, une infertilité d'origine masculine, des embryons congelés de type I ou II et une absence de perte de blastomère lors de la décongélation. Le taux de GC par ponction passe de 44,6% quand une congélation est effectuée à 61% grâce aux TEC.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Insémination intra-utérine avec sperme de conjoint (facteurs pronostiques)

OBJECTIF: Identifier les facteurs pronostiques de grossesse après IIU-AC. DESIGN: Etude rétrospective. LIEU: CPMA, Centre Hospitalo-Universitaire de la Conception, Marseille. PATIENTS: 2019 cycles d'IIU-AC chez 851 couples. METHODES: Après stimulation ovarienne contrôlée, l'IIU-AC a été réalisée 36 heures après déclenchement de l'ovulation ou 24 heures après un pic spontanée de LH. PRINCIPAUX CRITERES D'EVALUATION: Taux de grossesse par cycle (TG) et taux d'accouchement par cycle (TA). RESULTATS: Le TG global était de 14,8% et le TA de 10,8%. Des TG et TA plus élevées ont été observées chez les patients présentant des troubles de l'ovulation, en particulier SOPK, ou en cas d'infertilité masculine. Les facteurs de bons pronostic mis en évidence sont l'infertilité secondaire de la patiente, le taux basal de FSH =2), l'épaisseur de l'endomètre (10-11 mm), et le nombre de spermatozoïdes mobiles progressifs inséminés (> 1 million). CONCLUSION: Les tentatives d'IIU-AC peuvent être proposées aux patientes dont l'âge est 7UI/L, nombre de spermatozoïdes progressifs mobiles inséminées < 1 million), la FIV devra être envisagée comme traitement de première intentionAIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

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

Nomograms for predicting adverse obstetric outcome in IVF pregnancy: A preliminary study

International audienceBackground: In a previous study, we showed that the obstetric complication rate after in vitro fertilization (IVF) pregnancy was 40%. The main objective of our study was to determine maternal prognosis factors that influence the IVF pregnancy outcome.Methods: We conducted an observational retrospective monocentric study between January 2014 and January 2018. Pregnancy over 22 gestational weeks (GW) obtained after IVF in our infertility clinic was included. Maternal characteristics and pregnancy outcome were collected.Results: Data from 498 IVF pregnancies were analyzed. The most significant maternal prognosis factors for obstetric complications were maternal age above 40 years (OR 3,0 [95% IC 1,30-7,09], P = 0,010), twin pregnancies (3.8 [95% IC 1.49-9.99], P = .005), daily maternal smoking above 10 cigarettes (7.1 [95% IC 1.22-41.74], P = .029), maternal obesity (2.2 [95% IC 1.19-4.07], P = .012), endometriosis stages III and IV (6.4 [95% IC 1.52-27.04], P = .011), and history of ovarian hyperstimulation syndrome (OHSS) in early pregnancy (5.7 [95% IC 1.29-24.74], P = .021). Risk increase was independent of pregnancy type (singleton or twin) and allowed the elaboration of 2 nomograms.Conclusions: Our study showed a link between some maternal factors and increase in obstetric complications after IVF. Screening of these factors during preconceptional visit is essential to identify at high-risk pregnancies and adapt their monitoring

Glucocorticoïdes, 11β-hydroxystéroïde déshydrogénase de type 1 et obésité viscérale

L’importance des glucocorticoïdes dans le développement et le maintien de l’obésité ainsi que la genèse de ses complications métaboliques et cardio-vasculaires est maintenant bien reconnue. L’existence, chez l’obèse, de concentrations circulantes de cortisol normales a fait envisager la possibilité d’anomalies du métabolisme local des glucocorticoïdes, en particulier dans le tissu adipeux. Un ensemble de données récentes a mis en évidence, dans ce tissu, une surexpression de la 11β-hydroxystéroïde déshydrogénase de type 1, enzyme qui convertit la cortisone (inactive) en cortisol (actif). Cette surexpression engendre un hypercorticisme local. Le développement d’inhibiteurs spécifiques de la 11β-hydroxystéroïde déshydrogénase de type 1 pourrait constituer une nouvelle approche du traitement de l’obésité viscérale et de ses complications

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

Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR: comparison of in vitro fertilization outcome

International audienceSTUDY QUESTION: Does the live birth rate after IVF depend on the etiology of diminished ovarian reserve (DOR)? SUMMARY ANSWER: IVF outcome and live birth rate are significantly impaired in women with DOR caused by a previous cystectomy for endometrioma compared with women with idiopathic DOR. WHAT IS KNOWN ALREADY: The safety of the surgical treatment of endometriomas is being discussed in terms of damage to ovarian reserve. Several studies have reported a poor response to controlled ovarian stimulation and a significantly impaired IVF outcome in women with DOR consecutive to an endometrioma cystectomy compared with women with tubal factor infertility. STUDY DESIGN, SIZE, DURATION: Retrospective case-control study conducted in women aged under 40 treated in our Reproductive Medicine Center between January 2010 and January 2014 for a DOR defined by anti-Mullerian hormone level,2 ng/ml. Two groups of patients were selected: group A included patients with a DOR diagnosed after cystectomy(s) for endometrioma(s), group B included patients with an idiopathic DOR. In each group, subgroups of patients `poor ovarian responders', based on the ESHRE criteria ('Bologna criteria'), have been established. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 51 patients in group A were matched to 116 patients in group B, representing respectively 125 and 243 IVF cycles. Among them, 39 patients in group A and 78 patients in group B validated strictly by the Bologna criteria, representing 99 and 189 IVF cycles, respectively. Each patient underwent a controlled ovarian hyperstimulation and IVF with fresh embryo transfer. Primary end-point was the live birth rate. Secondary end-points were the number of retrieved oocytes, fertilization rate, implantation rate, clinical pregnancy rate, spontaneous abortion rate and cycle cancelation rate. MAIN RESULTS AND THE ROLE OF CHANCE: Significantly lower pregnancy (11.2% in group Aversus 20.6% in group B, P = 0.02) and live birth (7.2 versus 16.9% respectively, P = 0.01) rates per cycle were assessed in women in group A compared with women in group B. The same results were obtained in the Bologna criteria subgroup analysis with a significantly lower pregnancy (9.1 versus 20.1%, P = 0.016) and live birth (5.1 versus 15.3%, P = 0.001) rates per cycle in women in subgroup A compared with women in subgroup B. Patients in group A required significantly higher gonadotrophins doses (2881 IU +/- 1111 versus 2526 IU +/- 795, P = 0.005), longer ovarian stimulation (10.6 Days +/- 2.8 versus 9.9 Days +/- 2.4, P = 0.019) and higher cancelation rate for poor response (12 versus 6.2%, P = 0.05). Despite a mean number of retrieved oocytes similar with the group B (5.4 +/- 3.1 and 5.1 +/- 3.2, NS), and a significantly higher fertilization rate (65.7 versus 47.2%, P \textless 0.001), women in group A showed a significantly lower implantation rate (7.2 versus 13.5%, P = 0.03). Abortion rate, ectopic pregnancy rate and multiple pregnancy rate were similar in both groups. LIMITATIONS, REASONS FOR CAUTION: Data were collected retrospectively using the database of our Department. Sample size is relatively small but our study provides statistically significant evidence that the chances of IVF success are decreased in women with DOR after cystectomy for endometrioma. Further larger series are needed to confirm these findings. WIDER IMPLICATIONS OF THE FINDINGS: To our knowledge, this is the first study evaluating IVF outcome in patients with DOR after cystectomy(s) for endometrioma(s) versus in patients with an idiopathic DOR. In addition to the risk of damaging ovarian reserve, we hypothesize that endometrioma surgery would not have qualitative benefits on results in IVF in patients with DOR

Expression of the mRNAs Coding for the Glucocorticoid Receptor Isoforms in Obesity

International audienc