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Progrès en Urologie 07/2012; 22(9):553-4. · 0.58 Impact Factor
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ABSTRACT: The recent emergence of oncofertility raises the question of ovarian stimulation and its risks when performed for oocyte or/and embryo cryopreservation in a fertility preservation program. The relation between ovarian stimulation and cancer has been marked by the possible direct or indirect tumorigenic role for pituitary gonadotrophins in the tumorogenesis. Although the growth of many gonadal and extragonadal tumors is stimulated by gonadal sex hormones, whose production is regulated by gonadotrophins, there is still a lack of data to consider FSH and LH as tumor promoters. The purpose of this brief review is to present on one hand, the questions raised by the administration of exogenous gonadotrophins in cancer patients and on the other, to evaluate both experimental and clinical data about the possible relation between gonadotrophins and tumorogenesis.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 05/2012; 41(6):512-8. · 0.42 Impact Factor
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ABSTRACT: Une femme de 53 ans s’est présentée aux urgences pour une rétention aiguë d’urines. L’examen clinique objective la présence
d’un très volumineux fibrome pédiculé qui entraînait une occlusion complète de l’introïtus. Une échographie abdominopelvienne
ne montra aucune autre cause de rétention urinaire. Les douleurs présentées par la patiente étaient très importantes (EVA:
9/10). L’insertion d’une sonde de Foley fut impossible. Une anesthésie a dû être réalisée afin de sonder la patiente et de
procéder à l’exérèse du fibrome pédiculé par myomectomie vaginale. Aucune complication peropératoire n’est survenue. L’examen
histologique confirma le diagnostic de lésion léiomyomateuse bénigne. Le cathéter de Foley a été retiré le lendemain de l’intervention,
et la patiente est rentrée à son domicile le surlendemain compte tenu du fait que sa miction était complément normalisé. Les
très volumineux fibromes intracavitaires pédiculés peuvent être expulsés à la vulve et entraîner une rétention aiguë d’urines.
Celle-ci peut nécessiter une intervention en urgence sous anesthésie générale s’il est impossible de réduire l’extériorisation
du fibrome.
Both acute urinary retention and impacted pelvic mass are rare events in women. The objective of the current study was to
report a case of complete urinary retention caused by impaction of a large uterine pedunculated myoma. A 53-year-old woman
presented to the hospital (emergency department) for urinary retention. Clinical examination showed a large pedunculated impacted
myoma. Abdominal sonography revealed no other aetiology for urinary retention. The patient reported high-level painful (VAS:
9/10) and was unable to void. Insertions of Foley catheter have failed. General anesthesia was required to insert Foley catheter
and remove the pedunculated impacted myoma. Myomectomy was performed. No peroperative complication was noted. Pathology confirmed
the diagnosis of benign myoma. The Foley catheter was removed one day after surgery and the patient was discharged two days
after surgery since complete spontaneous voiding was observed. Urinary retention is a potential complication of large pedunculated
uterine myomas.
Pelvi-périnéologie 04/2012; 4(3):196-198. · 0.07 Impact Factor
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ABSTRACT: Ligation of the internal iliac arteries and embolization of the uterine arteries are two techniques routinely used in the management of postpartum hemorrhage. The objective of this study was to examine the long-term consequences of these techniques on women's subsequent reproductive outcome and subsequent delivery morbidity.
Retrospective study including women who underwent ligation and those who underwent embolization, for the treatment of postpartum hemorrhage. We analyzed resumption of menses, fertility, pregnancy and delivery outcome after each treatment.
The study included 85 women who underwent ligation and 90 who had embolization to treat postpartum hemorrhage. No adverse event related to menses, fertility, or pregnancy outcome followed either treatment. However, the rate of recurrent hemorrhage was high: 26% after ligation and 39% after embolization. All recurrences were treated medically in the ligation group, but in the embolization group, 42% (five of 12 patients) required invasive treatment and 33% (four patients) transfusions.
From the perspective of subsequent menses, fertility and pregnancy outcome, both ligation and embolization are safe procedures for the management of postpartum hemorrhage. However, our results showed a high risk of recurrent postpartum hemorrhage after both treatments. Recurrences seemed more serious after the latter.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 03/2012; 41(3):298-306. · 0.42 Impact Factor
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ABSTRACT: Growing evidence indicates that mild ovarian stimulation for in vitro-fertilization-embryo transfer may be an interesting approach to reduce the incidence and severity of complications, the number of treatment days, cost, patient discomfort and number of patient drop-outs. However, the heterogeneity of FSH-sensitive follicles, presumably requires multiple follicular growth to improve oocyte-embryo selection. In addition, whether the acceptability probably is similar between standard ovarian stimulation and mild stimulation, per-treatment pregnancy rates with conventional stimulation is superior to mild stimulation in unselected populations. Hence, some specific indications tend to emerge such as alterations of the ovarian follicular reserve in women of less than 38 years, bad embryo qualities and implantation failure after conventional stimulation, patients with previous history of hyperstimulation syndrome or contraindications to hyperoestrogenia (estrogeno-related cancers and thromboembolic diseases). However, no randomized trials have ever been performed to compare the results of mild versus conventional stimulation in young patients and good responders. Therefore, there is insufficient scientific evidence to shift from standard stimulation to mild stimulation for all patients. Cultural standards have to be considered in the choice of the type of stimulation.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/2012; 41(1):6-13. · 0.42 Impact Factor
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Clinical Genetics 10/2011; 80(4):403-5. · 3.13 Impact Factor
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ABSTRACT: This retrospective study aimed at analyzing IVF-ET management and outcome after cancellation of a first cycle for poor response.
One hundred and forty-two infertile patients were included in this observational study. After an overall analysis on the outcome of the second IVF-ET attempt, a sub-analysis was performed according to the presence or the absence of poor prognostic criteria defined as mentioned: patient age superior to 38 years old, antral follicle count (3-9 mm in diameter) inferior to 10 on cycle day 3 and day 3 serum AMH and FSH levels less than 1 ng/mL and more than 10 IU/mL, respectively. Main outcome measures were the cancellation rates, pregnancy and live birth rates.
When a controlled ovarian stimulation was performed, patients with poor prognosis had higher cancellation rates (37.8% vs. 13.3%, P<0.004) and lower pregnancy and live birth rates (22.2% vs. 35.0%, P<0.05 and 11.1% vs. 26.1%, P<0.05, respectively) as compared to good prognosis women.
The relatively high cancellation rate in patients with poor prognosis raises the question of the use of IVF modified natural cycle in this group.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 08/2011; 41(1):41-7. · 0.42 Impact Factor
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ABSTRACT: The ovarian hyperstimulation syndrome is a major complication of ovulation induction for in vitro fertilization, with severe morbidity and possible mortality. Whereas its pathophysiology remains ill-established, the VEGF may play a key role as well as coagulation disturbances. Risk factors for severe OHSS may be related to patients characteristics or to the management of the ovarian stimulation. Two types of OHSS are usually distinguished: the early OHSS, immediately following the ovulation triggering and a later and more severe one, occurring in case of pregnancy. As no etiologic treatment is available, the therapeutic management of OHSS should focus on its related-complications. Thrombotic complications that can occur in venous or arterial vessels represent the major risk of OHSS, possibly conducting to myocardial infarction and cerebrovascular accidents. Once the OHSS is diagnosed, prevention of thrombotic accidents remains the major issue.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 08/2011; 40(7):593-611. · 0.42 Impact Factor
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ABSTRACT: Over the past two decades, major advances in diagnostic modalities and treatment have markedly improved rates of cure for adult cancers. As a consequence, the number of long-term survivors is increasing, and fertility preservation has become a major issue for young patient about to start treatment for cancer. Whether fertility preservation is a promising option, most of the technologies currently used are far from being well established or are even still experimental. Patients should be aware that no method guarantees success. Psychological and ethical impacts of fertility preservation are major concerns and should be included in the multidisciplinary approach of the patients.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 06/2011; 40(6):487-91. · 0.42 Impact Factor
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ABSTRACT: Since in rodents anti-Müllerian hormone (AMH) has been shown to inhibit antral follicle responsiveness to FSH, we aimed at verifying whether a relationship exists between serum AMH levels and antral follicle responsiveness to exogenous FSH in normo-cycling women.
Serum AMH, estradiol (E(2)) and FSH levels were prospectively measured on cycle day 3 in patients undergoing controlled ovarian hyperstimulation (COH) with a time-release GnRH agonist and standardized FSH doses. In 162 patients, follicles were counted after pituitary suppression and before FSH administration (baseline; small antral follicles; 3-8 mm), and on the day of hCG (dhCG; pre-ovulatory follicles; 16-22 mm). Antral follicle responsiveness to FSH was estimated by the Follicular Output RaTe (FORT), determined by the ratio pre-ovulatory follicle count on dhCG × 100/small antral follicle count at baseline.
Serum AMH levels were positively correlated with the number of small antral follicles at baseline (r = 0.59; P < 0.0001) and pre-ovulatory follicles on dhCG (r = 0.17; P < 0.04). Overall, FORT was 47.5 ± 1.4% and failed to be influenced by the woman's age, BMI or basal E(2) and FSH level. Conversely, multiple regression analysis showed that FORT was negatively correlated with AMH levels (r = -0.30; P < 0.001), irrespective of duration of COH and total FSH dose.
The percentage of follicles that effectively respond to FSH by reaching pre-ovulatory maturation is negatively and independently related to serum AMH levels. Although the mechanisms underlying this finding remain unclear, it is in keeping with the hypothesis that AMH inhibits follicle sensitivity to FSH.
Human Reproduction 03/2011; 26(3):671-7. · 4.47 Impact Factor
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ABSTRACT: The objective is to compare the IVF procedures in modified natural cycle outcomes according to serum anti-Mullerian hormone (AMH) levels. We included in this retrospective study 342 patients undergoing their first IVF in modified natural cycle. Patients were regrouped in three groups according to their serum AMH level: group 1 was defined by patients with AMH level<0.97 ng/mL (<25th percentile), group 2, patients with AMH level between 0.97 ng/mL and 2.60 ng/mL (25-75th percentile), and group 3, patients with AMH level between 2.61 ng/mL and 6.99 ng/mL (>75th percentile). The main outcomes were cancellation rate, embryo transfer rate and clinical pregnancy rate, ongoing pregnancy rate and implantation rate. No difference has been observed on cancellation rate, embryo transfer rate, clinical pregnancy rate and implantation rate. The ongoing pregnancy rate per IVF cycle was respectively: 12.8±3.6% for AMH inferior to 0.97 ng/mL versus 12.5±2.5% for AMH between 0.97 to 2.60 ng/mL and 13.4±4.2% for AMH between 2.61 ng/mL and 6.99 ng/mL. In conclusion, IVF in modified natural cycles procedures should be considered as an option for patients with an altered ovarian reserve defined by a serum AMH inferior to 1 ng/mL. Serum AMH level seems a quantitative marker of the ovary but not a quality factor. Serum AMH level does not seem to be a prognostic factor for ongoing pregnancy rated in IVF modified cycles.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 03/2011; 40(3):205-10. · 0.42 Impact Factor
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ABSTRACT: Intra-uterine growth retardation (IUGR) is a frequent cause of consultation in antenatal care unit. The prognosis relies on the etiology: vascular, chromosomic, genetic, or infectious. Because of chronic fetal distress, hypotrophy increase morbidity, mortality and neurosensorial long term effect. Usually, infection is involved in 5 to 15% of the IUGR, mainly by Cytomegalovirus (CMV), Varicella Zoster virus, rubella, toxoplasmosis, herpes and syphilis. Maternal sera and amniotic liquid analysis make the diagnosis possible but fetal ultrasound scan is used to find other features. Most of the abnormalities are unspecific but their combination can worsen fetal prognosis. Infection should always be ruled out in the assessment of IUGR.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/2011; 40(2):109-15. · 0.42 Impact Factor
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ABSTRACT: A 34-year-old woman consulted the day before a scheduled caesarean for dry cough. A positive rhinopharyngeal sample for PCR testing for influenza A H1N1 led to a curative oseltamivir (Tamiflu®) treatment. At delivery a direct contact between the newborn and mother lasted only few seconds. The first healthy baby boy developped dry cough with a rhinopharyngeal sample positive for A H1N1. The minimal contact between mother and child and the positive neonatal sample only four hours after birth allow to think that it is a rare case of prenatal transmission of influenza A H1N1 to the fetus.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/2011; 40(5):473-5. · 0.42 Impact Factor
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ABSTRACT: Although female cancer incidence may be on rise, antineoplastic regimens have become more successful. As a result, an increasing number of women with cancer survive to endure the long-term consequences of chemotherapy. One of the most important long-term consequences of cancers treatments in young female is premature ovarian failure and infertility. Because of the increasing survival rates, many of these young women are seeking methods to preserve their fertility. Currently, embryo/oocytes cryoporeservation obtained after ovarian stimulation appears to provide the best fertility preservation option. However, patients may not have sufficient time to undergo ovarian stimulation prior to chemotherapy and/or the hormones used in ovarian stimulation are contra-indicated for estrogen-dependant tumors. In vitro maturation of oocytes (IVM) has been suggested to avoid ovarian stimulation and time requirement in patients with cancer, and can be combined with ovarian tissue cryobanking. In this review, we will discuss the position of IVM in the strategy of fertility preservation in young women.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 01/2011; 40(2):103-8. · 0.42 Impact Factor
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ABSTRACT: To reduce the twin pregnancy rate and their morbidity, several recommendations have been proposed to practice the "elective single embryo transfer" in a selected population. We decided to apply the criteria that were proposed in five articles from the literature to our population to evaluate the percentage of our population concerned and the impact on our twin pregnancy rate. The result is that these criteria only concern 2,4 to 10,8% of our population with a minor reduction of our twin pregnancy rate with a potential lake of chance concerning the pregnancy rate. We should study others possibilities than the population's criteria to reduce the number of embryo transferred.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2010; 40(4):323-8. · 0.42 Impact Factor
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M Grynberg,
N Chevalier,
A Mesner,
L Rocher,
N Prisant,
S Madoux,
E Feyereisen,
S Ferlicot,
R Fanchin,
R Frydman, N Frydman,
V Izard
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ABSTRACT: Analyzing the results and validating the procedure of testicular sperm extraction (TESE) performed on the day of oocyte retrieval in non obstructive azoospermia (NOA) patients.
Sixty TESE were performed on the day of oocyte retrieval (dOR), in 52 NOA men. Patients were sorted into three groups according to the results of the surgical procedure: 1: sperm recovery with possible sperm freezing (n=20); 2: sperm recovery without freezing (n=27); 3: "negative" biopsy (n=13). ICSI outcomes in the two groups with sperm recovery were compared to those of ICSI performed with frozen-thawed sperm obtained from TESE performed (n=13).
The rate of positive sperm retrieval was 78%. While the overall clinical pregnancy rate was 50%, no difference in the fertilization, implantation and clinical pregnancy rates was found in the two groups with positive sperm retrieval as compared to frozen-thawed sperm group. Twelve pregnancies were obtained in patients without further sperm cryopreservation.
After TESE in NOA men, cryopreserved sperm produced comparable results with freshly obtained sperm. However, TESE performed on dOR can offer the opportunity, in patients with rare sperm that might not survive freeze-thaw, to have a possible fresh embryo transfer. Couples should be counselled regarding the possibility of oocyte retrieval without sperm for ICSI.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2010; 40(2):130-6. · 0.42 Impact Factor
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ABSTRACT: Behçet's disease is a multisystemic disease of unknown origin characterized by a recurrent bipolar aphtosis (oral and genital) associated with vascular, digestive or articular symptoms. Gynecologists can be faced to this disease at any time of the life of their patients, including during the pregnancy. Given that the first demonstrations of the disease can be genital, they are in the front line to evoke this diagnosis. They thus have to know the main characteristics of the disease to make the diagnosis and to organize a multidisciplinary management. During pregnancy, the treatment of the disease is to be adapted to avoid teratogenic drugs, and adapt the doses of the treatment.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 10/2010; 40(4):283-90. · 0.42 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: The purpose of this review is to update the reader on the impact of cancer treatment on fertility, the options of fertility preservation, and the new markers to assess ovarian function. ESSENTIAL POINTS: The impact of chemotherapy and radiotherapy on fertility depends on the drugs and the doses used. It often affects ovarian reserve significantly, and the presence of menstruation is not a reliable reflection of it. Fertility preservation techniques, such as ovarian protection, and preferably cryopreservation combined with assisted reproductive medicine, should be individually discussed and possibly proposed to the patients. The use of new markers for ovarian reserve assessment will help to evaluate infraclinic chemotherapy and/or radiotherapy-induced effects on ovarian reserve, prior to clinical effects.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 10/2010; 39(6):433-43. · 0.42 Impact Factor
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ABSTRACT: To compare retrospectively the distribution of foetal biometry data as measured by midwives and physicians during second and third trimester screening of an unselected population of pregnant women.
Standard measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) were performed by four midwives and ten physicians at 20 to 24 weeks of gestation and at 30 to 34 weeks of gestation as part of routine ultrasound examinations over a 26-month period (Jan. 2005-Mar. 2007). All measurements were converted into Z-scores using different prediction equations. The reference chart best fitting our practice was determined for each fetal parameter (French College of Sonographers for BPD, Chitty et al. for HC and FL, Snidjers and Nicolaides for AC). The means and SDs of the Z-score distributions for data collected by midwives and physicians were compared using Student's t-test for means and the Fisher-Snedecor test for SDs.
We retrieved 1566 and 1631 measurements made by midwives and physicians respectively between 20 and 24 weeks of gestation, and 1710 and 1578 measurements made by midwives and physicians respectively between 30 and 34 weeks of gestation. Mean values recorded by midwives were significantly closer to 0 (p < 0.05) for many foetal parameters. SD values were also significantly lower and were below 1.
In this study, midwives have a greater tendency than physicians to normalize biometry data. Such normalization may hamper the sensitivity of routine ultrasound screening for abnormal foetal growth.
Prenatal Diagnosis 12/2009; 30(1):40-2. · 2.11 Impact Factor
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ABSTRACT: To evaluate the clinical use of hourly fetal urine production rate (HFUPR) in polyhydramnios.
This was a retrospective review of 33 singleton pregnancies with polyhydramnios, 30 of them unexplained and three due to gastrointestinal atresia. HFUPR was estimated using three-dimensional ultrasound and was compared with recently established nomograms. Abnormal midterm outcome, defined as diagnosis or persistence of pathology after the neonatal period until the age of 2 years, was analyzed according to prenatal HFUPR measurements and other polyhydramnios characteristics.
Seventeen of the 30 fetuses with unexplained polyhydramnios had an HFUPR above the 95(th) centile, and five (29.4%) of them developed midterm disorders. None of the 13 with normal HFUPR developed midterm disorders. The HFUPR was 1.9 (SD, 0.7) multiples of the median (MoM) in fetuses with an adverse childhood outcome and 1.4 (SD, 1.2) in fetuses with normal childhood outcome (P = 0.34). In the three fetuses with gastrointestinal atresia, the HFUPR was significantly lower than in those with unexplained polyhydramnios (P = 0.003).
HFUPR was associated with the mechanism of polyhydramnios but failed to help in the prognosis of unexplained polyhydramnios because of lack of power. Children with prenatal unexplained polyhydramnios and HFUPR above the 95(th) centile should nevertheless receive detailed pediatric follow-up.
Ultrasound in Obstetrics and Gynecology 11/2009; 34(5):521-5. · 3.01 Impact Factor
