[Ovarian drilling by fertiloscopy: feasibility, results and predictive values]. / Drilling ovarien par fertiloscopie : faisabilité, résultats et valeurs prédictives.

OBJECTIVES: The aims of this study were to assess the effectiveness of the ovarian drilling, compare the techniques by fertiloscopy or by laparoscopy, and search for prognostic factors of success. PATIENTS AND METHODS: This retrospective study focused on 154 ovarian drilling carried out between June 1998 and December 2010 where the drilling has been proposed after failure of the clomifene and before stimulation by FSH among PCOS patients. RESULTS: The post-drilling ovulation rate is 62%. The spontaneous on-going pregnancy rate is 31% and the total pregnancy rate scalable including secondary stimulation is 58%. No significant difference was found between laparoscopy and the fertiloscopy. The peroperative complications in fertiloscopy were more frequent but without consequences and 20% of the fertiloscopy had to be converted to laparoscopy, half of them for complications and half of them for technical difficulties. The only found preoperative predictors of success are an euthyroidy that increases the chances of pregnancy in general (including the side stimulation) and a lower FSH levels. However, it appears that the chances of pregnancy in FSH stimulation are dramatically decreased if the drilling did not induce ovulation versus the cases where it induced ovulation but no pregnancy (28.8% versus 58.1%, P<0.003). DISCUSSION AND CONCLUSION: Fertiloscopy results are comparable with those of laparoscopy, which suggests an advantage to this technique in terms of cost, comfort, and length of hospital stay. No usable in practice patient selection criteria could be highlighted. The study suggests that the absence of ovulation after drilling may be a direct indication for IVF.

[Reduction of multiple pregnancies in ART with large SET procedures over the period 2001-2010]. / Réduction des grossesses multiples en AMP par un usage large du SET (Single Embryo Transfer) sur la période 2001-2010.

OBJECTIVE: To evaluate delivery rate and multiple pregnancy rates in ART (assisted reproductive techniques) following introduction of an elective single embryo tranfer (eSET) policy. This strategy was started in 2002 including transfer of one embryo for women less than 35 years with a least two good quality embryo during their first or second attempts. PATIENTS AND METHODS: Retrospective study including all IVF cycles performed in the IVF centre of Clermont-Ferrand University Hospital from 01/01/2001 to 31/12/2010. Main outcome measures were number of embryos transferred, cumulative delivery and multiple pregnancy rates (including fresh and frozen embryo transfers). A subgroup analysis including patients' age was done. RESULTS: Cumulative delivery rate reached 27,3% in 2010 with a significant drop in multiple pregnancy rate: from 30% in 2001 to 7,9% in 2010. The average number of transferred embryo decreased from 2.29 to 1.55 in the same period. In our centre, eSET was performed in 85% of first IVF attempt and in 34,4% of second attempts for women less than 35 years. CONCLUSION: The implementation of an eSET policy does not change the delivery rate but significantly decrease the number of multiple pregnancies compared to double embryo transfer. eSET should be carried out during the 1st and 2nd attempts in patients under 35 years when at least two good quality embryos were obtained.

[Factors affecting the cumulative live birth rate in IVF cycles. Retrospective analysis of a 1001 couples cohort]. / Analyse des facteurs influençant les taux cumulatifs d'accouchement en AMP sur une cohorte de 1001 couples.

OBJECTIVE: To analyze the different factors influencing real and theoretical cumulative live birth rates following in vitro fertilization. PATIENTS AND METHODS: Retrospective study of 1001 couples starting an IVF/ICSI cycle between 2004 and 2006 that were followed-up after all their attempts. All abandoned cycles were taken in account. RESULTS: For all couples, the theoretical cumulative live birth rates after n attempts were 23.9%, 40.5%, 51.4%, 62.2%. The real cumulative live birth rates were 23.9%, 36%, 41.2% and 44.4%. With reference to age, success rates were better for women less than 35 (58,8%) and were reduced for women older than 38 (18,0%). Looking at the ovarian reserve, in the 35 to 38 years age group, the actuarial rates were satisfactory as long as the ovarian response resulted in five or more oocytes. Among older patients, success rates were influenced by the number of oocytes collected and only acceptable when more than eight oocytes were obtained. Multivariate analysis has demonstrated that women's age was determinant on the live birth rate (OR=0.17 [0.09-0.32] in the 38 to 39 group versus less than 30 group). In ovulatory disease, the success rates were the best compared to other infertility aetiology (OR=1.61[1.05-2.47]). Moreover, the number of embryos transferred had a strong impact on live birth rate with an OR of 1.62 [1.32-1.99] per extra embryo. DISCUSSION AND CONCLUSION: Live birth rates are dependent on the women' age. For women older than 38 years, the ovarian response to the stimulation and the number of embryos transferred are important factors for success.

[Laparoscopy during pregnancy: experience of the French university hospital of Clermont-Ferrand]. / Coelioscopie en cours de grossesse: expérience du centre hospitalier universitaire (CHU) de Clermont-Ferrand.

OBJECTIVE: To describe perioperative management and perinatal outcome for patients undergoing laparoscopy during pregnancy. PATIENTS AND METHODS: We conducted a retrospective study of all cases of laparoscopy during pregnancy performed in our university hospital over a period of six years (from February 2000 to February 2006). RESULTS: We observed 34 cases managed from five to 30 weeks of gestation (11 cases of adnexal torsion, ten adnexal masses, eight appendicitis, one cholecystitis, one sigmoid volvulus, one pelvic peritonitis, two heterotopic pregnancies). Open laparoscopy was used in 12 cases. Conversion was required in two cases mainly due to adherences (one borderline lesion at 16 weeks and one tubal cyst torsion at 24 weeks). No maternal complication was observed. One miscarriage occurred at Day 1 (peritonitis, five weeks of gestation) and one patient opted for abortion. No threatened preterm labour occurred after the perioperative course and no neonate required admission in neonatology unit. DISCUSSION AND CONCLUSION: This study illustrates safety and efficacy of laparoscopy in management of surgical diseases in the gravid patient. Emergent indications are the most common, highlighting the need for all physicians to know specific recommendations related to laparoscopy during pregnancy.