[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.

[Myocardial infarction and ovarian stimulation: case report]. / Infarctus du myocarde et stimulation ovarienne : à propos d'un cas.

Female infertility treated by ovarian stimulation can lead to arterial thrombosis particularly when ovarian hyperstimulation syndrome emerges. Myocardial infarction have been reported thrice, in one case even before artificial ovulation induction. A 25-year-old female with primary infertility underwent ovarian stimulation and eight days after ovulation induction and intra-uterine insemination suffered from a troponin positive non-ST-elevation myocardial infarction of the inferior wall. Coronary angiogram was normal and contrast-enhanced cardiovascular magnetic resonance imaging confirmed the subendocardial inferior infarct. This protocol included sole triptorelin administration followed by 23 recombinant follicle stimulating hormone injections and concluded by recombinant choriogonadotrophin. There was no ovarian hyperstimulation syndrome. Large biological screening did not retrieve any predisposition for arterial thrombosis. Clinical outcome was excellent. Despite weak causal link, we emphasize that chest pain during ovarian stimulation protocol should rise clinical concern for acute coronary syndrome.

[Laparoscopic management of occult cervical cancer discovered after simple hysterectomy]. / Prise en charge chirurgicale par voie d'abord coelioscopique du cancer du col utérin occulte découvert après hystérectomie simple.

OBJECTIVES: To assess the feasibility and morbidity of surgical management by combined laparoscopic and vaginal approach after cervical cancer diagnosed at the time of simple hysterectomy. PATIENTS AND METHODS: From 2000 to 2005, 10 patients were referred with occult cervical cancer discovered after simple hysterectomy. All these patients had laparoscopy for surgical staging. RESULTS: Eight on ten patients had complete laparoscopic staging: pelvic lymphadenectomy (N=8), radical colpectomy (N=5). Operative time, pelvic lymph nodes resected, postoperative stay were respectively 261.3 minutes (200-400), 27 (23-38), 4.4 days. There were 2 symptomatic lymphocysts. Pelvic lymph nodes were positive for 1 patient with negative paraaortic nodes. Residual disease was present in 2 cases: 1 parametrial and vaginal involvement, 1 ovarian metastasis. 5 patients had adjuvant treatment: 2 combined pelvic external radiotherapy and brachytherapy, 1 pelvic external radiotherapy, 1 pelvic concurrent chemoradiation and 1 brachytherapy only. Two on ten patients needed a laparoconversion, one for ovarian involvement and one for technical failure. With a median follow-up of 29.7 months (4-63), 3 patients recurred. 3 patients recurred above 5 patients with pelvic lymphadenectomy but without parametrectomy versus no recurrence above 5 patients with pelvic lymphadenectomy and parametrectomy. DISCUSSION AND CONCLUSION: Surgical staging of occult cervical cancer discovered after simple hysterectomy is necessary for indication of adjuvant treatment. Laparoscopy combined with vaginal surgery is feasible and safe, inducing fewer adhesions which is important for adjuvant radiotherapy. The realization of a radical parametrectomy seems to offer a local control of the disease and a decrease in the risk of recurrence, which need to be confirmed by conducting a study with more patients. This emphasize the necessity of creating a national record to register all women managed for occult cervical cancer.