[French clinical practice guidelines developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease]. / Indications de vitrification ovocytaire dans les pathologies gynécologiques bénignes : conseils de bonne pratique du CNGOF après étude de consensus par méthode Delphi.

OBJECTIVES: To provide clinical practice guidelines about fertility preservation (FP) for women with benign gynecologic disease (BGD) developed by a modified Delphi consensus process for oocyte vitrification in women with benign gynecologic disease. METHODS: A steering committee composed of 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices related to FP for BGD. Then 114 key stakeholders including various healthcare professionals (n=108) and patient representatives (n=6) were asked to participate in a modified Delphi process via two online survey rounds from February to September 2020 and a final meeting. Due to the COVID-19 pandemic, this final meeting to reach consensus was held as a videoconference in November 2020. RESULTS: Survey response of stakeholders was 75 % (86/114) for round 1 and 87 % (75/86) for round 2. Consensus was reached for the recommendations for 28 items, that have been distributed into five general categories: (i) Information to provide to women of reproductive age with a BGD, (ii) Technical aspects of FP for BGD, (iii) Indications for FP in endometriosis, (iv) Indications for FP for non-endometriosis BGD, (v) Indications for FP after a fortuitous diagnosis of an idiopathic diminished ovarian reserve. CONCLUSION: These guidelines provide some practice advice to help health professionals better inform women about the possibilities of cryopreserving their oocytes prior to the management of a BGD that may affect their ovarian reserve and fertility. STUDY FUNDING/COMPETING INTEREST(S): The CNGOF (Collège National des Gynécologues Obstétriciens Français) funded the implementation of the Delphi process.

[Repeated in vitro fertilization failure: Abnormalities identified in the diagnostic assessment]. / Échecs répétés de fécondation in vitro : anomalies retrouvées sur le bilan diagnostique.

OBJECTIVES: Investigate the proportion of abnormalities identified on the diagnostic assessment performed after at least two previous failed IVF attempts. Discuss the real benefit of this evaluation. METHODS: Retrospective descriptive study. Between January 2008 and January 2012, 205 couples with at least two consecutive failed IVF attempts had a diagnosis evaluation which consisted in couple's karyotypes; autoimmune and haemostasis biological check-up, pelvic ultrasound-Doppler and hysteroscopy for women. RESULTS: The main biological anomalies were autoimmune for 23.9% of women: antinuclear antibodies (5.7%), antithyroid peroxidase (11.5%) and antithyroglobulin (8.3%); thrombotic with antiphospholipid antibodies for 8.2% of women (1.4% lupus anticoagulant and 6.8% anticardiolipin antibodies), and heterozygous prothrombin gene mutation for 9.5%. Karyotypes were abnormal for 2.1% of women and 0% of men. Ultrasound-Doppler appeared to be abnormal in 44.7% of cases (pulsatility index of uterine artery≥3 and/or protodiastolic notch), and diagnostic hysteroscopy was abnormal in 14.6% of cases. In order to target the real implantation failure, we compared the groups "<8 embryos transferred" versus "≥8 embryos transferred" and "pregnancy after the third or fourth IVF cycle" versus "no pregnancy", but no statistically significant difference was found. CONCLUSION: The diagnostic assessment carried out for recurrent IVF failure can detect biological, karyotypic and morphological abnormalities, in the same proportion that in previous studies. Further studies will have to be conducted to evaluate the real impact of these abnormalities in the recurrent implantation failure and the effectiveness of therapeutic care.

[Fertility after endometrial osseous metaplasia elective hysteroscopic resection]. / Fertilité après résection élective hystéroscopique de lésions de métaplasie ostéoïde de l'endomètre.

OBJECTIVES: The endometrial osseous metaplasia is a rare disease which is characterized by the presence of osseous tissue in endometrium. It is often diagnosed in women with secondary infertility. The main objective of this work is to evaluate fertility after elective resection of osteoid metaplasia endometrial lesions by operative hysteroscopy in infertile women. PATIENTS AND METHOD: Retrospective and descriptive series of 7 cases observed in the Woman and Child department, CHU Jean-Verdier. The 7 women were in reproductive age, of African origin, with secondary infertility after abortions concerning 6 out of the 7 patients. RESULTS: In all cases, endovaginal pelvic ultrasound has raised endometrial calcification, and diagnostic hysteroscopy highlighted endometrial osteoid metaplasia. The operative hysteroscopic procedure consisted of elective diathermic resection to handle endometrial insertion of bone chips. A second diagnostic hysteroscopy was systematically done. It showed no recurrence. Six of the 7 patients began pregnancy, 3 spontaneously and 3 after IVF/ICSI in the first year following the hysteroscopic treatment. The evolution of pregnancies has been marked by 2 normal deliveries, 1 spontaneous miscarriage and then an ectopic pregnancy in one patient, 1 growth retardation intrauterine requiring caesarean at 38 SA, 1 HELLP syndrome in a twin pregnancy requiring ceasarean at 27 SA followed normal labor at term and 1 pregnancy lost sight. DISCUSSION AND CONCLUSION: Hysteroscopic elective resection seems to be the treatment of choice with a good prognosis on subsequent fertility.

[Methods and efficacy of medical and surgical treatment of non functional menorrhagia]. / Modalités et efficacité des traitements médicaux et chirurgicaux devant des ménométrorragies organiques.

OBJECTIVES: To assess the efficacy of therapies in menorrhagia related to atypical endometrial hyperplasia, polyps, myoma, adenomyosis and arteriovenous malformation of the uterus. MATERIALS AND METHODS: Medline and Cochrane contents were searched to June 2008. RESULTS: Atypical endometrial hyperplasia is classically treated by hysterectomy, but may temporarily regress under hormone therapy (progestins, Gn-RH agonists) in women of childbearing age. Hysteroscopic resection is the standard treatment for endometrial polyps. Recurrence of bleeding is reduced by combining it with endometrial ablation. Myoma-related menorrhagia can be treated by Gn-RH agonists for 3 months or levonorgestrel in utero (LNG-IUS). Hysteroscopic resection is the standard treatment of submucous myomas. Interstitial myomas can be treated by myomectomy, myolysis, uterine artery embolisation or occlusion, or hysterectomy. Laparoscopic myomectomy and uterine artery embolisation are effective, well tolerated, and the best researched. LNG-IUS is effective and well tolerated to treat adenomyosis-related menorrhagia. The effect of other conservative treatments of the uterus (endometrial ablation, uterine artery embolisation or occlusion) is limited, especially in case of deep and extensive adenomyosis. Uterine artery embolisation is the standard treatment for arteriovenous malformation. CONCLUSIONS: Numerous medical and technical innovations have been recently developed as conservative treatments for menorrhagia. However, hysterectomy remains the standard treatment of atypical endometrial hyperplasia and adenomyosis.