[GnRH agonist triggering in IVF and luteal phase support in women at risk of ovarian hyperstimulation syndrome]. / Déclenchement de l'ovulation par agonistes du GnRH en FIV et soutien de la phase lutéale chez les femmes à risque d'hyperstimulation ovarienne.

OBJECTIVE: To evaluate the efficacy and safety of ovulation triggering by agonists in antagonists IVF cycles with fresh embryo transfer in modulating low HCG dose for luteal phase support in patients at risk of ovarian hyperstimulation syndrome (OHSS). PATIENTS AND METHODS: In an observational study from September 2011 to March 2013, we triggered with agonist 107 cycles with OHSS risk, we initially triggered 39 cycles with 2 doses of Triptorelin 0.1 mg. Injection of 1500 IU HCG was performed one hour after the pick up and a second injection of 1500 IU was made 5 days later (group 1) combined with 400 mg of natural progesterone vaginally. In the following 68 cycles we removed the second HCG injection and increased to 600 mg vaginal progesterone associated with E2 4 mg orally (group 2). RESULTS: Group 1: the ongoing pregnancy rate and birth rate in fresh cycle is respectively 37.1% and 34.3% and the cumulative ongoing pregnancy rate and birth rate per patient is 43.6% and 41%. We recorded three late onset OHSS in pregnant women. Group 2: ongoing pregnancy rate in fresh cycle is 39.6%, the current cumulative ongoing pregnancy rate per patient was 45.6%. We observed a case of early onset OHSS. DISCUSSION AND CONCLUSION: Triggering with agonist and administering an injection of 1500 IU of HCG the day of the pick up appears to be effective in women at risk of OHSS. The exclusion of all OHSS is still not reached. The search for the best protocol and its indications should continue.

[Safety and 12-month results on stage 3-4 cystocele repair by the vaginal route using a light-weight mesh]. / Tolérance et résultats à 12 mois d'une prothèse légère pour la cure de cystocèle de stade 3-4 par voie vaginale.

OBJECTIVE: To assess safety and efficacy at short-term of a light-weight polypropylene mesh (28 g/m2) for stage 3-4 cystocele repair by the vaginal route. MATERIAL AND METHODS: A multicentric prospective cohort study, performed between 2010 and 2011 in seven centers. Pre-operative assessment included prolapse quantification using the POP-Q. Pre- and postoperative validated symptoms and quality of life questionnaires were used. Main objective was mesh safety. Secondary objectives were anatomical and functional success. RESULTS: One hundred and eleven patients, with a mean age of 67±9 years, were included in the study, and 94 were included in the analysis (84.7%). In 14 cases (12.8%), it was a secondary surgery. Two intra-operative complications occurred (2.2%). Safety analysis on 86 patients followed up at 12 months (91.5%) has shown satisfaction rate of 98.8% (85/86), mesh contraction rate of 9.3% (8/86), one case of vaginal mesh exposure (1.2%), no cases of pelvic pain and rate of postoperative dyspareunia of 5.5% (3/55). Anatomic success rate on cystocele (Ba point < -1) at short-term was 82/86 (95.3%) and improvement of symptoms and quality of life was highly significant. Five patients (5.3%) were reoperated. CONCLUSION: Cystocele repair by the vaginal route using a light-weight transobturator polypropylene mesh was safe and efficient at short-term. Long-term data are needed.

[Influence duration of the use of estrogens beyond the menses in estradiol IVF antagonist programming cycles]. / Influence de la durée de prise d'estrogènes au-delà des règles dans les cycles FIV antagonistes programmés par les estrogènes.

OBJECTIVE: To evaluate by the birth rate the impact of the number of days of estrogens continued beyond the menses in a four days estradiol IVF antagonist programming cycles. PATIENTS AND METHODS: Retrospective study from September 2004 to January 2009 among women of age ranging between 25 and 38 years. Four milligrams of provames is prescribed 3 to 5 days before the theorical menses and continued until the beginning day of stimulation, which is distributed equitably between Thursday and Sunday. The birth rate is evaluated according to the number of days of estrogen continued beyond the menses within a limit from 1 to 8. RESULTS: No significant difference appears neither in the duration of stimulation, in the quantity of gonadotrophin, the oocytes pick up, nor in the rate of birth between the groups. CONCLUSION: The programming by estrogens of the antagonist IVF cycles implies a variable number of days of estrogens continued beyond the menses, which does not seem to affect the birth rate.

[Efficiency of antagonist IVF cycle programming by estrogens]. / Efficacité de la programmation des cycles FIV en antagonistes par les estrogènes.

OBJECTIVE: Assess the efficiency of estradiol programming in In Vitro Fertilization (IVF) with antagonists by comparing with classical long luteal agonist protocol. PATIENTS AND METHODS: It is a prospective randomized study, comparing 426 cycles in the arm estradiol antagonist with 412 cycles in the arm long agonist. Estradiol 4 mg/day begins on the 25th day of the previous cycle and continues during the menses until the first day of the stimulation which is from Thursday to Sunday whatever the beginning of the menses. The luteal protocol use Decapeptyl 0,1mg which begins on the 20th day of the previous cycle. RESULTS: Our two populations are similar. No pick-up has been done on Sunday. We have got significantly less oocytes and embryos in estradiol-antagonist (6,8+/-5,3 vs 7,6+/-5,7) and (3,7+/-3,2 vs 4,1+/-3,6) respectively. The ongoing pregnancy rate is comparable in the two groups: 28,6 % for estradiol antagonist 27,9 % for agonist for the whole population and 37 % vs 34,8 % respectively when at least one top embryo was transferred. DISCUSSION AND CONCLUSION: Programming antagonist cycles with estradiol allows the organization of the center; it is easy to implement and seems to give results as good as a long agonist protocol.

[Ovarian hyperstimulation in medically assisted reproduction: which practical approach?]. / Les hyperstimulations ovariennes en PMA: quelle attitude pratique?

Ovarian hyperstimulation syndrome (OHS) with serious grade could be a live threatening disease, that occurs in 0.5% to 1% of in vitro fertilization program. The prevention of OHS is based on the recognition of risk factors and on ultrasonic and hormonal monitoring, with well adapted treatment in order to reduce the number of follicles. The level of oestradiol will determine the injection of human chorionic gonadotropins: between 2500 and 3000 pg/ml, the injection of HCG is reduced to 5000 U for the induction of ovulation, and the injections of HCG 1500 during the luteal period are avoided: between 3000 and 5000 pg/ml, the injection of HCG is reduced to 5000 U and the replacement of fresh embryos is deferred to an other cycle: after 5000 pg/ml, the injection of HCG must be abandoned. The treatment of the confirmed OHS is based on the rest, with hospitalization, correction of fluid, electrolyte and protein imbalance, prevention of thrombo embolism and aspiration of ascite fluid.

[Term birth of a twin after the rupture of the uterine horn at 15 weeks gestational age]. / Naissance à terme d'un jumeau après rupture d'une corne utérine à 15 semaines d'aménorrhée.

Having treated a case which resulted in the delivery at term of an intrauterine twin when the other twin had been lost after the rupture of a uterine cornu which itself followed a salpingectomy without removal of the interstitial portion of the tube brings the authors to discuss the physiopathology and the symptomatology of such cases. They also discuss the value of resecting the interstitial portion of the tube and what management should be when there is a live intrauterine pregnancy.

[Intratubal transfer of an embryo or a zygote. (TET or GIFT) Past, present and future? Comparative study of tubal embryo transfer (TET) versus in vitro fertilization]. / Le transfert intratubaire d'embryon ou de zygote (TET ou ZIFT). Passé, présent et avenir? Etude comparative tubal embryotransfer (TET) versus FIVETE.

The pregnancy rate per transfer does not appear to be increased if the embryos are placed in the Fallopian tube rather than using in-vitro fertilization or inserting the gametes into the tubule ampulla. Consequently, the indications are specific to particular cases.

[Nipple discharge without palpable tumor. Apropos of 46 cases]. / Les écoulements mamelonnaires sans tumeur palpable. A propos de 46 cas.

The authors report 46 cases of nipple discharge without any palpable lesion. The diagnostic is made, most of the time, by 3-views bilateral mammograms. The place of other examinations (ultrasonography, galactography) is reported. The cytology of the discharge, as well as its macroscopic appearance (bloody, serous or greenish), determine the surgical indications. Quadrantectomy centered around the discharging duct, is the procedure of choice in this disease, at the interface between diagnostic and treatment, in fact, if benign tumors (papillomas) or non tumoral diseases (fibrocystic mastopathy and duct ectasia) predominate, invasive or in-situ malignant lesions represent 13 p. cent of these 46 discharges, justifying the significance of this clinical sign.

[The value of fertilization in vitro and derived technics in oligo-astheno-teratospermia]. / Intérêts de la fécondation in vitro et techniques dérivées dans les oligo- asthéno- teratospermies.

The authors report the advantage of fertilization in vitro and ancillary techniques in hypofertility by male component. In their fertilization in vitro program, a male indication is individually found in 10% of the cases, but also in female indications, even those of tubal origin. In summary, sperm anomalies are reported in 25% of couples entering a program of fertilization in vitro. Therefore they explain their current approach toward one or two cycles of diagnostic FIV, and then propose the most appropriate technique of assisted procreation for each case.

[Hydrosalpinx and sterility. Value of studying tubal microbiopsies using scanning electron microscopy]. / Hydrosalpinx et stérilité. Intérêt de l'étude de microbiopsies tubaires en microscopie électronique à balayage.

Microbiopsies were taken from the tubes of 13 women who were sterile with hydrosalpinges. They were studied using scanning electron microscopy. It was possible to point out several degrees in the evolution of these lesions of the tubal epithelium. These lesions occurred in the fimbrial portion, the ampulla and the isthmus of the tubes. The value of this investigation in diagnosis and prognosis in cases of sterility due to hydrosalpinx is discussed.

[Demons-Meigs syndrome. Apropos of a case. Review of the literature]. / Le syndrome de Demons-Meigs. A propos d'un cas. Revue de la littérature.

On the basis of one case, the authors discuss the clinical, paraclinical and evolutive features of Demons-Meigs syndrome. They review the literature in an attempt to define the pathogenesis of this rare syndrome.

[Emergency uterine embolization in postpartum hemorrhage secondary to coagulopathy]. / Embolisation utérine de sauvetage dans une hémorragie de la délivrance secondaire à une coagulopathie.

Acute post-partum hemorrhage secondary to a coagulation disorder was successfully treated by embolization of the uterine arteries. The technique used is described, and the place of embolization as an alternative to surgical procedures discussed.

[Fetal bradycardia caused by an anomaly of auriculo-ventricular conduction. Apropos of a case with prenatal diagnosis. Review of the literature]. / Bradycardie foetale par anomalie de la conduction auriculo-ventriculaire. A propos d'un cas de diagnostic anténatal. Revue de la littérature.

In discussing a case of isolated A-V block, the authors note that this condition occurs frequently in association with other cardiac and non-cardiac foetal malformations. Diagnosis of this type of disorder has been greatly facilitated by the development of ultrasonography. Obstetric management depends on the degree of malformation. Neonatal monitoring is mandatory, as is the presence of a paediatric ressuscitation team at delivery.

[The diagnostic value of celioscopy in the evaluation of chronic pelvic pain. Apropos of 184 cases]. / Etude de l'apport diagnostique de la coelioscopie dans le bilan des algies pelviennes chroniques. A propos de 184 cas.

The authors report on a retrospective study of 184 laparoscopies carried out assessing the aetiology of chronic pelvic pain. The population that was studied has a mean age of 28.8 years, with most of the patients being between 20 and 30 years of age. The mean length of the history of the pain was 51 1/2 months. 51% of the cases had pain of a rhythmical nature associated with the menstrual cycle, 11.3% of cases had deep dyspareunia and 37.7% of the cases had repeated attacks of pain. Previous gynaecological pathology was found in 30% of cases and previous pelvis surgery in 11.1% of cases. 41.5% of the population were multiparous. Laparoscopy was only performed after a full clinical and paraclinical examination. It showed the presence of: endometriosis in 22.2% of cases, pelvic adhesions in 17.4%, varicose veins in the pelvis in 11.4%, ovarian cysts in 6.5%, ovarian dystrophies in 3.2%, Masters and Allen syndrome in 3.8%, sub-serous fibroids in 2.1%.

[Acute hydramnios and twin pregnancy. Apropos of 5 cases]. / Hydramnios aigu et grossesse gémellaire. A propos de 5 cas.

Five cases of acute hydramnios occurring in twin pregnancies are reported here. The obstetrical management is discussed in the light of our results and the facts given in the literature. It would seem that abdominal route amniocentesis drawing off quantities of liquor is a simple manoeuvre which can be repeated and work so that the inexorable progress to late abortion or premature labour is avoided.

[Injury of the umbilical cord during late amniocentesis]. / La blessure du cordon au cours de l'amniocentèse tardive.

Damage to the umbilical cord is a rare complication of late amniocentesis. It is so serious for the fetus that it should be recognized immediately and the baby should be delivered as quickly as possible. We report a new case here and analyse the principal features to be found in the literature.

[Cervical pregnancy. A rare entity that should not be missed]. / La grossesse cervicale. Une entité rare à ne pas méconnaître.

The authors report a new case of cervical pregnancy in a primigravid woman of 31 years of age who had had 15 weeks of amenorrhoea. They review the clinical and anatomo-pathological criteria necessary to make the diagnosis. The diagnosis which had become suspected because of ultrasound was confirmed by examination under a general anaesthetic before interrupting pregnancy. Conservative treatment was made possible because there was no very heavy bleeding after the curettage to evacuate the products.