Normal serum concentrations of anti-Mullerian hormone in a population of fertile women in their first trimester of pregnancy.

BACKGROUND: Anti-Müllerian hormone (AMH) levels are used to evaluate the ovarian reserve. AMH serum concentrations have recently been studied among women attending fertility centers, and among women with regular menstrual cycles but normative values have not been established among fertile women: the objective of this study was to establish those values. METHODS: This prospective cross-sectional study included 340 healthy fertile women attending a single centre, aged between 15 and 50 years. The women were all in the first trimester of pregnancy, had no serious medical history and attended the abortion service of the University Hospital of Nice, France. Serum AMH was measured using a second-generation AMH enzyme-linked immunosorbent assay. RESULTS: Median AMH concentration was 2.42 ng/ml (25-75 percentiles 1.19-4.12). The relationship between AMH concentration and age was best fitted by a polynomial function. Serum AMH values rose until age 29 years and then showed a significant decline (R(2)= 0.289, P < 0.001). Normative values for serum AMH were established in different age groups between 15 and 50 years. CONCLUSIONS: We established the normative values for serum AMH in a population of French fertile women in their first trimester of pregnancy.

[Oocyte donation in patients with Turner syndrome: A high-risk pregnancy]. / Procréation par don d'ovocytes dans le syndrome de Turner : une situation à haut risque.

Turner's syndrome is characterized by an ovarian failure, which occurs in most cases before puberty and leads to infertility. In vitro fertilization with oocyte donation has dramatically transformed the prognosis of infertility of these women. However, in the same time, it has become obvious that pregnancies in Turner's syndrome are at very high risk of possible sudden death because of a specific risk for cardiovascular complications involving aortic root dissection. We report the case of a serious cardiac failure occurred during a twin pregnancy obtained by oocyte donation in a 39-year-old patient with Turner's syndrome. Pregnancy outcome was hopefully favourable thanks to a foetal extraction at 27 weeks of amenorrhoea. If the most reported cases of maternal deaths in patients with Turner's syndrome are associated with an aortic root dissection, our observation is characterized by a full normal cardiologic assessment before the pregnancy and by the absence of aortic root dilatation during pregnancy. This case also illustrates the very high risk of pregnancy in women with Turner's syndrome and the importance of a multidisciplinary care by professionals informed and been used to this obstetric practice.

[Ovarian stimulation with gonadotrophins in patients with polycystic ovary syndrome]. / Stimulation ovarienne sous gonadotrophines chez des patientes atteintes de syndrome des ovaires polykystiques.

OBJECTIVES: The main objective of this study was to describe the ovulation rate in patients with polycystic ovary syndrome, treated with ovulation induction/intra-uterine insemination and follitropin alfa by gonadotrophins at a second attempt. METHODS: An observational, national and multicentre study was carried out: 51 French physicians (endocrinologists, gynaecologists) participated. Eligible patients were followed according to the usual clinical practices. The primary endpoint was the number of ovulations (spontaneous or triggered). Quality of life evaluation (by FertiQoL), compliance, and patient satisfaction were secondary endpoints. RESULTS: A total of 202 patients (mean age: 29.9 years; mean infertility: 2.9 years) were included: 78.4% met the Rotterdam definition. The ovulation rate was 93.3% (95% confidence interval [89.8; 96.8]%). At 12 weeks of gestation, 38 patients had an ongoing pregnancy. A difference of 10 points of the mean total FertiQoL score was observed between the two attempts. No patient reported missing injection. More than 9 in 10 patients said they were satisfied to very satisfied with the use of the pen injector for administration of follitropin alfa. Eight patients (4.0%) had hyperstimulation leading to cycle cancellation, and two patients (1.1%) reported ovarian hyperstimulation syndrome. CONCLUSIONS: At the second cycle of follitropin alfa stimulation, a high rate of ovulations, satisfactory compliance and tolerance profile associated with a change in quality of life were reported.

Pelvic ependymoma arising from the small bowel.

A 37-year-old woman underwent resection of an abdominal tumour which was adherent to the wall of the ileum. The diagnosis of an ependymoma was supported by evidence of typical perivascular pseudorosettes which stained positive for glial fibrillary acidic protein and contained abundant intermediate filaments within the elongated processes by electron microscopy. Flow cytometric study showed a diploid population of tumour cells. This is the first case of an ependymoma arising from the small bowel without any connection to the genital tract, the omentum or with the sacroccygeal area. As is the case with other unusual and ectopic localisations of ependymomas, prognosis of this tumour is difficult to evaluate.

Obesity in obstetrics and gynaecology.

In some countries, the incidence of obesity doubles every 10 years. For the obstetrician-gynecologist, there are many different situations where the patient's excess body weight calls for an adapted diagnostic and therapeutic approach. Obesity does not in itself appear to be a factor lowering fertility. However obesity-induced hormone disorders could contribute, in certain cases, to biological imbalance and thus favor the development of ovulation dysfunction. Pregnancy in obese women should be managed as a high risk pregnancy. The incidence of gestational diabetes and hypertension is increased. Macrosomatia is frequent. There is a 2- to 3-fold increase in the rate of cesarean sections with more complications. Fetal morbidity does not appear to be changed when maternal weight gain is limited. With obesity, there is an increased risk for breast and endometrial cancer due, for most authors, to elevated levels of circulating estrogens resulting from aromatization of male sex steroids in adipose tissue and decreased levels of sex hormone-binding globulin. Anesthesia and surgery in obese patients can be problematic and special care must be taken to prevent further morbidity. Laparoscopic surgery is possible under certain conditions, although its role remains to be determined. Prescription of hormone replacement must take into consideration several parameters which determine its usefulness and surveillance. Obesity is not a contraindication for hormone replacement therapy but is frequently a non-indication.

In vitro fertilization in women over 40 years of age. A study on retrospective data for eight years.

A retrospective (1987-1995), single-center study was conducted to evaluate the IVF success rate in women who were 40 years and over. Controls were randomly selected patients who were 35 years or younger from the same center. The main evaluation criterion was the number of pregnancies initiated in each group and especially the number of full-term deliveries (take-home baby rate). Differences were considered as statistically significant for P < or = 0.05: A total of 194 IVF attempts in women 40 years or over were compared to 209 attempts in the control group. The mean ages of the two groups was 40.9 vs. 29.3 years (P < 0.001). The duration of follicle stimulation was 12.9 vs. 13.1 days (not significant, NS). The number of ampules was 29.6 vs. 29.2 (NS). Serum estradiol levels were 1435.8 vs. 2020.8 pg/ml (P < 0.001). Oocytes: 4.6 vs. 7.3 (P < 0.001). Embryos: 1.7 vs. 2.8 (P < 0.0001). Full-term deliveries: 3.6 vs. 13.4% (P < 0.05). Better oocyte retrieval was achieved (5.3 vs. 3.3; P = 0.001) in the group that was 40 years or over, but there were no differences in the rate of embryo transfer (1.9 vs. 1.3; NS) and full-term deliveries (4.2 vs. 2.9%) in a long protocol compared to a short one. The results of the study are similar to those found in the literature. Indications for standard IVF without oocyte donation should be carefully thought out and couples should be warned of the low success rate.

[Prolactinoma: from quest of pregnancy to delivery]. / Adénome à prolactine : du désir de grossesse à l'accouchement.

Prolactinoma is the most frequent hormone-secreting pituitary tumor (100 for million patients) and a major cause of both female and male reproductive function disorders. Physician, gynecologist, urologist and sexologist can face this situation during their career. As part of the fertility restoration, treatment gives very satisfactory results. With adequate management, most women are expected to achieve successful pregnancies. The natural history of these tumors during pregnancy depends on their size with a risk of a clinically relevant estimate between 5 to 30 %. Their management is complex, requiring finding balance between effects of pregnancy on tumor growth and potential risks of overtreatment on fetal development. The aim of this study is to discuss the management of prolactinoma on woman before, during and after pregnancy, and to evaluate the medical and surgical alternatives regarding the actual literature.

[Comparison between two analgesic protocols on IVF success rates]. / Comparaison de deux protocoles antalgiques utilisés au cours de la ponction folliculaire sur les taux de réussite en fécondation in vitro.

OBJECTIVES: Analgesic protocols administered before a follicular puncture under local anesthesia are well tolerated when using NSAIDs, but we still do not know their possible impacts on in vitro fertilization (IVF) outcomes. MATERIAL AND METHODS: A retrospective monocentric study using two consecutive temporal cohorts of patients was conducted to compare two analgesic protocols: paracetamol/alprazolam (P/A), then nefopam/ketoprofen (N/K). RESULTS: We demonstrated that biochemical pregnancy rate and the others outcomes of IVF are not significantly influenced by the type of analgesic protocol used. CONCLUSION: The protocol N/K enhances patient comfort without jeopardizing the IVF success rates.

[Quality of transfer. Biologist and clinician's point of view]. / Qualité du transfert. Point de vue du biologiste et du clinicien.

Embryonic transfer is one of the briefest procedures in the long-lasting chain of events occurring during an infertility treatment. Embryo transfer is, however, one of the most crucial steps in assisted reproductive technologies. The realization of this ultimate gesture involves the control of numerous parameters that exert an impact on its success. These various influential factors engage the multidisciplinary team: biologist, clinician... to permanently search for ways to optimize embryo transfer outcome.

[Reproduction techniques and infectious risks: study of practices in French centers in 1997]. / Assistance médicale à la procréation et risques infectieux: enquête sur les pratiques des centres français en 1997.

In the absence of specific legislation or consensual recommendations in France regarding the routine screening of infectious transmissibility risk before intra-couple medically assisted procreation (MAP), an inquiry about the practice of screening management in France has been performed. 500 questionnaires were sent, and 104 answers were received. The results of such inquiry coming from 62 private and 42 public centers are the subject of this paper.

[Evaluation of risks of HIV transmission during medically assisted reproduction]. / Evaluation des risques de transmission du VIH au cours des PMA.

HIV transmission risks were specified during infertility treatment. An investigation was performed by gynecologists who work in IVF. Most of gynecologist refuse to treat infertility in these cases.

[Simultaneous pregnancy in each cavity of a bicornuate bicervical uterus with a double vagina]. / Grossesse simultanée dans chaque cavité d'un utérus bicorne bicervical avec vagin double.

A case of twin pregnancy in a bicervical uterus with double vagina is reported. The malformation was known before conception. Caesarean section was performed for premature rupture of the membranes at 34 weeks. This enabled the extraction of two low-birth-weight premature infants free of any particular pathology. The possibility of twin pregnancy in a bicervical bicornuate uterus is 1/1,000,000 and implies the maturation of at least two oocytes. This is a high risk pregnancy. Spontaneous abortions, prematurity (40%), low-birth-weight (25%) are the most notable complications. Although the probability of dynamic dystocia is multiplied by 7, vaginal delivery is not excluded when the obstetric past history is satisfactory and the presentation of both twins cephalic. Caesarean involves hysterotomy of each horn and raises no special technical problems. Double delivery increases the risk of hemorrhage.

[Umbilical endometriosis. A case report]. / Endométriose ombilicale. A propos d'un cas.

Umbilical endometriosis is a rare site of the disease. The authors report a case of umbilical endometriosis only. Umbilical involvement is estimated at 0.5 to 1% of all site of the disease. This is a disorder affecting women of childbearing age, with a mean age of about 40. Medical treatment by progestogens or Danazol is inconstantly and partially effective regarding umbilical endometriosis. Surgical excision remains the only effective treatment: omphalectomy with wide removal of the tumor and reconstruction of an umbilicus. Surgery enables histologic study and, in the presence of suggestive symptomatology, search for and treatment of other genital sites.

[Thrombophlebitis of the ovarian vein. New therapeutic approach]. / Thrombophlébites de la veine ovarienne. Nouvelle attitude thérapeutique.

The authors report two cases of puerperal right ovarian vein thrombophlebitis (POVT) with floating thrombus in the inferior vena cava (IVC). The originality of this report lies in the first line surgical treatment approach. POVT is recognized as presenting usually within the first week post-partum after about 0.05% of deliveries. The syndrome consists of lower abdominal or flank pain, unexplained fever and a tender abdominal mass. Abdominal or pelvic findings are often scanty. In some cases, the thrombus may extend to the inferior vena cava, leading to the risk of pulmonary embolism or low grade renal insufficiency. Diagnosis has been difficult in the past. Since acute appendicitis is the commonest differential diagnosis, laparotomy is frequent. CT scan provides a readily available, accurate, non invasive technique for the diagnosis of POVT. Criteria are: enlargement of the vein, a low density lumen within the vessel wall and a sharply defined vessel wall enhanced by contrast media. The treatment of POVT is initially medical. Antibiotics should be given to cover the commonest infecting organisms. Heparin should also be prescribed at therapeutic IV doses to be followed by oral anticoagulants for at least six weeks. Surgery is usually only recommended when the patient remains symptomatic despite proper medical management, develops clinical, scan or arteriographic evidence of pulmonary embolism, or cannot be anticoagulated. The recommended surgical technique is to clamp the anastomosis of the ovarian vein with the vena cava.(ABSTRACT TRUNCATED AT 250 WORDS)