Laparoscopic double sacrocolpopexy : a failure for the posterior compartment?

AIM: To evaluate the anatomical and functional outcomes of laparoscopic sacrocolpopexy using an anterior and a posterior prolen mesh, for the cure of genital prolapse. STUDY METHODS: This is a consecutive five year prospective observational study in which 80 patients presented with at least a Stage 2 apical prolapsed (Baden and Walker), with an anterior or a posterior vaginal wall prolapse, who underwent a double sacrocolpopexy. Two prolen prosthesis (Pro-swing® - Textile Hi-Tec™, Fr) were used for this technique. Pre- and post-operative data referring to prolapse quantitation (Baden and Walker classification), scores of quality of life and sexuality (French equivalent of the Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ) and Pelvic organ prolapse-urinary Incontinence-Sexual Questionnaire (PISQ-12) were compared. Peri and postoperative complications constituted the secondary outcome measures. RESULTS: At 2 years after surgery, all patients were accessible for evaluation. For these patients, the anatomical success rates (Stage 0 or 1) on the apical, anterior or posterior compartments were respectively 100%, 97.5% and 89.3%. On the functional level, all the scores of quality of life and sexuality were significantly improved except anorectal scores CRADI and CRAIQ. CONCLUSIONS: This study confirms that PFC is an effective technique for the treatment of the urogenital prolapsed. On the anatomical levelresults are less good for the posterior compartment. On the functional level, our results do not plead in favour of an improvement of anorectal disorders.

Basal follicle stimulating hormone level correlated to age is a good prognostic criterion for the outcome of intracytoplasmic sperm microinjection.

BACKGROUND: Age and increased FSH serum level in women are prognosis criteriae associated with decreased fertility. OBJECTIVE: The aim of this study was to investigate whether age-specific FSH concentration can be a predictor of the outcome of ovarian stimulation in women undergoing IVF. METHODS: A total of 676 women undergoing their first IVF cycle over a 3-year period were included in this retrospective cohort study. Patients were grouped according to age (< or ≥  38 years), and within each age range, patients were grouped into bFSH quartiles (< or ≥  9.6 mUI/L). We have considered four study groups: group A (Age < 38 years and FSH < 9.6 m UI/l), group B (Age < 38 years and FSH ≥ 9.6 m UI/l), group C (Age ≥ 38 years and FSH < 9.6 m UI/l), group D (Age ≥ 38 years and FSH ≥ 9.6 m UI/l). The outcome measures in each group included: consumed quantity of gonadotrophin, poor response, cycle cancellation, oocyte yield, number of embryos obtained, embryonic quality (grade 1 embryo), as well as, fertilization, implantation, clinical pregnancy and childbirth rates. Analysis of the Results compares laboratory parameters and ICSI Results, based on a statistical analysis that is essentially descriptive. RESULTS: High bFSH levels in young patients (< 38 years) predicts a higher poor response (p < 0.0001), higher stopped cycles (p < 0.0001), lower oocyte yield (p < 0.0001) and lower embryos obtained (p < 0.0001) in IVF cycles but does not translate to either lower pregnancy, childbirth or implantation rates. In old women high FSH level does not influence ICSI outcome but may increase poor response (p <0.01) and stopped cycles (p < 0.0001). In each age group, the rate of spontaneous miscarriage does not increase according to FSH level. The pregnancy rate and child birth rate are better in young women with high FSH levels than in older women with normal FSH levels (p < 0.05). CONCLUSION: The findings of this study suggest that basal FSH concentrations when correlated to age is a good predictive factor of ovarian response for assisted reproductive treatment. In young women a high FSH level may affect laboratary parametres but not pregnancy rate. In old women normal FSH level does not improve ICSI outcome but may increase "avorted" cycles. Pregnancy rate and child birth rate are better in young women with high FSH levels than in older women with normal FSH levels.

[Transvaginal cervico-isthmic cerclage using polypropylene tape: Surgical procedure and pregnancy outcome]. / Cerlage cervico-isthmique par voie vaginale avec bandelette de polypropylene. Technique chirurgicale et devenir des grossesses.

OBJECTIVE: To assess the efficacy of performing transvaginal cervicoisthmic cerclage (CIC) using synthetic tape in prevention of preterm labor in high-risk women. PATIENTS AND METHODS: A retro and prospective analysis of 23 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of two or more losses in the second trimester and/or prior failure of Hervet or Mac Donald's cerclage. Cerclage was at 14 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. RESULTS: The median age of the patients in this series was 33.2 years (range 25-41 years). No intra-operative complication occurred. The median operating time was 36.9 minutes (±4.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Term birth rate was 57.5% (3% before CIC; p<0.0001). Pregnancy loss in the second trimester was 7.8% (66% before CIC; p<0.0001). Preterm birth rate was 23.1% (31% before CIC). Birth at less than 28 weeks occurred in only 1patients (3.7%) (10.7% before CIC). In one case, the tape has been removed later because of secondary displacement. Amniotic fluid infection occurred in 4 cases (5%). Living birth rate was 80.7% (21% before CIC) and no neonatal death occurred (13% before CIC). CONCLUSION: Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.

Failure of in vitro fertilization: prognosis criteriae.

BACKGROUND: age, obesity and increased FSH serum level in women are prognosis criteriae associated with decreased fertility and adverse Assisted Reproductive Technologies (ART) outcomes. OBJECTIVE: To assess the effect of age, FSH and BMI on pregnancy rate in ICSI. METHODS: A retrospective and comparative study of 500 women who underwent ICSI cycle during the study period from January 2004 to December 2005. Age, FSH and BMI were compared in two groups of patients: Those achieving a pregnancy: The "pregnancy+" group and those failing to have a pregnancy: The "pregnancy-"group. For each of previous parameters ROC curve and logistic regression study were performed. RESULTS: age was significantly lower in "pregnancy+" group (32,4±3,9 years vs 33,7±4,8 ans ; p=0,005). Analysis of ROC curve and logistic regression study show that for age, the most discriminative cut-off for predicting pregnancy is 38 years (Se=7,5%, Sp=75,6%) (AUC=0,572; p=0,02) (OR=2,1 ; LR+=6,7 ;IC[1 ;1,4] ; p0,009). FSH was significantly lower in "pregnancy+" group (5,5±1,8UI /L vs 6,2±3UI/L, p=0,003). Analysis of ROC curve and logistic regression study show that for FSH, the most discriminative cut-off for predicting pregnancy is 9UI/L (Se=3,7%, Sp=85.2%) (AUC=0,539 ; p=0,03) (OR=3,6; IC[1,4 ;9,3]; LR+ =10,1; p=0,003). BMI was also significantly lower in "pregnancy+" group (24,7± 3,6 kgm-2 vs 27,1±4,5 kgm-2 ; p<10-3). The most discriminative cut-off for predicting pregnancy is 25,4 kgm- 2 (Se=31,7%, Sp=33,3%) (AUC=0,663 ; p<10-3) (OR=4; IC[2,1 ;7,7]; LR+ =19,38; p<10-3). CONCLUSION: age, FSH and BMI affect markedly the prognosis of ICSI. We found significantly lower Pregnancy rates in older women (> 38 years), in women with elevated FSH (> 9UI/L) or elevated BMI (> 25,4 kgm-2). Our results can be used when counseling and before including patients in an IVF program, to give them probability of success and weight loss required to optimize chances of pregnancy.

[Short vs long agonist protocols in poor responders undergoing IVF]. / Résultats de I'ICSI chex les mauvaises répondeuses : protocole court vs protocole long.

AIM: Compare among poor responders: stimulation results, laboratory parameters and the final IVF results by assessing 2 different stimulation protocols: the long agonist protocol and the short agonist protocol. METHODS: An analytical retrospective study carried out over of period of 2 years: January 2006 and December 2007. During this period, a total of 1192 IVF cycles of ICSI type were performed in 892 patients. INCLUSION CRITERIA: short agonist or antagonist stimulated patients protocols and presenting two of the three following criteria: 1- Patients aged more than 38 years with an FSH plasmatic rate on the 3rd day of the cycle 9.5 UI/ml. 2- Antral follicle count (AFC) 5 for both ovaries. 3- Failure of anterior ovary stimulation: abandonment of cycle or 3 oocytes at data collection in a previous cycle. EXCLUSION CRITERIA: PCOS or single ovary. RESULTS: 65 patients, undergoing 92 attempts of ICSI cycles have been included in this study. Long agonist protocol was performed in 48 cases and Short agonist protocol was performed in 44 cycles. Both groups were comparable as to age (40,09 ± 6, 59 vs 41, 04 ± 1,71 years; NS), BMI (25,2±3,92 vs 25,35±4,09 Kgm-2 ; NS), infertility type (primary 41% vs 59%;NS ; ou secondary 58% vs 40,9% ; NS), FSH (9,98±2,42 vs 10,01±2,75 ; NS) and antral follicle count on day 3 (4,13±1,12 vs 3,8±1,16 FA ; NS). The estradiol rate, dosed on the onset day was significantly higher in the short protocol group (1534,27±1034,34 vs 1133,31±1053,58 pg/ml; p=0.034). However, the consumed quantity of gonadotrophins was lower in the short protocol group (1550±235,45 vs 1725,55±450,35 UI, p=0.01). A total of 13 cycles was stopped: 9 times for the long protocol (18.75 %) and 4 times for the short protocol (9.09 %) with statistically significant difference. The number of collected oocytes was significantly higher in the short protocol (7,64±3,70 vs 4,55±2,01, P<0.001). We significantly obtained more embryos in the short protocol (4,31±2,9 vs 2,16±2,2 embryos ; p<0,001). With higher number of grade 1 embryos (2,61 vs 1,14 embryons; p<0.001).The results in terms of pregnancy and living births show no significant difference between the 2 groups. CONCLUSION: The short protocol is more suited to the profile of ovarian poor responders. The long protocol standard has no place in poor responders. However, the long micro dose protocol and the long degressed micro dose protocol yield results at least equivalent to the short protocol.

[The laparoscopic Vecchietti technique for vaginal agenesis]. / La technique de vecchietti par laparoscopie pour agénésie vaginale.

AIM: To evaluate feasibility and surgical long term, anatomic and functional results of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis. METHODS: We reported six cases of patients with a Mayer-Rokitansky-Küster-Hauser syndrome. The surgical procedure was the same for all patients. The results have been evaluated on the operative time, the intra and postoperative complications, the antalgic drugs consumption, the transit recovery, the hospital stay, the neovagina length, and the post operative sexual satisfaction. RESULTS: The mean operative time was 77.5 minutes. The mean paracetamol consumption was: 9.8 g. The mean transit recovery, and hospital stay were: 2 days, 9.8 days, respectively. No intra or postoperative complication occurred. The mean neovagina length evaluated at one year follow-up visit was 7.5 cm. Five patients have regular sexual activity. Three of them reported sexual satisfaction and showed having orgasm (clitoral: 3 cases, clitoral and vaginal: 2 cases). The 2 remaining patients reported dyspareunia. The global satisfaction index was of 71.6%. CONCLUSION: This surgical technique appeared to be safe, effective and reproducible. It allowed to obtain a neovagina with enough length and have encouraging results on sexual functioning Laparoscopy reduces the psychological and aesthetic consequences of surgery, especially for these young patients already distressed by their malformation.

[Clinicals and biological aspects of ICSI cycles on patients with polycystic ovary syndrome]. / Aspects cliniques et biologiques de l'ICSI chez les femmes porteuses du syndrome des ovaires Polykystiques.

AIM: To analyse clinical et biological pecularities of Polycystics Ovarian Syndrome (PCOS) patients enrolled on ICSI cycles and compare them to normo-ovulatory women. METHODS: 100 controlled ovarian stimulation cycles for ICSI in women with PCOS and 200 cycles in normo-ovulatory women. RESULTS: There was no significant difference in term of cancellation rate (5.5% in PCOS group vs 5%; NS). The mean number of follicles was higher in patients with PCOS (18.1 +/- 8.5 vs 9.4 +/- 5.5; p < 0.05). Oocyte mature rate and fertilization rate were higher in PCOS group (67% vs 52%; p < 0.05) (75% vs 63.7%; p < 0.05) respectively. Grade 1 embryo rate was significantly higher in PCOS group (69% vs 53%; p < 0.05). Implantation rate (16.6% vs 12.1%; NS) and clinical pregnancy rate per transfer (31.5% vs 22.2%; NS) did not differ statistically in the two groups. Miscarriage rate was higher in PCOS group but this did not reach the statistical significance (20% vs 7.1%; NS). 11 cases of Ovarian hyperstimulation syndrome occurred in PCOS group versus 4 on normo-ovulatory group. CONCLUSION: Use of ICSI as fertilization technique was correlated with good biologic parameters on PCOS patients with better fertilization rate and embryo quality and similar pregnancy rate comparing to normo-ovulatory women. However, it still be great concern about high risk of miscarriages and Hyperstimulation ovarian syndrome.

[Increased risk of early pregnancy loss and lower live birth rate with GNRH antagonist vs. long GNRH agonist protocol in PCOS women undergoing controlled ovarian hyperstimulation]. / Augmentation du taux de fausses couches spontanees precoces et diminution du taux de naissances vivantes avec le protocole antagoniste de la GNRH versus agoniste long chez les patientes porteuses d'un syndrome des ovaires polykystiques.

AIM: to compare standard long GnRH agonist protocol (Triptorelin) and GnRH antagonist regimens (Cetrorelix) in polycystic ovary syndrome (PCOS) patients undergoing controlled ovarian stimulation (COS) for ICSI cycles. METHODS: Retrospective case-control study. 106 PCOS patients undergoing COS for ICSI with long GnRH agonist protocol (Triptorelin) were matched with age and BMI to 106 PCOS patients undergoing COS for ICSI with GnRH antagonist (Cetrorelix) during the same period. Ovarian stimulation with recombinant follicle stimulating hormone (rFSH) was used in the two groups. Oral contraceptive pill pretreatment was used in all patients undergoing ovarian stimulation using GnRH antagonists. ICSI was performed for male infertility in all cases. The main outcome measures evaluated were: cancellation of the cycles, number of aspirated follicles, oocyte maturity, fertilization rate, Embryo quality, pregnancy and implantation rates, clinical abortion rate, multiple pregnancy rate and the live birth rate rate. Kchi2 test and t Student test were used for differences between normo-ovulatory and PCOS patients and the limit of significance was set at p < 0.05. RESULTS: There was no significant difference in term of cancellation rate (2.8% vs 1.8%; NS). Duration of gonadotrophin stimulation (9.7 +/- 0.7 vs. 11.2 +/- 1.9 days; p < 0.001) and gonadotrophin consumption (2209.0 +/- 548.3 vs. 1411.1 +/- 217.9 UI: p < 0.001) were significantly decreased with GnRH antagonist. The mean oestradiol level on the triggering day was significantly higher in the agonist group (3347.85 +/- 99 vs. 2354.45 +/- 839; p < 0.001 ).A fall in LH level of > or = 50% from stimulation day 8 (S8) to S1 was observed in GnRH antagonist group. Risk of ovarian hyperstimulation syndrome (OHSS) was significantly decreased with GnRH antagonist (1.8% vs 10.7%; p = 0.01). The mean number of retrival oocytes (15.9 +/- 5.9 vs. 17.3 +/- 8.3; ns) and the mean number of mature oocytes (11.43 +/- 4.2 vs. 11.91 6.4; ns) were similar in the two groups, fertilization rate (73.3% vs 75.8%; NS), mean number of grade 1 and 2 embryos (6.3 +/- 2.7 vs. 6.9 +/- 3.9; NS), mean number of transferred embryos (1.9 +/- 0.7 vs. 1.8 +/- 0.7; NS), implantation rate (13.3% vs. 18.45%; ns) and clinical pregnancy rate per transfer (28.6% vs 31.1% ; NS) did not differ statistically in the two groups. Twin and triplet pregnancies rates were also similar in the two groups (7.1% vs. 9.3%; NS) and (3.5% vs. 3.1%; NS) respectively. Live birth rate (12.2% vs. 20.7%; p < 0.001) was significantly lower in GnRH antagonist group and miscarrage rate was significantly higher in this same group (42.8% vs. 18.7%; p < 0.001). CONCLUSION: GnRH antagonist protocol is a short and simple protocol with a significant reduction in incidence of OHSS and amount of gonadotrophins. However, GnRH antagonist protocol provides a lower live birth rate and an increased risk of early pregnancy loss compared to the GnRH agonist long protocol. Further studies are necessary for more solid conclusions.

[A retrospective study of 339 ICSI cycles: assesment of the two first years of activity of the Assisted Reproductive Technology Center of Aziza Othmana Hospital]. / Etude retrospective de 339 cycles d'injection intra cytoplasmique de spermatozoïdes: bilan des deux premières années d'activité de l'unité d'assistance médicale à la procréation de l'hôpital Aziza Othmana.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) is a micromanipulation-assisted fertilization, whereby one spermatozoon is injected into the oocyte cytoplasm. Initially, ICSI was the treatment of choice for male factor infertility. However, because of the high fertilization and pregnancy rates achieved with this technique, the scope of the procedure has been widened to include couples with other causes of infertility. AIM: The aim of this study was to study the progression of the activity of the assisted reproductive technology's center of Aziza Othmana's Hospital and the ICSI results during the first two years. METHODS: Our study included 269 infertile couples who underwent 339 ICSI cycles between 1st May 2001 and 30 April 2003. Cycles with no oocytes obtained at the follicular aspiration and women aged over 40 years were excluded from this study. RESULTS: The number of ICSI cycles progressed in our center: 150 ICSI cycles in the 1st year, 189 ICSI cycles in the 2nd year. The mean number of picked-up oocytes was 8,8 +/- 5,6. The fertilization rate was 62%. The mean number of transferred embryos was 3,1 +/- 1,5. The pregnancy rate per transfer was 32,4%. The miscarriage rate was 28,4%. The take home baby rate was 67,9%. CONCLUSION: The number of couples undergoing ICSI cycles in our center is increasing. The fertilization rates and pregnancy rates in our center are similar to those published in the literature.

Y chromosome microdeletions screening in Tunisian infertile men.

The aim of this study was to establish the prevalence of chromosomal abnormalities and microdeletions on the Y chromosome in Tunisian infertile men with severe oligozoospermia or non-obstructive azoospermia. In cases of azoospermia, we aimed also to correlate histological results after negative testicular sperm extraction with the type of Y chromosome microdeletion. 84 infertile patients and 52 controls were screened for karyotypic abnormalities using G-banding and Yq chromosome microdeletions using multiplex PCR. 7 infertile males (8.3%) carried chromosomal abnormalities and 8 (9.5%) presented Y chromosome microdeletions. The frequency of chromosome abnormalities in azoospermic patients was 11.1% vs 3.3% in the severe oligozoospermic group. Klinefelter syndrome was the most frequent chromosomal abnormalities in 85.7% of cases. Only one patient had a 46,X,del Y/45,X karyotype. The frequency of microdeletions was 11.1% in the azoospermic group and 6.7% in the severe oligozoospermic group. Six out of 84 (7.14%) of the infertile patients had microdeletions in the AZFc region, one azoospermic male had microdeletion in the AZFbc regions and one in the AZFb region, no deletions in the AZFa region. Among the 6 azoospermic patients with microdeletions: 4 had Sertoly cell only syndrome (SCOS) and 2 had maturation arrest (MA). Genetic abnormalities in infertile Tunisian patients are similar to those reported in other countries. The knowledge of the existence of genetic abnormalities and microdeletions is useful to provide a correct diagnosis and it allows the clinician to refer the patient to adequate assisted reproduction technique and examine the value of testicular biopsy pertinence.

[Use of GnRh antagonist (Cetrorelix) in controlled ovarian hyperstimulation in women with polycystic ovary disease]. / Utilisation des antagonistes de la GnRH (Cetrorelix) dans la stimulation plurifolliculaire chez les patientes porteuses d'une dystrophie ovarienne micropolykystique.

OBJECTIVE: to evaluate the results of the use of GnRH antagonist (GnRH ant) cetrorelix and GnRH analog (GnRH a) in two matched groups of OPK ICSI patients in a retrospective matched pair analysis. METHODS: patients (n = 201 ) were stimulated with recombinant FSH (rFSH). In group A (n = 98), a dose of 3 mg of Cetrorelix was administered when follicles reached a diameter of > 14 mm. Patients in group B (n = 103) were first desensitized with GnRHa triptorelin long protocol. RESULTS: The mean lenth of stimulation, and the dose of FSH required per patient were significantly higher in group B: (11.2 +/- 1.9j vs 9.7 +/- 0.7j p < 0.001) and (2209.0 +/- 548.3 vs 1411.1 +/- 217.9: p < 0.001) respectively. The mean E2 level on day of hCG administration was significantly higher in the patients of group B (3347.85 +/- 99 vs 2354.45 +/- 839: p < 0.001), however, a progressive increase in serum E2 concentration during the cycle were noted in both groups. A median of 15.9 +/- 5.9 and 17.3 +/- 8.3, (p = 0.159) retrieved oocytes per patients was obtained respectively in group A and B. The median of mature oocytes per patient were similar in both groups (11.43 +/- 4.2 in group A vs 11.9 +/- 6.4 in group B: p = 0.526). Pregnancy rate were better in group B (31.1 vs 28.6% p = 0.69). No severe ovarian hyperstimulation (OHSS) occurred in group A vs 3 cases in group B. CONCLUSION: GnRHant and GnRHa provide comparable results in OPK patient, while GnRHant allows a higher flexibility in treatment, a lower dose of FSH required and a shorter period of stimulation.

[Thermal balloon endometrial ablation for dysfunctional uterine bleeding: technical aspects and results. A prospective cohort study of 152 cases]. / Thermoablation de l'endometre par ballonnet pour menometrorragies fonctionnelles. Etude prospective d'une cohorte de 152 cas.

BACKGROUND: Thermal balloon endometrial ablation is a new operative technique recently proposed in the treatment of dysfunctional uterine bleeding. AIM: To evaluate the efficacy of thermal balloon endometrial ablation in the treatment of dysfunctional uterine bleeding, and to identify the possible predictive factors for a successful outcome. METHODS: A prospective study was conducted including 152 patients with chronic abnormal uterine bleeding refractory to medical treatment. All patients were treated by thermal balloon endometrial ablation (Thermachoice, Gynecare) between January 1, 1996 and December 31, 2003. patients were included if their uterine cavities sounded to less than 12 cm and had undergone hysteroscopy, pelvic ultrasound and endometrial biopsie showing no structural or (pre) malignant endometrial abnormalities. INTERVENTION: A balloon catheter was placed through the cervix and after inflation in the endometrial cavity with 5% dextrose in water, was heated to 87 +/- 5 degrees C. No one required cervical dilatation. Balloon pressures were 160 to 170 mm Hg. All patients underwent 8 minutes of therapy. RESULTS: The average patient was 47 years (range: 30-62 years) and was followed for a mean of 3 years and 7 months (range: 6 months - 8 years). 31.6% of women reported amennorhea, 16.5% hypomenorrhea and 21% eumenorrhea. Menorrhagea persisted in 11.2% of patients. No intraoperative complications and minor postoperative morbidity occured in 10.5% of patients. Three prgnancy complicated by spontaneous abortions were reported after the treatment. A total of 78% of women reported overall satisfaction with the endometrial ablation procedure and 18% were dissatisfied. 17.8% of patients underwent hysterectomy within 1 to 5 years of balloon endometrial ablation. Increasing age and menopause were significantly associated with increased odds of success (p < 0.05). CONCLUSION: Thermal balloon endometrial ablation is a simple, easy, effective, and minimally invasive procedure in menhorragic women with no desire for further childbearing. The chance of successful treatment is thightly depinding of several factors such as increased age and menopause, that shows the importance of patients selection. Although rare, pregnancy after endometrial ablation is possible. Women of reproductive age should have a post operative contraception method.

[Are there any predictive factors for successful intracytoplasmic sperm injection. Statical analysis of 339 cycles]. / Existe-t-il des facteurs predictifs du succes de la micro-injection intracytoplasmique de spermatozoide. Analyse statistique a propos de 339 cycles.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) outcome is tightly depinding of male and female factors. The assesment of several clinical and laboratory parameters may predict results of ICSI. AIM: This study aimed at investigation wich parameter(s) may predict successful intracytoplamic sperm injection for infertility. METHODS: We restrospectively analysed patients who had intracytoplasmic sperm injection for male or female factor infertility. The clinical and laboratory factors that influenced the fertilization, pregnancy and implantation rates were also analysed. Three hundred and thirty nine cycles in 269 couples were analysed. Women's age, etiology of infertility, duration of infertility, number of retrived oocyts, sperm parametres and number of transferred embryos were evaluated. RESULTS: Optimal pregnancy rates were observed in women aged 25-35 years, with gradual decline with advanced age (p=0.049). The pregnancy/transfer rate was statistically depending of, the numbre of retrieved oocytes (p<0.001) and the numbre of transferred embryos (p<0.001). However, transferring more than three embryos was no significatively superior to two or three. Etiology of infertility had no influence in fertilization and pregnancy, but may predict the implantation rate (p=0.042). The duration of infertility was of no value in predecting the fertilization, implantation or pregnancy rates, and neither seam's to be the sperm parameters. CONCLUSION: The only statitically significant variables of ICSI outcome were women partner's age, numbre of retrived oocytes and numbre of transferred embryos.

[Intrauterine insemination with conjoint semen. How to increase the success rate?]. / L'insémination intra-utérine par sperme du conjoint. Comment optimaliser les chances du succès?

BACKGROUND: Intrauterine insemination is usually proposed as the first line therapy for infertility related to cervical hostility, male factor, unexplained infertility or mild endometriosis. The overall succes rate of IUI is about 10-20% clinial pregnancy per cycle. The Aim of this study is to evaluate factors that increase the succes rate of IUI. METHODS: we restrospectively analysed 206 cycles of IUI with partner's semen in 138 infertile couples. The clinical and laboratory factors that may influence the pregnancy rates were analysed: women's age, etiology of infertility, duration of infertility, ovarian stimulation, day of hCG and sperm parametres. RESULTS: The per-cycle clinical pregnancy rate was of 14.56%. Optimal pregnancy rates were observed in less than 38 years old women (18.29% vs 9.52%, p<0.05). The succes rate was statistically depending of the number of IUI cycles until three (p<0.05), the day of hCG (p<0.05) and the sperm count after conventionally prepared semen (p<0.05). Sperm parameters was of no value in predecting the pregnancy rates, and neither seam's to be the total dose of administrated Gonadotrophin or the etiology of infertility, but it seams that, when a cervical factor or PCO were involved, the succes rate is higher. Besides, getting three or more than three follicles may increase the succes rate but expose to a warrying risk of multiple pregnancy. CONCLUSION: According to this study, the only statitically significant factors that are associated with successful IUI were, women partner's age (<38 ans), number of IUI cycles (during the first three IUI cycles), day of hCG (>J13) and sperm count after conventional semen preparation (>1.106/mL).

[Non surgical management of ectopic pregnancy]. / La prise en charge non chirurgicale des grossesses extra-uterines.

During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantialy decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy with Methotrexate or expectant management. This therapeutic transition from surgical emergency to non surgical managment has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to expectant or medical managment versus those who are at high risk of rupture and require surgery. We have reviewed the scientific literature on ectopic pregnancy published over the past 20 years, with the aim to assess the value of non surgical managment of etopic pregnancy. Predictor factors of expectant managment are discussed. Medical therapy with methotrexate: results, indications, Unpleasant side effects and complications are detailed. Several protocols are defined and therapeutic supervision is etablished. The authors offred several recommandations for OB/GY wich will optimize the effectivness of non invasive methods for treatment of ectopic pregnancy.

[Hysterosalpingography in the assessment of tubal patency]. / Apport de l'hysterosono-salpingographie de contraste dans l'exploration de la permeabilite tubaire.

UNLABELLED: A major cause of infertility in women is occlusion of fallopian tubes. Hysterosalpingography (HSG) and laparoscopic chemoperturbation are the two traditionnal diagnostic options for tubal assessment. Recently hysterosalpingo-contrast sonography (HyCoSy), an ultrasound-based technique that uses as a contrast agent fluid injected into the fallopian tubes via the uterine cavity, is gaining importance as an alternative procedure. The aim of this study is the analysis of several technic and semiologic aspects of HyCoSy. RESULTS: advantges and limits are discussed throughout a review of literature. HyCoSy is a well tolerated outpatient technique. When performed by experienced operators, it servs as a valable first line screening test of tubal patency in low fertility women. It can confirme that tubes are patent and permits to select patients who need more invasive procedures.

[Juvenile granulosa cell tumor of the ovary. A case report]. / Tumeur juvenile de la granulosa ovarienne. A propos d'une observation.

Juvenile granulosa cell tumors of the ovary (JGCTs) are a rare form of neoplasm that makes up less than 5% of ovarians tumors in childhood and adolescence. About 90% are diagnosed in stage I (FIGO) with a favorable prognosis, whereas those at higher stages have a less favorable outecome. The authors describe a juvenile granulosa cell tumor expressed by an early pseudopuberty occurring in a 6 year old child. Clinically, an endocrine syndrome was associated with a pelvic mass. Hyperoestrogenia and serum alphafoetoprotein level were biologically detected. Tumor was localized strictly to the ovary, so conservative surgery was applied and proved sufficient to remove all tumor tissue. Histological examination showed typical microscopic aspect of a juvenile granulosa cell tumor. The patient is well, 14 years after surgery with a normal growth and mental developpment.

Corrigendum to "Extensive Thrombosis of the Inferior Vena Cava and Left Renal Vein in a Neonate".

[This corrects the article DOI: 10.1155/2015/569797.].