Cumulative parenthood rates in 1735 couples: impact of male factor infertility.

BACKGROUND: Most studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples by taking mainly the female factor into account. However, infertility is a couple's concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children. METHODS: We carried out a follow-up study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre and after discontinuation from 2000 through 2008. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant. RESULTS: We were able to contact 65% of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60-67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24-39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45-50) in the 1735 couples. CONCLUSIONS: More than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the woman's age, and these findings should encourage couples to attempt parenthood earlier.

Contraceptive efficacy of intrauterine devices.

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

Polyorchidism: presentation of 2 cases, review of the literature and a new management strategy.

OBJECTIVES: To present 2 cases with polyorchidism, to review the literature about polyorchidism, and to propose a rational therapeutic algorithm. METHODS: In our institution, we encountered 2 patients with polyorchidism: The 1st patient had bilateral double testis with testicular torsion, and the 2nd patient presented with an indolent scrotal mass. We also performed a literature search (PubMed) for other reports of polyorchidism. RESULTS: Polyorchidism is a rare congenital anomaly that is not well known by most urologists. So far, as illustrated by our 2 cases, the management of polyorchidism is rarely conservative, and usually the supernumerary testis is removed without any evidence supporting this attitude. Rare cases are complicated by torsion (case 1), cryptorchidism, or testicular neoplasm. In case of torsion, the conservative approach depends on the viability of the twisted testis. In case of cryptorchidism, notably in children or young adults, conservative management should be proposed, if technically feasible. In case of signs of malignancy, orchiectomy must be performed. CONCLUSIONS: Conservative treatment is advised in all uncomplicated cases. Complicated cases need a careful management, but several situations can be managed conservatively. Based on the literature, we propose a simple, rational therapeutic algorithm.

Sperm cryopreservation incidence in men with testicular cancer: towards a stabilization in testicular cancer incidence? Results from the CECOS network.

BACKGROUND: Testicular cancer (TC) represents 1% of all new male cancer cases but remains the most frequent cancer in adolescents and young adults in industrialized countries. In this study, we assessed time trends in use of sperm cryopreservation by men with TC from 1990 to 2013 in France. METHODS: We collected data from patients diagnosed with TC who underwent sperm cryopreservation in the French national network of sperm banks. Trends in the incidence of sperm cryopreservation were estimated through two statistical models: the commonly used Poisson regression model and the Verhulst model. RESULTS: Between 1990 and 2013, the overall incidence of sperm cryopreservation rose from 1.73 to 5.57 per 100,000 person-years. Poisson regression predicted an incidence of 9 per 100,000 [95% CI = 8.66-9.34] in 2020. However, since 2005, the observed sperm cryopreservation rate seems to be attenuating. The Verhulst model predicted an incidence of 6 per 100,000 after 2020. CONCLUSIONS: Limitations include the impossibility of analyzing age-standardized incidence. Based on the Verhulst model, results suggest that it is still relevant to follow up TC incidence and sperm cryopreservation in order to confirm or refute the potential decrease already observed in this disease.

CONTEXTE: Le cancer des testicules (CT) représente environ 1% de l'ensemble des cas de cancer chez les hommes, mais il demeure néanmoins le cancer le plus fréquent chez les adolescents et les jeunes adultes dans les pays industrialisés. Dans cette étude, nous avons évalué les variations temporelles des autoconservations de sperme réalisées par les hommes atteints d'un CT entre 1990 et 2013 en France. MÉTHODES: Les données proviennent des autoconservations de sperme réalisées auprès de patients diagnostiqués avec CT, issues du réseau national français des banques de sperme. Les tendances de l'incidence des autoconservations de sperme ont été estimées à l'aide de deux modèles statistiques: la régression de Poisson, couramment utilisée, et le modèle de Verhulst. RÉSULTATS: Entre 1990 et 2013, l'incidence globale des autoconservations de sperme est. passée de 1,73 à 5,57 pour 100,000 personnes-années. La régression de Poisson montre une estimation de l'incidence de près de 9 pour 100,000 [IC à 95% = 8,66-9,34] en 2020. Cependant, depuis 2005, le taux observé des autoconservations de sperme semble s'atténuer. Le modèle de Verhulst estime alors une incidence aux alentours de 6 pour 100,000 après 2020. CONCLUSIONS: Les limites de cette étude comprennent l'impossibilité d'analyser l'incidence standardisée sur l'âge. Sur la base du modèle de Verhulst, les résultats suggèrent qu'il est. toujours et encore pertinent d'étudier l'évolution de l'incidence du cancer du testicule et des autoconservations de sperme afin de confirmer ou non la diminution/stagnation potentielle déjà observée dans cette maladie.

Regulatory identification of BPA as an endocrine disruptor: Context and methodology.

BPA is one of the most investigated substances for its endocrine disruptor (ED) properties and it is at the same time in the center of many ED-related controversies. The analysis on how BPA fits to the regulatory identification as an ED is a challenge in terms of methodology. It is also a great opportunity to test the regulatory framework with a uniquely data-rich substance and learn valuable lessons for future cases. From this extensive database, it was considered important to engage in a detailed analysis so as to provide specific and strong evidences of ED while reflecting accurately the complexity of the response as well the multiplicity of adverse effects. An appropriate delineation of the scope of the analysis was therefore critical. Four effects namely, alterations of estrous cyclicity, mammary gland development, brain development and memory function, and metabolism, were considered to provide solid evidence of ED-mediated effects of BPA.

[Fertility before and after treatment of patients with Leydig cell tumour]. / Fertilité avant et après traitement des patients présentant une tumeur à cellule de Leydig.

OBJECTIVE: To determine the long-term fertility status of patients treated for Leydig cell testicular tumour. MATERIAL AND METHODS: [corrected] In a series of 506 testicular tumours observed in the Midi-Pyrenées region between 1980 and 1998, 17 were Leydig cell tumours (3.3%) and constituted the study population. Andrological records were available for all patients. Information concerning fertility before and after orchidectomy was obtained by validated letter questionnaire. All patients completed the questionnaire. RESULTS: The mean follow-up was 84 months (range: 36-173). The mean age at diagnosis was 32 years (range: 24-51). The presenting symptom was gynaecomastia in 9 cases (53%), enlarged testis in 4 cases (24%), scrotal pain in 2 cases (12%) and male infertility in 2 cases (12%). Before onset of their disease, 13/17 (76.5%) patients had tried to have a child and 6 (46.2%) had successfully fathered a child. After treatment of their Leydig cell tumour, 10/17 (58.8%) had tried to have a child and 7 (70%) were successful. CONCLUSION: The population of men with Leydig cell tumour of the testis is a population with decreased fertility before treatment of the tumour. Resection of the tumour improves this situation, but 3 out of 10 patients remain infertile, indicating the need for semen storage measures in this population.

Sperm cryopreservation in adolescents and young adults with cancer: results of the French national sperm banking network (CECOS).

OBJECTIVE: To determine the feasibility of fertility preservation in adolescent males with cancer. DESIGN: Large multicenter retrospective study of male patients ≤20 years from 23 centers of a national network of sperm banks over a 34-year period. SETTING: Sperm banks. PATIENT(S): A total of 4,345 boys and young men aged 11 to 20 years. INTERVENTION(S): Age, cancer diagnosis, feasibility of sperm banking, and sperm parameters. MAIN OUTCOME MEASURE(S): Description of patients, and success of their fertility preservation. RESULT(S): We observed a mean yearly increase in referred patients of 9.5% (95% confidence interval, 9.1%-9.8%) between 1973 and 2007. Over the study period, the percentage of younger cancer patients who banked their sperm increased, especially in the 11-14 year age group, rising from 1% in 1986 to 9% in 2006. We found that 4,314 patients attempted to produce a semen sample, 4,004 succeeded, and sperm was banked for 3,616. The mean total sperm count was 61.75 × 10(6) for the 11-14 year age group, and 138.81 × 10(6) for the 18-20 year age group. It was noteworthy that intercenter variations in practices involving young patients seeking to preserve their fertility before cancer therapy were observed within this national network. CONCLUSION(S): Our results emphasize the need for decisive changes in public health policy to facilitate the access to reproductive health-care for young cancer patients.

Ectopic pregnancy in Africa: a population-based study.

OBJECTIVE: To estimate the incidence of ectopic pregnancy in Yaounde, the capital of Cameroon (Central Africa). METHODS: In 2000, all women admitted for an ectopic pregnancy to health facilities in the city of Yaounde were systematically enrolled. Sociodemographic information on the women and their reproductive history was collected by questionnaire during a face-to-face interview. Medical and obstetrical data (clinical findings at hospital entry, medical history, type of surgery, and final vital status) were collected from gynecologic and surgical files and admission registers. RESULTS: We recorded 320 cases of ectopic pregnancy in health facilities in the city of Yaounde and we estimated that 40100 live births occurred during the same study period (January to December 2000). The population-based incidence rate of ectopic pregnancy in the city of Yaounde was 0.79% (95% confidence interval 0.72%, 0.88%) in 2000. Three maternal deaths were recorded giving a mortality rate of 0.94% (95% confidence interval 0.32%, 2.72%). CONCLUSION: The 0.79% ectopic pregnancy incidence rate observed in this African country must be considered a minimum due to probable underestimation. Nevertheless, this rate is lower than that currently observed in industrialized countries. Late diagnosis, low percentage of conservative treatment, and subsequent maternal deaths are important findings that should encourage African gynecologists to promote ectopic pregnancy prevention programs and to improve the care given to women with ectopic pregnancy. LEVEL OF EVIDENCE: III

Determinants of maternal deaths in induced abortion complications in Ivory Coast.

Persistently high levels of maternal mortality have been reported in Abidjan, the capital of Ivory Coast, with a high prevalence of deaths related to complications of induced abortion. In order to assess the determinants of maternal deaths in induced-abortion complications, this study investigated women admitted to the gynecological departments of four reference hospitals throughout Ivory Coast. Information concerning abortion events was collected by means of a questionnaire during a confidential, face-to-face interview. Medical records were used to collect clinical data and final vital status. In our series, 60% of women declared that they induced abortion themselves at their home; a large majority mentioned "insertion of objects into the vagina" or "ingestion of traditional plants" for this purpose. On the other hand, 40% declared that abortion had been performed by a health worker, mostly at a health facility and by using surgical methods (dilatation and curettage). Less-educated women were more likely to have chosen to induce abortion themselves at home, and more-educated women had undergone abortion through a health professional. Our findings highlight the role of both women and health professionals in responsibility for induced abortion complications.

Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study.

OBJECTIVE: To assess the maternal mortality ratio in maternity units of reference hospitals in large west African cities, and to describe the distribution of complications and causes of maternal deaths. STUDY DESIGN: Prospective descriptive study in twelve reference maternities located in three African countries (Benin, Ivory Coast, Senegal). Data (clinical findings at hospital entry, medical history, complications, type of surgery, vital status of the women at discharge) were collected from obstetrical and surgical files and from admission hospital registers. All cases of maternal deaths were systematically reviewed by African and European staff. RESULTS: Of a total of 10,515 women, 1495 presented a major obstetric complication with dystocia or inappropriate management of the labour phase as the leading cause. Eighty-five maternal deaths were reported, giving a global hospital-based maternal mortality ratio of 800/100,000. Hypertensive disorders were involved in 25/85 cases (29%) and post-partum haemorrhage in 13/85 cases (15%). Relatively few cases (14) of major sepsis were reported, leading to three maternal deaths. CONCLUSION: The results of this multicentre study confirm the high rates of maternal mortality in maternity units of reference hospitals in large African cities, and in addition to dystocia the contribution of hypertensive disorders and post-partum haemorrhage to maternal deaths.

[Prevalence of erectile dysfunction in France: results of an epidemiological survey conducted on a representative sample of 1004 men]. / Prévalence de l'insuffisance érectile en France: résultats d'une enquête épidémiologique menée auprès d'un échantillon représentatif de 1004 hommes.

OBJECTIVE: Several studies have recently reported the prevalence rates of erectile dysfunction (ED) that vary according to the country. The authors report the results of a survey conducted in France in 2001. MATERIAL AND METHODS: This study was conducted by telephone conversation with a representative sample of 1,004 men over the age of 40. The prevalence of ED was measured by the patient's self-assessment and by the IIEF-5 index. RESULTS: The results show that about 1 man in 3 (31.6%) suffers from ED in France, which is essentially mild to moderate (according to IIEF-5). The majority of men reporting ED declared to be dissatisfied with their relationship with their partner. Finally, a large proportion of men declared that they would be willing to consult a practitioner. CONCLUSION: This survey confirms the high prevalence of erectile dysfunction in France. It is responsible for a distress that is still difficult to express and assess. This disease needs to be more accurately evaluated by rigorous and standardized methods, especially as simple and effective treatments are now available.

Treatment discontinuation in couples consulting for male infertility after failing to conceive.

OBJECTIVE: To evaluate rates and reasons for treatment discontinuation in couples with male factor infertility and who failed to conceive. DESIGN: Retrospective study. SETTING: Male Sterility Center, University Hospital. PATIENT(S): A total of 407 couples consulting for male factor infertility and who discontinued treatment without conceiving. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Treatment, reasons for dropout, and reproductive outcomes after discontinuation. RESULT(S): Of the 407 patients, 218 (54%) had had fertility treatment (medical or surgical), and 189 (46%) underwent assisted reproductive techniques (ART) (intrauterine insemination [IUI], in vitro fertilization [IVF], or intracytoplasmic sperm injection [ICSI]). The main reasons for dropout were painfulness of treatment (15% for patients with non-ART treatment vs. 32% for patients who had undergone ART), its ineffectiveness (12% vs. 26%), and separation of the couple (18% vs. 7%). Of the 407 patients, 27% consulted in another fertility center, 8% succeeded in having a child by ART with male partner sperm, 1% by ART with donor sperm, and 11% through adoption. CONCLUSION(S): About half of the couples consulting for male factor infertility discontinued fertility treatment, and of those who discontinued only a fifth finally succeeded in having a child. Although support is available to couples during fertility care, ART is a physical and psychological burden.

Reduced maternal mortality in Tunisia and voluntary commitment to gender-related concerns.

OBJECTIVE: To estimate the number and causes of maternal deaths in Tunisia from 1999 to 2007, and compare the results with the last report (1993-1994). METHODS: Data on all deaths of women of reproductive age in the public (1999-2007) and private (2006 only) health sectors were collected and assessed for whether the death was due to pregnancy. Number of live births was provided by the National Institute of Statistics. RESULTS: Mean maternal mortality ratio (MMR) in Tunisia decreased from 68.9 per 100000 live births in 1993-1994 to 36.3 (95% confidence interval, 27.9-46.5) in 2005-2007 (P<0.001). Causes of maternal death did not change significantly during the study period (1999-2007): hemorrhage and hypertensive disorders were the main causes. The gap between urbanized and more rural regions observed in 1993-1994 had narrowed, although MMR remained higher in central and western regions than on the east coast. CONCLUSION: The improvement in MMR can be credited to the voluntary political commitment focused on gender-related concerns that has been made in Tunisia, including access to family planning; legalization of abortion; and creation of the National Board for Family and Population, and the Tunisian Safe Motherhood initiative in 1999.

Ejaculatory function after permanent 125I prostate brachytherapy for localized prostate cancer.

PURPOSE: Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent (125)I prostate brachytherapy for localized prostate cancer. PATIENTS AND METHODS: Of 270 sexually active men with localized prostate cancer treated with permanent (125)I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain. RESULTS: Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001). CONCLUSION: Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.

Doubling of testicular cancer incidence rate over the last 20 years in southern France.

In recent decades, testicular cancer incidence has considerably increased in a majority of industrialized countries. In France, short reports suggested that the testicular cancer incidence rate has also risen, especially in north-eastern regions. In Europe, geographical variation of incidence rates has been observed in Baltic countries and a clear birth cohort effect has been revealed. This study aimed to assess temporal trends in testicular cancer incidence in southern France. We examined incidence rates over a 20-year time period in a series of 506 consecutive cases of testicular cancer recorded from 1980 to 1999 in the Midi-Pyrenees region of France. Age, calendar period, and birth cohort effects were examined simultaneously using Poisson regression models. Our analysis found a significant rise in the overall incidence rate of testicular germ cell tumors from 1.27 to 3.04 per 100,000 between 1980-1984 and 1995-1999, an annual increase of 5.70%. These results, the first obtained in a large series in southern Europe, show a twofold increase in incidence rate of testicular cancer in the Midi-Pyrenees region, which is very similar to that observed in all European countries, more or less doubling in the last 20 years. Interestingly, this major jump and the apparent testicular cancer gradient between northern and southern Europe suggest considerable geographical heterogeneity in incidence, but low geographical variation in temporal trends.

Sperm deoxyribonucleic acid fragmentation as assessed by the sperm chromatin dispersion test in assisted reproductive technology programs: results of a large prospective multicenter study.

OBJECTIVE: To assess the value of sperm DNA fragmentation, measured by the sperm chromatin dispersion (SCD) test, in predicting fertilization rate, embryo quality, and pregnancy outcome. DESIGN: Prospective study. SETTING: Four French infertility centers, from January to August 2005. PATIENT(S): Six hundred twenty-two couples participating in their first IVF or ICSI program. INTERVENTION(S): Analysis of DNA fragmentation by the sperm chromatin dispersion test in sperm samples used for IVF or ICSI. MAIN OUTCOME MEASURE(S): Correlations and associations between sperm parameters, sperm DNA integrity, and pregnancy outcomes. RESULT(S): A statistically significant correlation was observed between sperm DNA fragmentation rate and the following sperm characteristics: sperm motility, morphology, and concentration. We found a statistically significant relationship between sperm DNA fragmentation rate and fertilization rate, and we were able to suggest a threshold sperm DNA fragmentation rate of 18%, above which fragmentation rate was predictive of fertilization rate. Regarding embryo quality, we observed a relationship between sperm DNA fragmentation and embryo quality. No significant relationship was found between sperm DNA fragmentation rate and clinical pregnancies or births. CONCLUSION(S): The results of this study confirm the utility of the sperm chromatin dispersion test for assessment of DNA fragmentation.