Serum progesterone level and ongoing pregnancy rate following frozen-thawed embryo transfer after artificial endometrial preparation: a monocentric retrospective study.

INTRODUCTION: In some studies, early pregnancy loss (EPL) rate is higher with artificial cycle (AC) endometrial preparation for frozen-thawed embryo (FET) transfer than with other protocols, even though pregnancy rates are similar. An inadequate luteal phase support could explain these findings. The aim of this study was to compare, among the patients who had a pregnancy after FET with AC endometrial preparation, serum progesterone (PG) levels between those who experienced an EPL or an ongoing pregnancy. MATERIAL AND METHODS: A monocentric retrospective cohort study, conducted at a University affiliated fertility center, studied 130 FET cycles with AC endometrial preparation between June 2016 and July 2017. Serum PG rates were compared according to reproductive outcomes and to endometrial preparation protocol on day 10 or 12 after FET (PG0) according to the embryo stage, and every 48h in case of pregnancy (i.e. PG1; PG2). RESULTS: Among patients who had a pregnancy after FET with AC (n=33), serum PG levels were higher in case of an ongoing pregnancy than EPL, only significantly at PG1 (PG0 12.4ng/mL [7.5-14.6] vs 8.2ng/mL [6.0-13.0], p= 0.320; PG1 15.0 ng/mL [14.0-15.9] vs 8.5ng/mL [5.9-13.8], p= 0.048). DISCUSSION: We found that serum PG level was lower in women experiencing early pregnancy loss after FET with AC endometrial preparation, potentially reflecting a lack of appropriate luteal phase support with PG. A cycle AC test, monitoring serum PG levels after its steady state, could detect this lack of PG, allowing physicians to adapt PG supplementation.

[Assisted reproductive technologies in HIV patients: Which results and which strategy in France in 2019?] / Prise en charge des couples porteurs du VIH en assistance médicale à la procréation : quels résultats et quelle stratégie en France en 2019 ?

With the use of antiretroviral therapy, HIV transmission from mother to fetus and between sexual partners has been significantly reduced, successively allowing pregnancy, then assisted reproductive technologies, and targeted unprotected sex among couples living with HIV. Since first French Morlat report in 2013, natural procreation is now possible under certain conditions for these couples living with HIV and the use of assisted reproductive technologies is increasingly limited to the treatment of infertility. While the results of intrauterine insemination seem satisfactory for serodiscordant couples living with HIV, in vitro fertilization results appear to be unfavorable when the woman is infected with HIV. In vitro fertilization results appear to be comparable to those in general population when only the man is infected with HIV. It can be assumed that ovaries are impacted by the treatment and/or the HIV in infected women.

[An update on adenomyosis and implantation]. / Adénomyose et implantation : mise au point.

Adenomyosis is an enigmatic disease whose impact on implantation and fertility outcome is still controversial. A negative effect on IVF outcome was already observed, but it is mainly explained by an increase in early spontaneous miscarriages. We reviewed scientific data in order to bring relevant information about adenomyosis and endometrial receptivity for patient counselling and to precise if screening of adenomyosis is indicated before IVF treatment.

[Preoperative imaging of deeply infiltrating endometriosis in: Transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging]. / Imagerie préopératoire dans l'endométriose profonde : échographie pelvienne, écho-endoscopie rectale et IRM.

OBJECTIVES: Compare the accuracy of transvaginal ultrasonography (TVUS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) before deeply infiltrating endometriosis surgery. PATIENTS AND METHODS: A retrospective study with 25 deeply endometriosis patients underwent the three imaging examinations before surgery. Calculation of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the different locations: ovaries, uterosacral ligaments and torus, rectovaginal septum, rectosigmoid junction, bladder. RESULTS: Ovarian and deep pelvic endometriosis was found in surgery and confirmed by histology in all patients. Sensitivity and specificity are respectively: for ovaries: 88.2% and 71% of TVUS; 80% and 81.2% of RES; 87.5% and 71% of MRI. For uterosacral ligaments: 63% and 82,6% of TVUS; 37% and 100% of RES; 69% and 82.6% of MRI. For torus: 57.1% and 100% of TVUS; 76.2% and 100% of RES; 76.2% and 100% of MRI. For rectovaginal septum: 63.2% and 100% for TVUS; 89.5% and 66.7% of EER; 47.4% and 100% of MRI. For rectosigmoid junction: 73.7% and 66.7% of TVUS; 94.7% and 66.7% of RES; 89.5% and 50% of MRI. For bladder: 16.7% and 100% of TVUS; 16.7% and 100% of RES; 33.3% and 89.5% of MRI. DISCUSSION AND CONCLUSION: We found that TVUS is the more performant for endometriomas, it is MRI for torus, uterosacral ligaments and little bladder lesions, RES for rectovaginal septum and rectosigmoid junction. So in the clinical practice, the three imaging examinations are complementary for the preoperative assessment of deeply endometriosis.