[Flow Index Vascularization dynamics in the preovulatory phase of controlled ovarian hyperstimulation: profile and relationship with conception rate]. / Dynamique de l'index de vascularisation et de flux dans la phase préovulatoire de l'hyperstimulation ovarienne contrôlée. Relation avec le taux de conception.

OBJECTIVES: To study the evolution of subendometrial vascularization flow index (VFI) in controlled ovarian hyperstimulation (COH+IIU) cycles and compare its dynamic changes in pregnant and non pregnant women. PATIENTS AND METHODS: This is a retrospective study on 61 couples. To determine the profile of IVF just before ovulation, patients had 3D-Power Doppler angiography (3D-PDA) in this precise preovulatory phase. RESULTS: We observed a decreasing profile of VFI in 52% (32/61) of the main group cycles, in 45% (14/31) of the subgroup with spontaneous peak of LH (luteinizing hormone), and in 60% (18/30) of the hCG (human chorionic gonadotropin) trigger subgroup. There were ten conceptions, (10/61, 16.4%), including eight (8/32, 30%) that were associated with a decreasing profile of VFI versus two (2/29, 7%) that were associated with an increasing profile (NS). In the detection of LH peak subgroup, we observed five conceptions (5/14, 36%) associated with a decreasing profile versus one conception (1/17, 6%) associated with an increasing profile of VFI (OR: 8.3; confidence interval [CI] 95%: 0.8-444; P=0.06 in favor of a of decreasing VFI profile). In the hCG subgroup, there were three conceptions in the decreasing VFI profile (3/18, 17%) and one conception with increasing VFI (1/12, 17%, P=0.6). DISCUSSION AND CONCLUSION: In controlled ovarian hyperstimulation, a decreasing VFI profile is more common compared to an increasing one. Such au profile seems to be associated with a higher conception rate in cycles with spontaneous LH surge.

[Fort Lauderdale congress report: advances in infertility treatment - Florida, 24-26 January 2002]. / Compte rendu du congrès de Fort Lauderdale : progrès dans le domaine du traitement de l'infertilité - Floride, 24-26 janvier 2002.

The goal of the treatment of infertility is to apply therapeutic techniques to patients in a safe manner and at the same time increase the chances for conceiving and delivering healthy babies: basic and clinical research is more and more finalized directed to these goals. The conference "Advances in Infertility Treatment" held in Fort Lauderdale, Florida on January 24-26, 2002 covered many clinical and research aspects of this important therapeutic area. Important discussed issues included the impact of age, lifestyle, and the genetic set-up of patients in the pathogenesis and development of infertility-causing disorders such as male reproductive dysfunction, polycystic ovary syndrome, and ovarian failure. New ovulation induction regimens that may optimize, reduce complications, and lower costs of ovarian stimulation procedures and of assisted reproduction in general were presented. This was the 5th Ferring Pharmaceuticals Conference in the area of reproductive medicine held in Florida.

Intracytoplasmic sperm injection in infertile patients with structural chromosome abnormalities.

In the present study we investigated the results of cytogenetic analysis in male and female patients included in an intracytoplasmic sperm injection (ICSI) programme for severe male infertility as well as in conceptuses resulting from these ICSI treatments. In the 261 couples treated, 11 male (4.2%) and three female (1.2%) abnormal karyotypes were found, all consisting of structural chromosome anomalies. Chromosomal translocation exhibited the highest frequency (eight males and two females), and there were also three cases of chromosomal inversion (two males and one female) and one male with one additional marker chromosome. There was no difference in fertilization rates among couples with abnormal (n = 14) and normal (n = 147) cytogenetic results, and the rates of clinical pregnancy per ICSI attempt were 25.0% (5/20) and 20.6% (78/ 378) respectively. In pregnancies obtained in couples with normal karyotypes, all of the 108 fetuses were free of chromosomal abnormalities. Among the eight fetuses from couples with chromosome structural anomalies, three out of five and two out of three inherited from the cytogenetic defects found in their father or mother respectively. In this series of 83ICSI pregnancies there were no chromosomal abnormalities other than those inherited from the parents. These findings suggest that normal pregnancy rates can be obtained by ICSI in cases of chromosomal translocation in couples with severe male infertility. However, until further evaluations of available data can be performed, cytogenetic analysis must be conducted prior to ICSI in men with low sperm counts, and genetic counselling must include prenatal diagnosis for all growing conceptuses.

Spermatid injection into human oocytes. II. Clinical application in the treatment of infertility due to non-obstructive azoospermia.

We have reported recently the first birth after intrauterine transfer of embryos obtained by injection of round spermatids into oocytes in cases of unexpected azoospermia. Here we provide a complete documentation of the series of 11 cases in which this novel method of infertility treatment was employed. In four of these cases, elongated spermatids were identified in the ejaculate, and it was decided to perform elongated spermatid injection (ELSI). In the other six cases, only round spermatids were present, and round spermatid injection (ROSI) was done. In one case, ROSI was given preference to ELSI because of a very poor viability status of elongated spermatids present in the ejaculate. Fertilization of at least one oocyte was achieved in 10 of the 11 treatment cycles; the fertilization rate in these 10 cycles ranged between 7 and 100% with a mean value of 45%. All of the two-pronucleated zygotes cleaved and were transferred to the patient's uterus. A singleton pregnancy was achieved in two ROSI cycles. Both pregnancies developed uneventfully and resulted in the birth of normal infants. These data show the intra-ooplasmic injection of spermatids obtained from the ejaculate may become the treatment of first choice in patients with non-obstructive azoospermia.

Cyclooxygenase and lipoxygenase inhibitors--induced changes in the distribution of glycosaminoglycans in the pregnant rat uterine cervix.

In order to study the hormonal control mechanisms of cervical maturation, we investigated cyclooxygenase and 5-lipoxygenase inhibitors-induced changes in the distribution of glycosaminoglycans (GAG) in pregnant Wistar rat uterine cervices at term. The GAG were measured in a control (n = 11), in a Diclofenac (cyclooxygenase inhibitor) treated group (n = 8), in a BW 755C (dual inhibitor of cyclooxygenase and 5-lipoxygenase) treated group (n = 6), and a L 651392 (5-lipoxygenase inhibitor) treated group (n = 9). The results of these studies suggest, that cervical hyaluronic acid metabolism and cervical hydration are controlled in association by prostaglandins and leukotrienes (and perhaps by other phospholipids metabolites), whereas heparan sulphate metabolism is obviously controlled by prostaglandins. Nevertheless complete and normal cervical maturation is probably controlled in association by arachidonic acid metabolites and other factors (steroids and peptides).

[Per-celioscopic surgery of the distal fallopian tube in infertility]. / La chirurgie percoelioscopique de la trompe distale dans l'infertilité.

Twenty five patients who had distal tubal blocks were operated on laparoscopically between the months of November 1986 and April 1988. Eleven fimbrioplasties and 20 salpingostomies were carried out, 16 patients also had division of adhesions. Both tubes were operated on in 6 patients and only one in 19 patients. After 12 months the cumulative pregnancy rate was 28.4% overall composed of 40% for fimbrioplasties and 20% for salpingostomies. No pregnancy occurred more than 10 months after the operations. There was no inter or post operative complication. The results of this study and an analysis of the literature shows that laparoscopic operations are a worthwhile alternative to laparotomy in distal obstructions of the tubes that are not very severe. In severe stages however, it would seem better to carry out an assisted reproduction technique.

Tubal desterilization through exclusive laparoscopy.

The first case of tubal desterilization after Yoon rings through exclusive laparoscopy is reported. Yoon ring tubal segment excision was performed with CO2 laser and coelioscopic scissors, after mesosalpinx haemostasis by ornithine--vasopressin infiltration. Tubal anastomosis was managed with biological glue on an intraluminal guide which was pulled out after 48 h. Follow-up hysterosalpingography 3 months later showed perfect tubal patency. This case proves that complete tubal reversal by exclusive coelioscopy is possible. At present, this procedure is restricted to only one tube during coelioscopic evaluation, preserving, in case of failure, the chance of microsurgery either on the contralateral tube or even on the previously operated one. The advantages of such a technique are those of coeliosurgery: no laparotomy, shortened hospitalization and minimal post-operative adhesions. Since this first case, others have been performed. It is still too early to appreciate the results in terms of intrauterine pregnancy.

Prostaglandin E2-induced changes in the distribution of glycosaminoglycans in the isolated rat uterine cervix.

In order to study the hormonal control mechanisms of cervical ripening, we investigated the prostaglandin E2 (PGE2)-induced changes in the distribution of glycosaminoglycans (GAG) using hysterectomized and ovariectomized rats, leaving the vascularized uterine cervix in situ, as an animal model. In the first series of experiments, the GAG were measured in a control (n = 22 Wistar rats) and in a PGE2-treated group (n = 20 Wistar rats) without steroid supplementation. In the second series of experiments, the GAG were measured in a control (n = 19) and in a PGE2-treated group (n = 18) receiving estradiol and progesterone supplements. After PGE2 treatment in the two series of experiments, and despite being surgically isolated from the uterine corpus, the cervix was still able to undergo some of the structural changes associated with normal ripening (increased hydration and hyaluronic acid concentration). This suggests that PGE2, acting directly on the cervix, could be, at least in part, a modulator of biochemical events which underlie normal cervical maturation. The animal model described here seems to be suitable for studying the hormonal mechanisms of cervical ripening and the regulatory relationship between cervical maturation and myometrial contractility, which are probably subject to concordant endocrine regulation.