[Single-embryo transfer: Rennes' Hospital experience]. / Transfert monoembryonnaire : expérience du CHU de Rennes.

In 2005-2006, 905 punctures of oocytes were realised in the Assisted Reproductive Technology Centre of Rennes' Hospital in France, the source of 173 pregnancies after fresh embryos transfers and 185 pregnancies after frozen embryos transfers. The single-embryo transfer (SET) was proposed in all patients aged less than 38 years with at least two embryos type I or II on the first two cycles. Sixty-three percent of patients (n=293 cycles) chose the SET with 21.5% pregnancies through fresh embryo transfer. The SET with frozen embryos has been completed on 708 cycles with 16.8% of pregnancies per transfer. The cumulative rate of pregnancies by puncture is 39% and the overall risk of multiple pregnancies has dropped to 12%. The SET associated with an effective embryo cryopreservation therefore allows to reduce the risk of multiple births while maintaining a satisfactory pregnancy cumulative rate.

[Intrauterine insemination: against systematic ovarian stimulation]. / Insémination intra-utérine: contre une stimulation systématique de l'ovulation.

Intrauterine insemination is a technique proposed of first intention in many situations of non-tubal infertilities. It is very frequently associated with a stimulation of ovulation, with the objective of precisely synchronizing the intra uterine stimulation and ovulation, and an increase in follicular recruitment. If intrauterine stimulation is often a determining factor in obtaining pregnancy, stimulation of ovulation does not always bring about an obvious benefit and its interest must be discussed according to the indications, knowing on the other hand that it is determining in the occurring of multiple pregnancies.

Geographic variations in probability of pregnancy in four cities of France.

BACKGROUND: Several studies have described geographic variations in human fecundability, but this phenomenon has almost exclusively been studied at an international level rather than within a given country. Our aim was to describe geographic variations in fecundability, the monthly probability of pregnancy, between four cities of France. METHODS: We conducted a cross-sectional study in four French maternity units from Toulouse, Rennes, Lyons and Paris, among partners of pregnant women. Women were asked about the time to pregnancy (TTP) of their current pregnancy. TTP was analysed with a discrete Cox model allowing to estimate fecundability ratios (FR). RESULTS: Time to pregnancy was defined for 894 couples. There was no strong evidence of heterogeneity in fecundability between the four compared cities (p=0.05 without adjustment and p=0.25 after adjustment for behavioural and medical factors). The highest fecundability was observed in Rennes and the lowest in Toulouse (fecundability ratio (FR)=1.28, 95% CI: 1.01-1.63). Differences in fecundability were smaller between the other cities. CONCLUSION: We highlighted a possibly slightly higher fecundability in Rennes compared to Toulouse. Possible explanations for this finding are discussed. We note that the finding is consistent with previous observations indicating a higher sperm concentration among semen donors in Rennes than in Toulouse.

Assessment of acrosome-reacted boar spermatozoa using monoclonal antibody GB 24 and propidium iodide.

Fluorescein-labeled GB 24, a mouse monoclonal antibody, was evaluated as an acrosomal dye for boar spermatozoa that had previously been stained with propidium iodide (PI) to assess sperm viability. A specific sperm-staining pattern with fluorescein-labeled GB 24 was shown to be associated with acrosome reaction on freshly ejaculated sperm when fixed with acetone or induced with ionophore A 23187, whereas the presence of PI staining was typical of dying spermatozoa. The GB 24-PI procedure was as accurate as the glutaraldehyde method in assessing acrosomal presence or absence on freshly ejaculated spermatozoa when spontaneous or A 23187-induced acrosomal reactions were considered. Approximately half of A 23187-induced spermatozoa with acrosomal loss did not exhibit a PI fluorescence; these were potentially viable acrosome-reacted spermatozoa. On semen diluted in a boar sperm-specific diluent (BTS-A) and stored, percentages of spermatozoa with nonintact acrosome from glutaraldehyde and GB 24-PI were not significantly different. Conversely, data from GB 24-PI was significantly lower than those from glutaraldehyde when semen were undiluted. This suggested that spermatozoa with reacted acrosome gradually lost their ability to bind with GB 24. Providing unequivocal and rapid scoring of acrosome-reacted spermatozoa, the GB 24-PI procedure may be a valuable tool in the evaluation of the acrosomal status of porcine fresh spermatozoa.

Improvement of motility of post-thaw Poitou jackass sperm using glutamine.

The relative effectiveness of L-glutamine in preserving motility and movement characteristics of Poitou jackass spermatozoa diluted at 60 x 10(6) sperm/ml in INRA 82 medium modified by 4 % (v/v) glycerol and 2 % (v/v) quail's egg yolk during the cooling and freezing-thawing process was studied. After cooling to 4 degrees C, glutamine at 80, 120 or 240 mM did not improve the percentages of motile and progressively undulating spermatozoa or the movement characteristics (VCL = curvilinear velocity, VSL = straight line velocity, VAP = velocity of the average path, LIN = VSL/VCL x 100, ALH = amplitude of the lateral head displacement, BCF = beat cross frequency) assessed by the automated analyzer ATSM. However, after the FT process, 80 mM glutamine significantly improved motility, the percentage of progressively undulating spermatozoa and all the movement characteristics analyzed. The presence of glutamine at 80 mM in a glycerol-FT medium thus improves the motility of Poitou jackass spermatozoa during the freezing-thawing process. The presence of glutamine at 80 mM was not sufficient to offset the need to use glycerol in the freezing-thawing medium. This could indicate that glutamine has a mechanism of cryoprotection for Poitou jackass spermatozoa that is independant of glycerol.

[Artificial insemination with donor frozen sperm]. / Insémination artificielle avec sperme congelé de donneur.

The cryopreservation of human sperm decreases its fecondity, by reduction in the number of motile sperm. However the fertilizing ability of the spermatozoa is not faded. The use of frozen sperm requires an optimization of the methods of artificial insemination to hope to approach the results obtained with fresh sperm. Intrauterine insemination with sperm selection meets this aim.

[Is the limitation to 6 cycles of insemination with donor sperm justified?]. / La limitation à six cycles d'inséminations en AMP avec don de sperme est-elle justifiée?

OBJECTIVE: To evaluate the effect of the limitation at 6 cycles of artificial insemination in a program of sperm donation. STUDY DESIGN: 266 couples included in a program of sperm donation underwent 1,354 cycles including 532 intracervical insemination (ICI), 678 intrauterine insemination (IUI) and 133 in vitro fertilization (IVF). RESULTS: The birth rate by cycle was 10.8% in ICI, 18% in IUI, 21.9% in IVF. The risk of multiple pregnancies was 0% in ICI, 13% in IUI, 33% in IVF. The authors feign then two strategies, the first one with 6 ICI followed by 6 IUI, and the other one with 6 IUI alone. The birth rate, the risk of multiple pregnancies and the cost of these two strategies is discussed. CONCLUSION: The restriction to 6 IA Cycles in a donor semen program does not change the birth rate, but increases the multiple pregnancy rate and the cost of the treatment of these patients.

[Teratospermia consisting of the absence of the head of the spermatozoa because of a fault in the joint between the head and the neck of the sperm in man (author's transl)]. / Tératospermie consistant en l'absence de tête spermatique par défaut de connexion tête-col, chez l'homme.

An ultrastructural sperm study was conducted in a sterile man whose sperm count showed 100 percent headless spermatozoa. Testicular biopsy showed abnormal spermatogenesis : within the spermatid, the sperm head developed separately from the flagellum, which alone was ejected during spermiation.

[Inhibin, a second testicular hormone (author's transl)]. / L'inhibine, seconde hormone testiculaire.

Germinal epithelium secretes a peptide hormone, inhibin, that regulates FSH secretion. This substance originates inside the seminiferous tubules, from the Sertoli cells, and is transported towards the head of the epididymis where it is reabsorbed, and thus passes into the bloodstream. Inhibin blocks FSH pituitary secretion; its effect on the hypothalamus is debatable. Inhibin also exists in the female, in ovarian follicles and may have a role in follicular growth regulation.

[Measurement of seminal fluid 5 alpha dihydrotestosterone levels during investigations of sterility (author's transl)]. / Intérêt du dosage de la 5 alpha dihydrotestostérone du liquide séminal dans l'étude des stérilités.

Two androgens (testosterone, 5 alpha dihydrotestosterone) were measured by radioimmunoassay in the seminal liquid. A statistic comparison of the results has been applied to samples taken from sterile men and classed chiefly according to sperm count. Different groups were explored: normospermia; oligospermia; various azoospermias. No significant differences in testosterone were found between the groups. Levels of DHT are lower in oligospermia, and much more in azoospermia. The signification of the results is discussed.

[Severe oligospermia with normal FSH. Comparison between radioimmunologically and immunoradiometrically determined levels of LH]. / Oligospermies sévères à FSH normale. Comparaison entre les dosages radio-immunologiques et immuno-radiométriques de la LH.

We have noted in a group of oligospermic patients with normal FSH levels and normal sized testes that there can be a significant drop in the LH levels estimated by IRMA, compared with a control group of fertile men. On the other hand, there is no correlation between IRMA and RIA levels of LH in oligospermic men when there is such a correlation in the control group. As oligospermia is usually testicular in origin preliminary results suggest that there may be a disturbance of gonadotrophin secretion in one type of oligospermia and we intend to continue this preliminary study.

[Microsurgical epididymal sperm aspiration (MESA), testicular biopsy and intracytoplasmic sperm injection (ICSI) in the treatment of male infertility]. / Aspiration microchirurgicale des spermatozoïdes épididymaires (MESA), biopsie testiculaire et injection intra-cytoplasmique du spermatozoïde (ICSI) dans le traitement de l'infertilité masculine.

OBJECTIVE: To assess if ICSI using epididymal or testicular spermatozoa is effective in the treatment of couples with male factor infertility. MATERIAL AND METHODS: 56 couples suffering from male infertility underwent a total of 88 treatment cycles of ICSI, in combination with microsurgical epididymal sperm aspiration (MESA): 62 cycles, or testicular sperm retrieval: 26 cycles. RESULTS: Overall, fertilization rate was 63% per injected metaphase II oocyte. In MESA group, fertilization rate was 64% compared to 61% embryos in testicular sperm aspiration. The overall pregnancy rate was 26% per started ICSI cycle. Pregnancy rates were also similar in both group: 24% for MESA and 32% for testicular sperm extraction. 9 pregnancy (41%) were obtained using cryopreserved epididymal sperm (6 cases) or testicular sperm (3 cases). CONCLUSION: ICSI combined with epididymal or testicular sperm achieved a high fertilization and pregnancy rate. It constitutes an efficient alternative in the treatment of men suffering of testicular failure or azoospermia not amenable to surgical reconstruction.

[What strategy to improve the recruitment of gamete donors?]. / Quelle stratégie pour améliorer le recrutement des donneurs de gamètes?

To a high demand for donated gametes, sperm and oocytes, centers often face difficulties in recruiting enough donors. To increase the number of donors are needed financial and human resources to accommodate them in good conditions, information and a strong promotion to motivate approaches donations, diversify recruitment methods. In France, the gametes donation comes from couples with children and is free. The opening of the gift for men and women without children and remuneration of these gifts are discussed.

[Anonymity and gamete donation]. / Anonymat du don de gamètes.

In France the gamete donation is based on the major principles: anonymity, no payment, solidarity and this mode of procreation can be used only if a medical indication is present in recipient couples. In prerequisite and during the revision of the law of bioethics, a wide debate took place about the anonymity of gamete donation. The objectives of this article is to review the concept of the anonymity and its links with the questions of the origin, the secret of the modalities of the conception and the mourning of the fertility, children, donors and the recipient couples waiting for gamete donation. The international situation is also addressed. The contribution of the CECOS, the centers which practice the sperm and the egg donations is highlighted. The anonymity cannot be discussed without addressing all these links and the complexity of this particular mode of conception. To date, the French society has maintained the anonymity in the new law of bioethics.

[Secrecy and anonymity in gametes donation]. / Secret et anonymat du don de gamètes.

In France, gamete donation is based on some fundamental principles such as anonymity, gratuity, and solidarity. In Europe a trend appeared for a removal of anonymity. This paper highlights the reasons for this removal of anonymity, and consequences for the donor's offspring, the gamete donor, the infertile couples. In particular, an examination of practice shows that removing the anonymity of gamete donation favors maintaining the secrecy of the circumstances of the conception, resulting in inefficiency of the law.

[Oocyte donation as in France]. / Pour un don d'ovocytes à la française.

Oocyte donation, initially proposed in agonadal women, saw indications expand to ovarian deficiencies and failures of in vitro fertilization (IVF), resulting in a significant increasing demand. The recruitment of oocyte donors is a critical issue for all countries that have allowed this practice. The French legislation, with the laws of bioethics, is clearly the most restrictive of European countries, imposing an absolute free gift from mother. The different solutions in the neighboring countries are analysed and in particular the interpretations made in respect of gratuity and compensation. Motivating donors (spontaneous, relational, or by reciprocity), but also motivating the medical teams can organize a program of oocyte donation in France. The authors present their results of three years experience, demonstrating that this system is possible in the current legislative framework.