A study of factors affecting the success of human fertilization in vitro. II. Influence of semen quality and oocyte maturity on fertilization and cleavage.

The incidence of in vitro fertilization was analyzed with respect to the degree of cumulus dissociation (expansion) at the time of oocyte recovery and also the semen quality. Of the oocytes surrounded by perfectly ("++") or moderately ("+") dissociated cumuli, 78.6% and 30.8%, respectively (P less than 0.001), were fertilized when the husband's semen analysis was in the normal range. The proportion of fertilized oocytes was not decreased in cases of polyzoospermia (greater than 130 X 10(6) spermatozoa/ml), but was decreased (P less than 0.05) when the semen analysis revealed other anomalies: oligozoospermia (less than 15 X 10(6) spermatozoa/ml), asthenozoospermia (less than 50% motile cells) or teratozoospermia (greater than 50% abnormal spermatozoa). The proportion of fertilized eggs cleaving in vitro was unaffected by semen quality but was lower when "+" cumulus oocytes were collected than when "++" cumulus oocytes were obtained (58.3% vs. 87.0%, P less than 0.02). In vitro incubation of the oocyte prior to insemination increased the incidence of fertilization by about 28% for both "+" (22.2 to 50.0%) and "++" (65.7 to 93.9%) cumulus oocytes. Finally, 67.6% of "++" cumulus oocytes developed into embryos when the insemination with spermatozoa from normal semen samples was delayed by several hours, compared with only 29.0% when the conditions were suboptimal ("+" cumulus oocyte, abnormal semen analysis or no delay prior to insemination). Eight pregnancies began following the replacement of 38 embryos in 34 patients. Six spontaneous abortions occurred, and chromosomal abnormalities were proven in the two cases analyzed. Two pregnancies continued for more than 3 months, resulting in term deliveries of two normal babies.

[Plasma and intrafollicular hormone profiles in the late preovulatory phase. I. Spontaneous cycles]. / Profil hormonal plasmatique et intrafolliculaire au cours de la période préovulatoire tardive. I. Cycles spontanés.

The hormone state of development in the late preovulatory phase is described in its relationship to the start of the LH surge which occurs 37-39 hours before ovulation. No precise relationship has been found between the oestradiol (E2) peak in the plasma and that which occurs before ovulation. All the same, the succession of hormone events that have been observed in 77 spontaneous cycles is the following: the level of E2 suddenly rises between 35 and 30 hours before the ovulatory discharge and this rise is immediately followed by a rise in the level of LH. Then the plasma concentration of 17-hydroxyprogesterone (17-OHP) increases 5 hours before the LH surge. In the preovulatory follicle 5 hours after the start of the LH surge, a drop in the level of E2 and a rise in the level of progesterone is noted. Concentrations of androgens only lessen in the last 12 hours before ovulation whereas the level of 17-OHP stays stable. We have thus been able to work out the sequence of plasma hormone phenomena that occur in determining whether a preovulatory gonadotrophic surge will occur. We have described the hormone levels in follicular fluid immediately before spontaneous ovulation. These findings will be able to serve as a reference to evaluate the quality of the late preovulatory phase in abnormal cycles or in cycles that have been induced.

[Complications of voluntary interruption of pregnancy]. / Les complications des interruptions volontaires de grossesse (IVG).

PIP: Although the legalization of abortion has almost eliminated the risk of mortality, the experience is still psychologically difficult for many women, increasing the need for sympathetic treatment by the staff. Intraoperative complications may result from regurgitation, cardiovascular irregularities, or allergic reaction caused by the general anesthesia usually employed; from uterine perforation by the operative instruments, most commonly among multiparas and women who have undergone cesareans or have a uterine infection; or uterine hemorrhage. Uterine perforation is usually evaluated by celioscopy and may require surgical intervention if bleeding occurs. Infection and peritonitis may result from perforation. Complications of anesthesia may be reduced by using local anesthetic, while complications of uterine perforation may be reduced by careful examination of the patient under general anesthesia before the procedure begins. In the event that no products of conception are recovered, the instruments must be checked for malfunction, evidence of pregnancy should be reexamined, and ectopic pregnancy ruled out through clinical examination and celioscopy. Immediate postoperative complications may include uterine or tubal infection caused by retention of debris or perforation, peritonitis, and septicemia, and can result in secondary sterility. Continuation of the pregnancy is a rare complication. Late complications may include sterility due to cervico-isthmal weakening, uterine synechia, tubal occlusion, or psychological factors.^ieng

[Prediction of ovulation]. / La prédiction de l'ovulation.

Predicting ovulation is the basis on which the fertile period is determined. When we carried out observations on 60 spontaneous cycles it was possible to detect with precision the discharge of LH which would produce ovulation by taking series of plasma levels of LH. The start is defined as the time when the level of LH becomes 180% greater than the mean level observed in the previous 24 hours. Ovulation occurs between 37 and 39 hours after this threshold has been crossed. The discharge of LH is the most constant criterion and the most precise one, and it does make it possible to work out the chronology of the events that precede ovulation. Ultrasound and estimation of levels of oestradiol in the plasma or in the urine do allow one to appreciate how the follicle is maturing.