Laparoscopic ovarian tissue harvesting and orthotopic ovarian cortex grafting for fertility preservation: less is more.

OBJECTIVE: To describe our surgical techniques for laparoscopic ovarian tissue harvesting and orthotopic ovarian cortex grafting (LOOCG). DESIGN: This video article uses surgical cases to demonstrate the detailed surgical techniques. Institutional Review Board approval was not required for this video presentation. SETTING: University hospital. PATIENT(S): Patients presenting with indication for fertility preservation by means of ovarian tissue harvesting and orthotopic ovarian cortex grafting (in case of setting up a high risk of gonadotoxicity treatment or patients presenting with a pathology with risk of premature ovarian failure). INTERVENTION(S): Ovarian tissue harvesting: The entire ovary is harvested by placing an EndoGIA stapler to ensure the control of infundibulopelvic ligament and then, after reloading, the section of the mesovarium. LOOCG one-step procedure: A large and superficial incision of the peritoneum is performed to create a peritoneal pocket. The fragments of ovarian cortex are secured with the use of nonresorbable surgical wire (Prolene 5.0) and introduced into the peritoneal pocket. The peritoneum is not closed after placing the graft. MAIN OUTCOME MEASURE(S): Value and feasibility of LOOCG. Restoration of endocrine function and fertility results. RESULT(S): Thirty-four patients were included from November 2011 to October 2017. LOOCG restored ovarian endocrine activity in 88.2% of cases. Ten patients had become pregnant (29.4%), and the same number gave birth to at least one child. CONCLUSION(S): Our surgical approach is simple, safe, and reproducible and seems to be as effective as previously described techniques. It deserves to be proposed to patients eligible for ovarian cortex grafting.

[Left paravesical cystic urothelial tumour: an exceptional case?]. / Tumeur urothéliale kystique para-vésicale gauche: une observation exceptionnelle?

Pelvic cystic masses are frequent in women of childbearing potential and usually arise from the adnexae. The authors report a rare case of paravesical malformative cyst (Gartner cyst) with left silent kidney. In view of the unusual histology, comprising carcinoma in situ and a transitional cell papillary tumour with metastatic lymph node extension, the authors reviewed the literature on this subject and identified only one similar case (5).

Importance of planning ovulation induction therapy in systemic lupus erythematosus and antiphospholipid syndrome: a single center retrospective study of 21 cases and 114 cycles.

OBJECTIVE: To analyze the results and complications of ovulation induction therapy (OIT) in women with systemic lupus erythematosus (SLE) and/or the antiphospholipid syndrome (APS). METHODS: A retrospective study of 21 women followed in a single tertiary-referral French center who underwent 114 OIT cycles with or without in vitro fertilization and embryo transfer (IVFET). RESULTS: Before OIT, SLE was present in 6 women, APS in 3, SLE-related APS in 3, and discoid lupus in 1. Eight women had no identified disease and underwent 36 cycles of OIT. Diagnosis (SLE, n = 3; primary APS, n = 5) was made after OIT complication: spontaneous abortion (n = 5), SLE flare (n = 2), and thrombophlebitis (n = 1). Five women with known disease intentionally concealed their history from their gynecologists and underwent 34 cycles. Forty-four cycles were planned in 11 women, in 3 of them after complications of prior OIT performed without particular therapy and monitoring. Eighteen pregnancies occurred, which ended in 9 live births, 4 fetal deaths, and 5 embryonic losses. The pregnancy rate was higher with gonadotropin and/or gonadotropin-releasing hormone analog (GnRHa) (25% of cycles) than with clomiphene (4% of cycles, P <.0001). When the gynecologists did not know the underlying disease, three-quarters of pregnancies induced by OIT with IVFET ended in embryonic losses or fetal deaths. In contrast, 6 of 7 pregnancies induced by planned OIT with IVFET ended in live births (P <.0001). Phlebothromboses were observed only with gonadotropin treatment. The SLE flare rate was higher with gonadotropin and/or GnRHa (27% of cycle) than with clomiphene (6%, NS). It also was higher (30%) when the gynecologists did not know the underlying disease than in the planned procedures (10%, NS). CONCLUSIONS: The OIT may precipitate SLE or APS. A careful review of the patient's history and appropriate laboratory tests should be undertaken before OIT. Clomiphene complications are rare. When gonadotropins are prescribed, preventive anti-inflammatory therapy should be considered in women with SLE, in addition to heparin and/or anti-aggregant therapy in patients with asymptomatic anti-phospholipid antibodies or prior thrombotic events.

Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma on a 2002-2011 survey.

OBJECTIVES: To estimate the frequency of detectable seminal HIV-1 viral load in men with repeatedly undetectable blood viral load, in the recent past years and over a 10-year period (2002-2011) in a large cohort of HIV-1-infected men from couples requesting assisted reproduction technologies. We also searched for an association between HIV-1 RNA seminal viral load, HIV-1 RNA plasma viral load measured by ultrasensitive assay, and blood HIV-1 DNA in a subgroup of 98 patients. METHODS: Three hundred and four HIV-1 infected men have provided 628 paired blood and semen samples. In a subset of 98 patients for which a blood sample was available, residual viremia, HIV-1 RNA in semen and HIV-1 DNA were studied. RESULTS: Twenty of 304 patients (6.6%) had detectable HIV-1 RNA in semen, ranging from 135 to 2365 copies/ml, corresponding to 23 samples, although they had concomitantly undetectable HIV-1 RNA in blood while they were under antiretroviral therapy. This prevalence was stable over time even in recent years. There was an association between HIV-1 RNA plasma viral load measured by ultrasensitive assay and HIV-1 DNA in blood, but both were not associated with seminal HIV-1 RNA viral load. CONCLUSION: It seems cautious individually to maintain the recommendations of safe sex and the recourse to ART, or at least to inform the couple of the residual potential risk, in serodiscordant couples desiring a child.

HIV-1 or hepatitis C chronic infection in serodiscordant infertile couples has no impact on infertility treatment outcome.

The objective was to evaluate the viral infection effects on infertility treatment outcome in HIV-1 or hepatitis C (HCV) monoinfected infertile serodiscordant couples, in a retrospective case-controlled, university-based study. Clinical pregnancy rate for HIV-1 or HCV infertile serodiscordant couples was not significantly different from that for seronegative controls.

Can cumulative pregnancy rates be increased by freezing and thawing single embryos?

OBJECTIVE: To evaluate the extent to which transfers of frozen single embryos increase cumulative pregnancy rates. DESIGN: Retrospective analysis. SETTING: IVF unit of a university hospital. PATIENT(S): Patients undergoing IVF cycles that were carried out from 2001 to 2005 (n = 1758). Patients were assigned to three groups according to the number of embryos frozen: group A, no cryopreservation; group B, a single embryo frozen; group C, several embryos frozen. INTERVENTION(S): Analysis of fresh ETs as a function of the number of embryos frozen and comparison outcomes for the thawing of a single embryo between subgroups B* (only one embryo frozen and thawed) and C* (last embryo of the cohort thawed). MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates after fresh ETs and embryo survival and pregnancy rates after the transfer of a single thawed embryo. RESULT(S): The pregnancy rate per fresh ET increased significantly with the number of embryos frozen: 16.2% in group A, 21.4% in group B, and 26.5% in group C. For single thawed embryos, survival was higher in group C* (91.7%) than in group B* (72.6%). The pregnancy rate was also significantly higher in group C* (19.4% vs. 0%). CONCLUSION(S): The freezing of single embryos is of no benefit in cumulative pregnancy rates. ET strategies should therefore be reviewed.

How viable are zygotes in which the PN are still intact at 25 hours? Impact on the choice of embryo for transfer.

OBJECTIVE: To evaluate the pertinence of kinetic observations of embryonic development 25 hours after IVF, with a view to optimizing the choice of embryos for transfer. DESIGN: Retrospective study of 471 cycles with embryo transfer. SETTING: University Hospital. INTERVENTION(S): Observations of changes in zygotes, in the 25th hour after insemination (25 h PI). MAIN OUTCOME MEASURE(S): Identification of three stages of development: two cells (2C), loss of the pronuclei (in syngamy; 0PN) and persistence of the two pronuclei (2PN). Embryonic morphology at 48 hours, according to the stages identified at 25 hours, was correlated with the rates of implantation and clinical pregnancy. RESULT(S): Two thousand four hundred seventy-eight day-2 embryos were observed. The number of blastomeres on day 2 differed significantly according to stage of development at 25 hours (2C: 69.8% vs. 0PN: 55% and 2PN: 24.6%). Implantation rates were significantly lower for cycles in which only 2PN embryos were produced (7%, n = 160) than for cycles with at least one 2C embryo and/or, preferably, a 0PN embryo (14.4%). The implantation rate was significantly lower for the transfer of only 2PN embryos (7.6%) than for the transfer of only embryos that had advanced further by 25 h PI (15.2%). If only one type of embryo was transferred (2PN vs. 2C or 0PN), for embryos with a similar morphology at 48 hours, four-blastomere embryos derived from 2PN embryos implanted less efficiently than those derived from 2C and/or 0PN embryos. CONCLUSION(S): Observation at 25 h PI is a simple, rapid, and cheap method for identifying the best embryos to transfer. A lack of zygote development at 25 hours is associated with a poor prognosis, unless the zygote concerned has two to three cells on day 2. The development of zygotes with 2PN at 25 h PI should be taken into account as a function of their development at 48 hours.

Detection of HIV-1 RNA in seminal plasma samples from treated patients with undetectable HIV-1 RNA in blood plasma.

Five percent of 145 HIV-1 infected men enrolled in an assisted reproductive technology (ART) program harbored detectable HIV-1 RNA in semen, although they had no other sexually transmitted disease and their blood viral load was undetectable for at least 6 months under antiretroviral treatment. This result justifies measuring HIV-1 RNA in semen before the ART process and suggests that a residual risk of transmission has to be mentioned to the patients who would like to have unprotected sexual intercourse.