ABSTRACT
OBJECTIVE: We aimed at developing a method to recover trophoblastic cells from the cervix through a completely non-invasive approach and obtaining a genetic proof of their fetal nature implying that they can be used for non-invasive prenatal diagnosis (NIPD). METHODS: We studied obstetrical samples from 21 pregnant women between 8 and 12 weeks of gestation scheduled for chorionic villus sampling or undergoing elective termination of pregnancy. A cytobrush was used to extract cells from the external parts of the cervix and transferred to 10 ml of preservative solution. Cells were layered on filters with 8 microns pores using the ISET system (Isolation by SizE of Tumor/Trophoblastic cells) and stained. Putative fetal cells were collected by single cell laser-assisted microdissection and identified as fetal or maternal cells by Short Tandem Repeat genotyping. NIPD was blindly performed on 6 mothers at risk of having a fetus with Cystic Fibrosis or Spinal Muscular Atrophy. RESULTS: Trophoblastic cells were recovered from all tested cervical samples with a frequency of 2-12 trophoblasts per 2 ml. NIPD was blindly obtained and verified in 6 mothers at risk of having a fetus with Cystic Fibrosis or Spinal Muscular Atrophy. DISCUSSION: Although larger confirmation studies are required, this is the first report providing a solid proof of principle that trophoblasts can be consistently and safely recovered from cervical samples. Since they are a source of pure fetal DNA, i.e. fetal DNA not mixed with maternal DNA, they constitute an ideal target to develop NIPD of recessive diseases, which is a technical challenge for methods based on cell free DNA.
Subject(s)
Cervix Uteri/cytology , Genotyping Techniques/methods , Prenatal Diagnosis/methods , Single-Cell Analysis/methods , Trophoblasts/cytology , Chorionic Villi Sampling/methods , Cystic Fibrosis/diagnosis , Cystic Fibrosis/genetics , Female , Genetic Testing/methods , Humans , Male , Muscular Atrophy, Spinal/diagnosis , Muscular Atrophy, Spinal/genetics , Pregnancy , Pregnancy Trimester, FirstABSTRACT
Laparoscopy is the gold standard in gynecological surgery. Single-port laparoscopic surgery, has been developed in order to improve minimally invasive surgery. We analyzed single-port approach in benign gynecologic pathology and made a bibliographic research on Pubmed and Medline from January 2000 to January 2015. From what emerges from the papers taken into consideration, single-port laparoscopy can be used for salpingostomy or salpingectomy to treat tubal ectopic pregnancy, benign adnexal disease (ovarian cystectomy, salpingo-oophorectomy), and for hysterectomy. We do not have enough data for complex procedures like myomectomy or hysteropexy. Robotic single-port laparoscopy seems to be a very attractive perspective and its use in benign gynecology surgery is expanding. More and more ergonomic limitations of single-port laparoscopy are corrected by development of articulated or flexible instruments and camera. Beyond these preliminary results, more ample prospective studies with an adapted and standardized instrumentation are thus essential to highlight real profits.
Subject(s)
Genital Diseases, Female/surgery , Gynecologic Surgical Procedures/methods , Laparoscopy/methods , Equipment Design , Female , Genital Diseases, Female/physiopathology , Gynecologic Surgical Procedures/instrumentation , Humans , Laparoscopy/instrumentation , Minimally Invasive Surgical Procedures/instrumentation , Minimally Invasive Surgical Procedures/methods , Pregnancy , Robotic Surgical Procedures/instrumentation , Robotic Surgical Procedures/methodsABSTRACT
AIM OF THE STUDY: The objective of this study was to assess the impact of tadalafil on endometrial growth, the uterine artery pulsatility index (PI) and the uterine artery resistance index (RI) in patients under clomiphene ovarian stimulation for intrauterine insemination (IUI). METHODS: This randomized crossover study included 30 patients with a normal endometrium over 53 cycles, and 46 of those cycles in 23 patients were included in the analysis. In group A the patients were under 100 mg clomiphene daily for five days (2-6) and 5 mg tadalafil daily for 7 days (4-10). For Group B (control) the patients only received clomiphene. Measurements of the endometrium, PI, RI and estradiol determinations were taken on cycle days 4, 8 and 10. RESULTS: We observed a better endometrial growth in Group A compared to Group B: 7.5 ± 2.1 mm vs 5.5 ± 1.2 mm, P < 0.0002 and 8.9 ± 1.8 mm vs 6.3 ± 1.8 mm, P < 0.0002 on days 8 and 10, respectively. Additionally, a progressive decrease in the RI was observed in Group A but not in Group B from day 8 (0.77 ± 0.15 vs 0.85 ± 0.18, P = 0.059) to day 10 (0.74 ± 0.20 vs 0.87 ± 0.14, P < 0.017). However, no differences were observed in PI or serum estradiol between Group A and Group B. CONCLUSION: The use of tadalafil improved endometrial growth in patients under clomiphene ovarian stimulation with no significant effect on the uterine artery Pulsatility Index and serum estradiol.
ABSTRACT
Conservative and functional surgery is increasingly used in surgical oncology. Although radical surgery remains the gold standard for treatment of cervical, endometrial and ovarian cancers, conservative approaches have been developed, aiming at preserving the potential of fertility of young patients. These procedures are proposed to selected patients, depending on histological parameters and prognostic factors as well. Therefore, a multidisciplinary approach is mandatory to weight the benefits and risks of fertility-sparing surgery.
Subject(s)
Fertility Preservation/methods , Organ Sparing Treatments/methods , Endometrial Neoplasms/surgery , Female , Humans , Ovarian Neoplasms/surgery , Uterine Cervical Neoplasms/surgeryABSTRACT
BACKGROUND: Metformin is a drug used in the treatment of diabetes and of some disorders related to insulin resistance, such as polycystic ovary syndrome. Gestational diabetes can cause complications for both mother and child, and some studies have shown a beneficial effect of metformin during pregnancy without an increase in perinatal complications. However, the effects on the gonads have not been properly studied. Here we investigated the effect of metformin administered during pregnancy on the development and function of the fetal testis. METHODS: A dual approach in vitro and in vivo using human and mouse models was chosen. Cultures of human and murine organotypic testes were made and in vivo embryonic testes were analysed after oral administration of metformin to pregnant mice. RESULTS: In human and mouse organotypic cultures in vitro, metformin decreased testosterone secretion and mRNA expression of the main factors involved in steroid production. In vitro, the lowest observed effect concentration (LOEC) on testosterone secretion was 50 µM in human, whereas it was 500 µM in mouse testis. Lactate secretion was increased in both human and mouse organotypic cultures with the same LOEC at 500 µM as observed in other cell culture models after metformin stimulation. In vivo administration of metformin to pregnant mice reduced the testicular size of the fetal and neonatal testes exposed to metformin during intrauterine life. Although the number of germ cells was not affected by the metformin treatment, the number of Sertoli cells, the nurse cells of germ cells, was slightly yet significantly reduced in both periods (fetal period: P = 0.007; neonatal period: P = 0.03). The Leydig cell population, which produces androgens, and the testosterone content were diminished only in the fetal period at 16 days post-coitum. CONCLUSIONS: This study showed a potentially harmful effect of metformin treatment on the development of the fetal testis and should encourage future human epidemiological studies.
Subject(s)
Hypoglycemic Agents/adverse effects , Metformin/adverse effects , Organogenesis/drug effects , Prenatal Exposure Delayed Effects , Testis/drug effects , Testis/embryology , Animals , Animals, Newborn , Cell Proliferation/drug effects , Embryo, Mammalian/drug effects , Embryo, Mammalian/metabolism , Female , Gene Expression Regulation, Developmental/drug effects , Humans , Hypoglycemic Agents/pharmacology , Male , Metformin/pharmacology , Mice , Mice, Inbred Strains , Organ Culture Techniques , Organ Size/drug effects , Pregnancy , RNA, Messenger/metabolism , Testis/growth & development , Testis/metabolism , Testosterone/metabolismABSTRACT
The recent emergence of oncofertility raises the question of ovarian stimulation and its risks when performed for oocyte or/and embryo cryopreservation in a fertility preservation program. The relation between ovarian stimulation and cancer has been marked by the possible direct or indirect tumorigenic role for pituitary gonadotrophins in the tumorogenesis. Although the growth of many gonadal and extragonadal tumors is stimulated by gonadal sex hormones, whose production is regulated by gonadotrophins, there is still a lack of data to consider FSH and LH as tumor promoters. The purpose of this brief review is to present on one hand, the questions raised by the administration of exogenous gonadotrophins in cancer patients and on the other, to evaluate both experimental and clinical data about the possible relation between gonadotrophins and tumorogenesis.
Subject(s)
Fertility Preservation , Gonadotropins/therapeutic use , Neoplasms/therapy , Adenocarcinoma/therapy , Breast Neoplasms/therapy , Cryopreservation/statistics & numerical data , Female , Fertility Agents, Female/therapeutic use , Fertility Preservation/methods , Fertility Preservation/statistics & numerical data , Humans , Neoplasms/rehabilitation , Oocytes , Ovarian Neoplasms/therapy , Ovulation Induction/methods , Ovulation Induction/statistics & numerical data , PregnancyABSTRACT
The present study was conducted to determine whether exposure to the mono-(2-ethylhexyl) phthalate (MEHP) represents a genuine threat to male human reproductive function. To this aim, we investigated the effects on human male fetal germ cells of a 10â»5 M exposure. This dose is slightly above the mean concentrations found in human fetal cord blood samples by biomonitoring studies. The in vitro experimental approach was further validated for phthalate toxicity assessment by comparing the effects of in vitro and in vivo exposure in mouse testes. Human fetal testes were recovered during the first trimester (7-12 weeks) of gestation and cultured in the presence or not of 10â»5 M MEHP for three days. Apoptosis was quantified by measuring the percentage of Caspase-3 positive germ cells. The concentration of phthalate reaching the fetal gonads was determined by radioactivity measurements, after incubations with ¹4C-MEHP. A 10â»5 M exposure significantly increased the rate of apoptosis in human male fetal germ cells. The intratesticular MEHP concentration measured corresponded to the concentration added in vitro to the culture medium. Furthermore, a comparable effect on germ cell apoptosis in mouse fetal testes was induced both in vitro and in vivo. This study suggests that this 10â»5 M exposure is sufficient to induce changes to the in vivo development of the human fetal male germ cells.
Subject(s)
Apoptosis/drug effects , Diethylhexyl Phthalate/analogs & derivatives , Germ Cells/drug effects , Testis/drug effects , Animals , Carbon Radioisotopes , Caspase 3/metabolism , Diethylhexyl Phthalate/pharmacokinetics , Diethylhexyl Phthalate/toxicity , Dose-Response Relationship, Drug , Germ Cells/metabolism , Humans , In Vitro Techniques , Male , Mice , Mice, Inbred C57BL , Species Specificity , Testis/embryologyABSTRACT
OBJECTIVE: Ligation of the internal iliac arteries and embolization of the uterine arteries are two techniques routinely used in the management of postpartum hemorrhage. The objective of this study was to examine the long-term consequences of these techniques on women's subsequent reproductive outcome and subsequent delivery morbidity. METHODS: Retrospective study including women who underwent ligation and those who underwent embolization, for the treatment of postpartum hemorrhage. We analyzed resumption of menses, fertility, pregnancy and delivery outcome after each treatment. RESULTS: The study included 85 women who underwent ligation and 90 who had embolization to treat postpartum hemorrhage. No adverse event related to menses, fertility, or pregnancy outcome followed either treatment. However, the rate of recurrent hemorrhage was high: 26% after ligation and 39% after embolization. All recurrences were treated medically in the ligation group, but in the embolization group, 42% (five of 12 patients) required invasive treatment and 33% (four patients) transfusions. CONCLUSION: From the perspective of subsequent menses, fertility and pregnancy outcome, both ligation and embolization are safe procedures for the management of postpartum hemorrhage. However, our results showed a high risk of recurrent postpartum hemorrhage after both treatments. Recurrences seemed more serious after the latter.
Subject(s)
Fertility , Postpartum Hemorrhage/therapy , Pregnancy Outcome , Blood Transfusion , Embolization, Therapeutic , Female , Humans , Iliac Artery/surgery , Ligation , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/surgery , Pregnancy , Recurrence , Retrospective Studies , Uterine ArteryABSTRACT
INTRODUCTION: This retrospective study aimed at analyzing IVF-ET management and outcome after cancellation of a first cycle for poor response. PATIENTS AND METHOD: One hundred and forty-two infertile patients were included in this observational study. After an overall analysis on the outcome of the second IVF-ET attempt, a sub-analysis was performed according to the presence or the absence of poor prognostic criteria defined as mentioned: patient age superior to 38 years old, antral follicle count (3-9 mm in diameter) inferior to 10 on cycle day 3 and day 3 serum AMH and FSH levels less than 1 ng/mL and more than 10 IU/mL, respectively. Main outcome measures were the cancellation rates, pregnancy and live birth rates. RESULTS: When a controlled ovarian stimulation was performed, patients with poor prognosis had higher cancellation rates (37.8% vs. 13.3%, P<0.004) and lower pregnancy and live birth rates (22.2% vs. 35.0%, P<0.05 and 11.1% vs. 26.1%, P<0.05, respectively) as compared to good prognosis women. CONCLUSION: The relatively high cancellation rate in patients with poor prognosis raises the question of the use of IVF modified natural cycle in this group.
Subject(s)
Fertilization in Vitro/methods , Live Birth , Menstrual Cycle/physiology , Ovulation Induction/methods , Pregnancy Rate , Treatment Refusal , Adult , Age Factors , Anti-Mullerian Hormone/blood , Anti-Mullerian Hormone/deficiency , Female , Fertilization in Vitro/statistics & numerical data , Follicle Stimulating Hormone/blood , Humans , Outcome Assessment, Health Care , Ovarian Follicle/anatomy & histology , Pregnancy , Prognosis , Retrospective Studies , Treatment Failure , Treatment Refusal/statistics & numerical data , Young AdultABSTRACT
Growing evidence indicates that mild ovarian stimulation for in vitro-fertilization-embryo transfer may be an interesting approach to reduce the incidence and severity of complications, the number of treatment days, cost, patient discomfort and number of patient drop-outs. However, the heterogeneity of FSH-sensitive follicles, presumably requires multiple follicular growth to improve oocyte-embryo selection. In addition, whether the acceptability probably is similar between standard ovarian stimulation and mild stimulation, per-treatment pregnancy rates with conventional stimulation is superior to mild stimulation in unselected populations. Hence, some specific indications tend to emerge such as alterations of the ovarian follicular reserve in women of less than 38 years, bad embryo qualities and implantation failure after conventional stimulation, patients with previous history of hyperstimulation syndrome or contraindications to hyperoestrogenia (estrogeno-related cancers and thromboembolic diseases). However, no randomized trials have ever been performed to compare the results of mild versus conventional stimulation in young patients and good responders. Therefore, there is insufficient scientific evidence to shift from standard stimulation to mild stimulation for all patients. Cultural standards have to be considered in the choice of the type of stimulation.
Subject(s)
Ovulation Induction/methods , Age Factors , Clomiphene/administration & dosage , Embryo Implantation , Female , Fertility Agents, Female/administration & dosage , Fertilization in Vitro/methods , Follicle Stimulating Hormone/administration & dosage , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Humans , Iatrogenic Disease/prevention & control , Ovarian Neoplasms/prevention & control , Ovulation Induction/adverse effects , Pregnancy , Pregnancy Rate , Reproductive Techniques, AssistedABSTRACT
Preimplantation genetic diagnosis (PGD) is authorized in France since 1999. After 10 years, technical results are encouraging. With the development of new technologies, our team is able to diagnosis the large majority of chromosome translocations and 75 monogenic diseases. However, PGD remains limited because of the growing augmentation of demands causing an increasing delay for the first procedure of more than 18 months. Since 2006, 19 couples asked for a PGD with HLA typing. In January 2011, 11 couples have already been included in our PGD program. The birth of the first child after PGD with HLA typing offers new perspectives of treatment for these couples.
Subject(s)
Genetic Testing/methods , Histocompatibility Testing , Preimplantation Diagnosis/methods , Adult , Female , France , Genetic Testing/ethics , Genetic Testing/legislation & jurisprudence , Humans , Infant, Newborn , Male , Pregnancy , Preimplantation Diagnosis/ethics , Young AdultABSTRACT
The ovarian hyperstimulation syndrome is a major complication of ovulation induction for in vitro fertilization, with severe morbidity and possible mortality. Whereas its pathophysiology remains ill-established, the VEGF may play a key role as well as coagulation disturbances. Risk factors for severe OHSS may be related to patients characteristics or to the management of the ovarian stimulation. Two types of OHSS are usually distinguished: the early OHSS, immediately following the ovulation triggering and a later and more severe one, occurring in case of pregnancy. As no etiologic treatment is available, the therapeutic management of OHSS should focus on its related-complications. Thrombotic complications that can occur in venous or arterial vessels represent the major risk of OHSS, possibly conducting to myocardial infarction and cerebrovascular accidents. Once the OHSS is diagnosed, prevention of thrombotic accidents remains the major issue.
Subject(s)
Ovarian Hyperstimulation Syndrome/diagnosis , Ovarian Hyperstimulation Syndrome/prevention & control , Anti-Mullerian Hormone/analysis , Chorionic Gonadotropin/adverse effects , Estradiol/adverse effects , Female , Humans , Incidence , Interleukins/analysis , Luteinizing Hormone/adverse effects , Myocardial Infarction/etiology , Myocardial Infarction/prevention & control , Ovarian Hyperstimulation Syndrome/complications , Ovarian Hyperstimulation Syndrome/epidemiology , Ovulation Induction/adverse effects , Pregnancy , Renin-Angiotensin System/physiology , Risk Factors , Severity of Illness Index , Stroke/etiology , Stroke/prevention & control , Thrombosis/etiology , Thrombosis/prevention & control , Vascular Endothelial Growth Factors/physiologyABSTRACT
Over the past two decades, major advances in diagnostic modalities and treatment have markedly improved rates of cure for adult cancers. As a consequence, the number of long-term survivors is increasing, and fertility preservation has become a major issue for young patient about to start treatment for cancer. Whether fertility preservation is a promising option, most of the technologies currently used are far from being well established or are even still experimental. Patients should be aware that no method guarantees success. Psychological and ethical impacts of fertility preservation are major concerns and should be included in the multidisciplinary approach of the patients.
Subject(s)
Fertility Preservation/methods , Interdisciplinary Communication , Neoplasms/therapy , Women , Adult , Attitude to Death , Female , Humans , Infertility, Female/prevention & control , Infertility, Female/psychology , Neoplasms/psychology , Neoplasms/rehabilitation , Therapeutic Human Experimentation , Treatment Refusal/psychologyABSTRACT
The objective is to compare the IVF procedures in modified natural cycle outcomes according to serum anti-Mullerian hormone (AMH) levels. We included in this retrospective study 342 patients undergoing their first IVF in modified natural cycle. Patients were regrouped in three groups according to their serum AMH level: group 1 was defined by patients with AMH level<0.97 ng/mL (<25th percentile), group 2, patients with AMH level between 0.97 ng/mL and 2.60 ng/mL (25-75th percentile), and group 3, patients with AMH level between 2.61 ng/mL and 6.99 ng/mL (>75th percentile). The main outcomes were cancellation rate, embryo transfer rate and clinical pregnancy rate, ongoing pregnancy rate and implantation rate. No difference has been observed on cancellation rate, embryo transfer rate, clinical pregnancy rate and implantation rate. The ongoing pregnancy rate per IVF cycle was respectively: 12.8±3.6% for AMH inferior to 0.97 ng/mL versus 12.5±2.5% for AMH between 0.97 to 2.60 ng/mL and 13.4±4.2% for AMH between 2.61 ng/mL and 6.99 ng/mL. In conclusion, IVF in modified natural cycles procedures should be considered as an option for patients with an altered ovarian reserve defined by a serum AMH inferior to 1 ng/mL. Serum AMH level seems a quantitative marker of the ovary but not a quality factor. Serum AMH level does not seem to be a prognostic factor for ongoing pregnancy rated in IVF modified cycles.
Subject(s)
Anti-Mullerian Hormone/blood , Fertilization in Vitro , Adult , Embryo Implantation , Embryo Transfer , Female , Humans , Pregnancy , Retrospective Studies , Treatment OutcomeABSTRACT
A 34-year-old woman consulted the day before a scheduled caesarean for dry cough. A positive rhinopharyngeal sample for PCR testing for influenza A H1N1 led to a curative oseltamivir (Tamiflu®) treatment. At delivery a direct contact between the newborn and mother lasted only few seconds. The first healthy baby boy developped dry cough with a rhinopharyngeal sample positive for A H1N1. The minimal contact between mother and child and the positive neonatal sample only four hours after birth allow to think that it is a rare case of prenatal transmission of influenza A H1N1 to the fetus.
Subject(s)
Infectious Disease Transmission, Vertical , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/diagnosis , Influenza, Human/transmission , Pregnancy Complications, Infectious/diagnosis , Adult , Antiviral Agents/therapeutic use , Female , Humans , Infant, Newborn , Influenza A Virus, H1N1 Subtype/drug effects , Influenza, Human/drug therapy , Male , Nasopharynx/drug effects , Nasopharynx/virology , Oseltamivir/therapeutic use , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/virologyABSTRACT
Intra-uterine growth retardation (IUGR) is a frequent cause of consultation in antenatal care unit. The prognosis relies on the etiology: vascular, chromosomic, genetic, or infectious. Because of chronic fetal distress, hypotrophy increase morbidity, mortality and neurosensorial long term effect. Usually, infection is involved in 5 to 15% of the IUGR, mainly by Cytomegalovirus (CMV), Varicella Zoster virus, rubella, toxoplasmosis, herpes and syphilis. Maternal sera and amniotic liquid analysis make the diagnosis possible but fetal ultrasound scan is used to find other features. Most of the abnormalities are unspecific but their combination can worsen fetal prognosis. Infection should always be ruled out in the assessment of IUGR.
Subject(s)
Fetal Growth Retardation/etiology , Infections , Chickenpox/complications , Chickenpox/diagnostic imaging , Chickenpox/embryology , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnostic imaging , Cytomegalovirus Infections/embryology , Female , Fetal Diseases/microbiology , Fetal Growth Retardation/diagnostic imaging , Fetal Growth Retardation/microbiology , Herpesviridae Infections/complications , Herpesviridae Infections/diagnostic imaging , Herpesviridae Infections/embryology , Humans , Pregnancy , Prognosis , Rubella/complications , Rubella/diagnostic imaging , Rubella/embryology , Syphilis/complications , Syphilis/diagnostic imaging , Syphilis/embryology , Toxoplasmosis/complications , Toxoplasmosis/diagnostic imaging , Toxoplasmosis/embryology , Ultrasonography, PrenatalABSTRACT
Although female cancer incidence may be on rise, antineoplastic regimens have become more successful. As a result, an increasing number of women with cancer survive to endure the long-term consequences of chemotherapy. One of the most important long-term consequences of cancers treatments in young female is premature ovarian failure and infertility. Because of the increasing survival rates, many of these young women are seeking methods to preserve their fertility. Currently, embryo/oocytes cryoporeservation obtained after ovarian stimulation appears to provide the best fertility preservation option. However, patients may not have sufficient time to undergo ovarian stimulation prior to chemotherapy and/or the hormones used in ovarian stimulation are contra-indicated for estrogen-dependant tumors. In vitro maturation of oocytes (IVM) has been suggested to avoid ovarian stimulation and time requirement in patients with cancer, and can be combined with ovarian tissue cryobanking. In this review, we will discuss the position of IVM in the strategy of fertility preservation in young women.