[Adverse obstetric and perinatal outcome with in vitro fertilization technology: A French nationwide population-based study]. / Risques de morbidité maternelle et périnatale en fécondation in vitro : une étude nationale de cohorte française.

OBJECTIVES: The objective of this study was to quantify the risk of maternal and perinatal morbidity with in vitro fertilization (IVF) technology compared to non-IVF pregnancies in a recent French national cohort. METHOD: The data was extracted from the hospital information data system, including all pregnancies with a delivery from 2013 to 2016. The risks of preterm birth, maternal morbidity (venous and arterial thrombosis, gestational diabetes, vascular disorders, placenta previa, placenta abruption), hypotrophy and congenital malformation were compared in both groups in univariate and multivariate analysis after adjustment on the characteristics of women (age, parity, obesity, tobacco dependence, history of diabetes or high blood pressure), multiple deliveries and sex of children. RESULTS: In all, 2,875,662 pregnancies and 2,922,712 births were analyzed, of which 49,224 were derived from IVF (1.7%). In multivariate analysis, all risks were significantly higher in IVF: premature deliveries (ORajusted=1.28; CI95%=1.24-1.32), maternal morbidity (ORajusted=1.24; CI95%=1.21-2.28), (mainly for thrombosis venous, placenta previa and placenta abruption). The risks of hypotrophy (ORajusted=1.13; CI95%=1.10-1.16) and congenital malformations (ORajusted=1.11; CI95%=1.05-1.17) were slightly increased. CONCLUSION: The results of this study on a large cohort of recent births in France confirm that there was an increased risk of maternal and perinatal morbidities in IVF. These risks were similar to those published in the international literature. This study is the starting point for a forthcoming surveillance.

A giant parapharyngeal lipoma causing obstructive sleep apnea.

Lipoma is the most common soft tissue mesenchymal neoplasm. Its occurrence is low in the oral cavity (1 to 4%) and in head and neck region (20 to 25%). Usually asymptomatic and slowly growing, lipoma can compress neighboring cervico-facial structures causing dysphagia, dyspnea, or obstructive sleep apnea. We describe an unusual case of giant cervico-parapharyngeal lipoma causing an obstructive sleep apnea in a 69-year-old man and with the complete remove of OSA after surgical procedure.

Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults.

INTRODUCTION: The treatment of fractures in the mandibular condylar process remains controversial. The aim of this study was to assess the outcomes of isolated functional treatment versus open reduction and internal fixation (ORIF) of mandibular condylar fracture with articular impact based on clinical and radiological criteria. MATERIALS AND METHODS: Eighty-three patients with a mandibular condylar fracture with articular impact were included in this retrospective study. They were divided according to Loukota, Spiessl and Schroll, Mercier and Rasse, Neff, and Hlawitschka classifications. Two groups were created: operated patients (operated) and non-operated patients (non-operated). Occlusal and functional features were evaluated using clinical measurements at 1, 3, 6, and 12 months after the treatment as well as radiological measurements performed preoperatively, 6 weeks later, and at the end of the follow-up. RESULTS: A male predominance was observed in the data (69.9%, P<0.0001). Isolated functional treatment was applied in 55 patients (66.26%). Twenty-eight patients (33.7%) were operated upon using a pre-auricular or modified Risdon's approach. Maximal mouth opening (MMO) was lesser in "operated" group compared to "non-operated" group until 6 months (25.75mm vs 31.96mm, 34.76mm vs 37.95mm, 38.06mm vs 41.87mm respectively 1, 3 and, 6 months, P<0.05). Results were satisfactory 1 year after treatment (41.29mm vs 45.22mm, P>0.05). There was no difference concerning temporo-mandibular joint dysfunctions between operated and non-operated patients. For unilateral fractures, the loss of height of the ramus was significantly higher in operated patients initially compared to "non-operated" group (P=0.0137). After surgical correction, there was no difference between the two sides of mandible. At the end of the follow-up, the there was no difference between operated and non-operated ramus (P=0.1304 and 0.6420). CONCLUSION: The present study showed that a properly followed isolated functional treatment provided similar clinical results to ORIF for mandibular condylar fractures with articular impact. Surgical treatment should be preferred when the loss of height of the ramus is severe to restore the ramus height since adult condylar remodeling is less efficient than in children.

[Legislative and regulatory situation of oocytes donation in France]. / Situation législative et réglementaire du don d'ovocytes en France.

In France, medically assisted procreation (MAP) activities and gamete donation are strictly regulated by the bioethics law. The main ethical principles applied to the donation--no remuneration, anonymity, and the requirement for free and informed consent--aim to protect donors. In the same spirit, since MAP with oocytes donation is recognized as a healthcare activity, receiving couples benefit from exemption from co-payments by the health insurance system. Thus, it is widely accessible to couples presenting medical infertility requiring oocytes from a donor, but availability is insufficient to cover needs. This shortage in supply results in moving the demand abroad where this particular MAP is exercised at varying levels of supervision.

[Egg donation: regulation of the donation and the hidden face of the cross-border reproductive care]. / Prise en charge du don d'ovocytes: réglementation du don, la face cachée du tourisme procréatif.

In France egg donation is not sufficient to meet the needs of infertile couples. As a consequence there is a long waiting time for those couples who may be driven to search solutions abroad. Nonetheless in some countries practice of egg donation raises medical and ethical questions regarding the quality of care provided to the recipients as well as the recruitment and follow-up of egg donors. Meanwhile the scope of this type of "cross-border reproductive care" remains difficult to assess, even though this trend seems to be growing and is reinforced by a recent regulation facilitating the free movement of people seeking cross-border health care within the European Union. These observations lead to question the possible causes of "cross-border reproductive care" in the light of national laws, to identify potential consequences in order to suggest possible actions at both national and international level.

ICSI outcomes in obstructive azoospermia: influence of the origin of surgically retrieved spermatozoa and the cause of obstruction.

BACKGROUND: Spermatozoa can be retrieved from the testis and epididymis of men with obstructive azoospermia (OA) and used for ICSI. However, it is unknown whether the outcome of ICSI depends on the cause of obstruction or the origin of surgically retrieved spermatozoa. METHODS: A cohort of 171 men with OA and normal spermatogenesis were included in this retrospective study. They were divided into three groups according to the site and origin of obstruction: 83 men had congenital bilateral absence of vas deferens; 55 and 33 had acquired epididymal and deferent duct obstructions, respectively. The outcome of 368 ICSI cycles was determined and compared according to the origin of spermatozoa: epididymal (n = 253) or testicular (n = 115). RESULTS: Fertilization and clinical pregnancy rates did not differ between spermatozoa of different origin (58.9% versus 51.9% and 22.1% versus 24.3% with epididymal and testicular spermatozoa, respectively). However, the miscarriage rate was significantly higher for testicular spermatozoa (35.7% versus. 12.5% P < 0.05, chi2 test). Findings were similar whatever the aetiology of the OA. CONCLUSION: This study suggests that the use of testicular spermatozoa, even those generated during normal spermatogenesis, alters embryonic development and that epididymal spermatozoa should be preferentially used, irrespective of the aetiology of OA.

Sequential feeding programs for broiler chickens: twenty-four- and forty-eight-hour cycles.

Sequential feeding programs (Seq) of 2 feeds, 1 protein rich-energy poor and 1 energy rich-protein poor, during the same day or every other day were compared with a control complete diet for male broiler growth and body composition from 15 d to market weight. In experiment 1, BW gain and breast meat yield were significantly lower than those of controls for 24-h-cycle Seq with extreme protein content difference between the 2 feeds. BW gain and breast meat yield were higher than those of controls when feeds with moderate differences [feed moderately rich in protein (PM) = 26% CP; feed moderately rich in energy (EM) = 16% CP] were fed. Feeding periods that were half as long but changed twice as frequently gave less favorable results. In experiment 2, effects of allowing access to feed for different lengths of time were measured. The treatments in a 24-h cycle were a constant control diet, 50% PM-50% EM, 40% PM-60% EM, or 80% PM-20% EM decreasing to 40% PM-60% EM. Chickens fed 40% PM-60% EM had a 6% lower BW gain and a 3% higher feed/gain ratio and were fatter than those from other treatments. In experiment 3, male chickens fed a 48-h-cycle Seq of EM and PM every other day had the same BW gain, feed intake, and feed/gain ratio as controls. In experiment 4, five 48-h-cycle Seq with varying differences of energy and protein contents between EM and PM gave similar or slight reduction of performances compared with controls. A field trial with 8 flocks of broilers confirmed that feeding high and low protein feeds on alternate days resulted in performance similar to that from feeding a complete feed despite large day-to-day variations in lysine intake. Converse to shorter phases, Seq for 48-h cycles offers new opportunities for practical application and also for studies of short-term regulation of protein and lipid metabolism in chickens.

Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies.

This meta-analysis was intended to evaluate differences in pregnancy rates after in-vitro fertilization (IVF) in tubal fertility with and without hydrosalpinx. It examined nine published retrospective comparative series and five series published as abstracts for which additional information was obtained. In all, these studies involved 5592 patients (1004 with hydrosalpinx and 4588 with tubal infertility without hydrosalpinx). The main outcome measures were rates of pregnancy, implantation, live delivery, and early pregnancy loss. Pregnancy rates were significantly lower in the presence of hydrosalpinx: 31.2% for the tubal sterility group without hydrosalpinx and 19.7% for the group with hydrosalpinx (odds ratio: 0.64; 95% confidence interval: 0.56, 0.74). Similarly, the implantation rate and the delivery rate per transfer in the hydrosalpinx group were only slightly more than half those of the non-hydrosalpinx group (implantation: 8.5 and 13.7%, respectively; delivery: 13.4 and 23.4%). The incidence of early pregnancy loss was also higher in the hydrosalpinx group (43.7%) than in the control group (31.1%). This meta-analysis makes it clear that hydrosalpinx present during IVF-embryo transfer has negative consequences on the rates of pregnancy, implantation, live delivery, and early pregnancy loss. It would be premature, nonetheless, to conclude that routine salpingectomy should be performed on all patients with hydrosalpinx.

Identification and localization of G protein subunits in human spermatozoa.

Antibodies to alpha and beta subunits of guanine nucleotide regulatory proteins (G proteins) were used to identify which G proteins are present in mature human spermatozoa and to determine their subcellular localization. Immunoblots of membranes from spermatozoa demonstrate the presence of Galphai2, Galphai3, Galphaq/11 and Gbeta35 and the absence of Galphai1, Galpha0, Galphas, Galpha12, Galpha13, Galpha16, Galpha and Gbeta36. Indirect immunofluorescence demonstrates the presence of Galphaq/11 in the acrosome, with the highest proportion in the equatorial segment. Galphai2 is present in the acrosome, midpiece and tailpiece and Galphai3 in the postnuclear cap, midpiece and tailpiece. The Gbeta35 subunit is found mostly in the midpiece, with marginal labelling of the head, tailpiece and the equatorial segment of the acrosome. The distinct pattern of distribution of G proteins suggests that they may couple to receptors or effectors which also have discrete regions of localization in spermatozoa. These highly localized signal transduction pathways may regulate discrete functions, such as activation of the acrosome reaction, fusion with the oocyte and motility.

Does hydrosalpinx reduce the pregnancy rate after in vitro fertilization?

OBJECTIVE: To determine the effect of hydrosalpinges on the pregnancy rate in an IVF program. DESIGN: Multicentric retrospective analysis of clinical and laboratory data. SETTING: Two assisted reproductive technology centers in university hospitals. PATIENT(S): Four hundred forty-three women, under 38 years of age, with pure tubal infertility. The patients were classified into the following five groups: bilateral hydrosalpinges (n = 37), unilateral hydrosalpinx (n = 54), bilateral tubal occlusion (n = 207), unilateral tubal occlusion (n = 55), and severe tubal disease without complete occlusion (n = 90). MAIN OUTCOME MEASURE(S): Pregnancy and implantation rates. RESULT(S): The pregnancy and the implantation rates per transfer (12.3% and 5.4%) obtained by women with bilateral hydrosalpinges are significantly lower than the rates (means = 23.1% and 12%) for all other tubal infertility groups. CONCLUSION(S): Bilateral hydrosalpinges have a deleterious effect on the outcome of IVF program.

[Mixed secretory and obstructive azoospermia. Transseptal vasovasostomy by vas deferens transposition: a case report and review of the literature]. / Azoospermie mixte sécrétoire et obstructive. Vasovasostomie trans-septale par transposition des déférents: à propos d'un cas et revue de la littérature.

The authors report a case of complex azoospermia in a 35-year-old man, due to a combination of right testicular atrophy and an iatrogenic lesion of the contralateral vas deferens. Vasovasostomy with transseptal transposition of the vasa deferens restored fertile ejaculation.

[Prognostic sperm factors in intra-uterine insemination with partner's sperm]. / Facteurs pronostiques spermatiques des inséminations intra-utérines avec sperme du conjoint.

We studied the prognostic value of sperm characteristics for the outcome of intra-uterine insemination with partner sperm (IUIPS). A total of 712 cycles of IUIPS following induction of ovulation with gonadotrophin (hMG/hCG) for 277 sterile couples attending the assisted reproductive technology centre of Poissy Hospital (78300-France) between January 1991 and December 1994 was studied retrospectively. Ninety-two clinical pregnancies were obtained giving an overall rate of 12.9% per cycle. None of the characteristics of the sperm as assessed initially correlated with outcome. In contrast, the number of motile spermatozoa given (n) affected outcome: for n < 1 x 10(6) the pregnancy rate was 2%; for n = 5 to 8 x 10(6) the rate was 19%. However, for +/- 8 x 10(6) the proportion of biochemical pregnancies and miscarriages was 40% which was significantly higher than for smaller concentration. The resort of IVF following 4 IUIPS failures leads to a pregnancy rate per cycle of only 6.7%.

Prospective randomized comparison of intrauterine and intracervical insemination with donor spermatozoa.

From March 1990 to September 1993, 20 women underwent a total of 89 cycles of intracervical inseminations with donor semen (ICI) and 23 women underwent 67 cycles of intrauterine inseminations with donor semen (IUI). The women were assigned to the two groups randomly, but ensuring that the ages of the women and pathologies of the male partner (azoospermia or severe oligozoospermia) were similar in the two groups. There was no significant difference between the characteristics of the two groups and the method used to induce ovulation (HMG/HCG) was identical. Two semen straws were used for each insemination cycle. Semen was prepared for IUI on a Percoll gradient. Thirteen clinical pregnancies were obtained in the IUI group (19.4% of the attempts) and six in the ICI group (6.75%). After six cycles of insemination, 75.4% of the women of the IUI group obtained a pregnancy, as compared to 35% in the ICI group. These good results may be due to the method of induction of ovulation, but also to the technique itself, increasing the number of motile spermatozoa at the site of fertilization. The time taken to obtain a pregnancy is thus shorter with IUI than with ICI, and the number of semen straws required is smaller. In-vitro fertilization (IVF) should be proposed after six failures by IUI.

[Retrospective evaluation of an intra-uterine insemination program with donor]. / Evaluation rétrospective d'un programme d'insémination intra-utérine avec donneur.

The results of 109 intra-uterine inseminations with cryopreserved prepared donor semen (IUId) in stimulated cycles, performed among 42 couples from November 1987 to June 1991, were analysed. The single IUId was performed 39 +/- 3 hours after the injection of human chorionic gonadotrophin. For each IUID 1,25 +/- 1.4 x 10(6) motile spermatozoa (mean +/- standard deviation) were inseminated. 27 pregnancies were obtained and the pregnancy rate per cycle was 24.8%. The number of motile spermatozoa inseminated was significantly higher in the group of pregnant women than in the population without pregnancy (1.64 x 10(6) x 10(6)/IUI versus 1.13 x 10(6)/IUI). The sperm count and the number of motile spermatozoa inseminated were significantly higher when the semen was prepared on discontinuous Percoll gradients than after swim-up in Menezo B2 medium (8.2 x 10(6)/ml versus 4.3 x 10(6)/ml and 1.7 x 10(6) versus 0.77 x 10(6)). Among the 27 clinical pregnancies, 3 were twins and 2 were triplets. The ovarian hyperstimulation associated with the use of a prepared semen of donor, generate a high risk of multiple pregnancies. To improve the results without increasing the risk of multiple pregnancies, we propose to inseminate about 1.5 x 10(6) motile spermatozoa with a maximum plasma estradiol level of 1 100 pg/ml, on the day of hCG injection, associated with 2 preovulatory follicles. This technique may augment the rate of pregnancy and represents an appreciable time gain. These results must be confirmed by randomized prospective studies.