Fertility Check Up: A concept of all-in-one ultrasound for the autonomous evaluation of female fertility potential: Analysis and evaluation of first two years of experience.

RESEARCH QUESTION: Today, women can plan for parenthood and family life, but delaying pregnancy is often associated with anxiety regarding the question of future fertility. We aim to evaluate if there is a benefit to offering fertility evaluation to all women, including those who have no immediate plans for pregnancy. DESIGN: We developed in our reproductive center a new concept of an all-in-one ultrasound open to all women of reproductive age. Fertility Check Up (FCU) is a medical and ultrasound exam followed by an interview with a fertility expert, accessible to all women of childbearing age whether or not they are planning a pregnancy. The FCU provides an anatomical and functional evaluation of the reproductive system and indicates the theoretical likelihood of conception, along with advice from fertility experts. RESULTS: In the first year, 440 women between 24 and 48 were screened, 56% of whom had never attempted to conceive. An anatomical abnormality was found in 58.5% of women, the examination concluded to a low-for-age ovarian reserve in 14% of the cases. 37.5% of the women in our study were referred either for ART treatment, fertility preservation or oocyte donation. Six months after, 50% of the women who had no immediate pregnancy plans stated that the FCU had modified their personal or professional plans regarding a possible future pregnancy. CONCLUSIONS: Fertility assessment for all women, whether infertile or not, with or without immediate pregnancy plans, allows for information, advice, and treatment if necessary.

Comparison of predictive models for cumulative live birth rate after treatment with ART.

RESEARCH QUESTION: Can a machine learning model better predict the cumulative live birth rate for a couple after intrauterine insemination or embryo transfer than Cox regression based on their personal characteristics? STUDY DESIGN: Retrospective cohort study conducted in two French infertility centres (Créteil and Tenon Hospitals) between 2012 and 2019, including 1819 and 1226 couples at Créteil and Tenon, respectively. Two models were applied: a Cox regression, which is almost exclusively used in assisted reproductive technology (ART) predictive modelling, and a tree ensemble-based model using XGBoost implementation. Internal validations were performed on each hospital dataset separately; an external validation was then carried out on the Tenon Hospital's population. RESULTS: The two populations were significantly different, with Tenon having more severe cases than Créteil, although internal validations show comparable results (C-index of 60% for both populations). As for the external validation, the XGBoost model stands out as being more stable than Cox regression, with the latter having a higher performance loss (C-index of 60% and 58%, respectively). The explicability method indicates that the XGBoost model relies strongly on features such as the ages of a couple, causes of infertility, and the woman's body mass index or infertility duration, which is consistent with the ART literature about risk factors. CONCLUSIONS: Overall performances are still relatively modest, which is coherent with all reported ART predictive models. Explicability-based methods would allow access to new knowledge, to gain a greater comprehension of which characteristics and interactions really influence a couple's journey. These models can be used by practitioners and patients to make better informed decisions about performing ART.

Comparison of stimulated versus modified natural cycles for endometrial preparation prior to frozen embryo transfer: a randomized controlled trial.

RESEARCH QUESTION: To compare stimulated cycle (STC) versus modified natural cycle (MNC) for endometrial preparation prior to frozen embryo transfer (FET) in terms of convenience and efficacy. DESIGN: Prospective, open-label, randomized controlled study including 119 patients aged 20-38 years, undergoing intra-conjugal IVF/intracytoplasmic sperm injection, having regular cycles, at least two day 2 or day 3 frozen embryos, for whom it was the first or second FET performed, randomized to either MNC (n = 59) or STC (n = 60). Monitoring consisted of ultrasound and hormonal measurements. The number of monitoring visits required was compared between the two groups. RESULTS: STC required a significantly lower number of monitoring visits compared with MNC (3.6 ± 0.9 versus 4.4 ± 1.1, respectively, P < 0.0001), a lower number of blood tests (2.7 ± 0.8 versus 3.5 ± 1.0, respectively, P < 0.0001) and of ultrasounds (1.2 ± 0.4 versus 1.5 ± 0.6, respectively, P = 0.0039). FET during 'non-opening' hours (22.6% versus 27.5%, respectively, P = 0.32) and cancellation rates (11.7% versus 11.9%, respectively, P = 0.97) were comparable between the STC and MNC groups. No difference concerning HCG-positive rates (34.0% versus 23.1%, respectively, P = 0.22) nor live birth rates (24.5% for STC versus 23.1% for MNC, respectively, P = 0.86) was observed. Quality of life as defined by the FertiQol score was not different (P > 0.05 for each item). CONCLUSION: Altogether, these findings can be used for everyday clinical practice to better inform patients when deciding on the protocol to use for FET. These results suggest that MNC is a good option for patients reluctant to have injections, but requires increased monitoring. STC may offer more flexibility for patients and IVF centres.

A novel concept for female infertility exploration: the Fertiliscan©, a dedicated all-in-one 3D ultrasound exploration.

The investigation of the probable cause of infertility is mandatory to propose an accurate therapeutic option to the infertile couple i.e. good chance of pregnancy. Usually, this investigation in woman includes at least hormonal dosages to estimate the ovarian function and reserve, a pelvic ultrasound scan and a hystero-salpingography to determine tubal patency. We introduce a unique investigation based on the realization of a high quality 3D ultrasound scan that involves the assessment of tubal patency. It is called Fertiliscan as opposed to the standard pelvic scan. The Fertiliscan assesses both the anatomy and the function of the uterus, the ovaries as well as the tubes. It includes a hystero-sonography for the analysis of the uterine cavity and with respect to tubal patency, a hysterosalpingo-foam-sonogography (Hyfosy). The investigation is woman-friendly, cheaper and shorter. It allows a fast track to a treatment if needed and shortens "time to pregnancy" for the couple.

Detection of freezing of gait in Parkinson disease: preliminary results.

Freezing of gait (FOG) is a common symptom in Parkinsonism, which affects the gait pattern and is associated to a fall risk. Automatized FOG episode detection would allow systematic assessment of patient state and objective evaluation of the clinical effects of treatments. Techniques have been proposed in the literature to identify FOG episodes based on the frequency properties of inertial sensor signals. Our objective here is to adapt and extend these FOG detectors in order to include other associated gait pattern changes, like festination. The proposed approach is based on a single wireless inertial sensor placed on the patient's lower limbs. The preliminary experimental results show that existing frequency-based freezing detectors are not sufficient to detect all FOG and festination episodes and that the observation of some gait parameters such as stride length and cadence are valuable inputs to anticipate the occurrence of upcoming FOG events.

Assessment of theca cell function prior to controlled ovarian stimulation: the predictive value of serum basal/stimulated steroid levels.

BACKGROUND: Serum androgen levels correlate with ovarian sensitivity to follicle-stimulating hormone (FSH) but in practice, standard baseline serum testosterone (T) levels prior to in-vitro fertilization (IVF) may not be the most appropriate marker for determination. METHODS: Infertile women enrolled in an IVF programme were included in this study. Serum T and Delta4-androstenedione (A), and the androgen precursor 17-hydroxyprogesterone (17-OHP) were measured before and 24 h after a gonadotrophin-releasing hormone agonist stimulation test (GAST). An early follicular phase antral follicle count (AFC) was also performed. Patients were subsequently enrolled in a long gonadotrophin-releasing hormone agonist protocol with a standard FSH dose (150 IU) for 7 days to assess the association between androgen levels and ovarian responsiveness to FSH. RESULTS: The GAST elicited a significant increase in serum androgen levels that was well correlated with AFC. 17-OHP showed the greatest response to GAST and strongest correlation with AFC. The 17-OHP response to GAST differentiated patients with high ovarian reserve (OR) from those with low or normal OR as assessed by AFC, whereas only the estradiol response could differentiate those with low AFC. GAST-stimulated serum levels of 17-OHP were also correlated with ovarian response to FSH. Using receiver operating characteristic curve analysis, stimulated 17-OHP levels were predictive of the ovarian response to controlled ovarian stimulation, with similar power to that observed with AFC but lower power than with anti-Müllerian hormone. CONCLUSIONS: Serum androgen levels following GAST are correlated with AFC and ovarian response to FSH. Serum T is a less sensitive marker of theca cell function than 17-OHP.

"Empty follicle syndrome" after human error: pregnancy obtained after repeated oocyte retrieval in a gonadotropin-releasing hormone antagonist cycle.

OBJECTIVE: To report a case of empty follicle syndrome (EFS) after human error occurring in hCG administration and discuss the specific management of this event in a GnRH antagonist cycle. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 27-year-old woman admitted for a first oocyte retrieval resulting in empty follicle syndrome. The cause was the lack of administration of hCG injection 36 hours earlier. MAIN OUTCOME MEASURE(S): Serial measurements of hCG, LH, and P. RESULT(S): Because no injection of GnRH antagonist had been given for 2 days, the occurrence of endogenous LH surge was assessed by measurement of serum LH, P, and E(2). In the absence of any spontaneous LH surge, EFS was successfully treated by administering 250 microg of recombinant hCG in the evening of the first failed ovarian puncture and rescheduling the second oocyte retrieval 36 hours later. Four oocytes were retrieved and two resulting embryos were transferred. Pregnancy was obtained and patient gave birth to a healthy male baby at term. CONCLUSION(S): Our case is the first report of pregnancy obtained after a successful treatment of EFS in a GnRH antagonist cycle. In contrast to GnRH agonist down-regulated cycles, the management of EFS in GnRH antagonist cycles has to take into account the possible occurrence of spontaneous endogenous LH surge.

Cryptic Xp duplication including the SHOX gene in a woman with 46,X, del(X)(q21.31) and premature ovarian failure.

BACKGROUND: Premature ovarian failure (POF) is defined as amenorrhoea for >6 months, occurring before the age of 40, with an FSH serum level in the menopausal range. Although Xq deletions have been known for a long time to be associated with POF, the mechanisms involved in X deletions in order to explain ovarian failure remain unknown. In order to look for potentially cryptic chromosomal imbalance, we used high-resolution genomic analysis to characterize X chromosome deletions associated with POF. METHODS: Three patients with POF presenting terminal Xq deletions detected by conventional cytogenetics were included in the study. Genome wide microarray comparative genomic hybridization (CGH) at a resolution of 1 Mb and fluorescence in situ hybridization (FISH) was performed. RESULTS: Microarray CGH and FISH studies characterized the three deletions as del(X)(q21.2), del(X)(q21.31) and del(X)(q22.33). Microarray CGH showed that the del(X)(q21.31) was also associated with a Xpter duplication including the SHOX gene. In these patients with POF, deletions or duplications of autosomes have been excluded. CONCLUSION: This study is the first one using microarray in patients with POF. It demonstrates that putative X chromosome deletions can be associated with other chromosomal imbalances such as duplications, and therefore illustrates the use of microarray CGH to screen chromosomal abnormalities in patients with POF.