[In vitro fertilization (IVF): why doing it in stimulated cycles?]. / En fécondation in vitro (FIV), pourquoi je stimule?

Assisted reproductive technology is a difficult course for the couples. Our purpose is to be effective without damaging the patient and the child to be born. The cumulative rates of success are strictly dependent on the number of oocytes and on the obtained top quality embryos and thus on the realization of an effective stimulation. The risk of multiple pregnancies can be adjusted by an adapted policy of transfer. The transfer of a fresh embryo followed by cycles of frozen embryos transfers gives very satisfactory cumulative pregnancy rates.

[How to improve IVF results from a clinical point of view?]. / Comment améliorer d'un point de vue clinique les résultats en FIV?

This study reports the last data of the literature on the possibilities of optimizing chances of pregnancy during in vitro fertilization attempts, our research concerning only the clinical point of view while excluding biologic possibilities. The selection of the patients, the management of controlled ovarian hyperstimulation protocols, the optimalisation of the transfer and the luteal phase support will be cross-reviewed.

[Analysis of the cancellations and temporary suspensions: the FIVNAT data]. / Analyse des annulations et des déprogrammations: les données de FIVNAT.

This article reports the results of the FIVNAT database concerning the cancellation of cycles in IVF programs. 8,980 cycles have been cancelled (11,5%), mostly because of a poor ovarian response to stimulation (66%). The chances of success of a second cycle of IVF following a cycle cancelled for poor ovarian response halved by 2 (compared with patients cancelled for HSO or for personal reasons).

[Fort Lauderdale congress report: advances in infertility treatment - Florida, 24-26 January 2002]. / Compte rendu du congrès de Fort Lauderdale : progrès dans le domaine du traitement de l'infertilité - Floride, 24-26 janvier 2002.

The goal of the treatment of infertility is to apply therapeutic techniques to patients in a safe manner and at the same time increase the chances for conceiving and delivering healthy babies: basic and clinical research is more and more finalized directed to these goals. The conference "Advances in Infertility Treatment" held in Fort Lauderdale, Florida on January 24-26, 2002 covered many clinical and research aspects of this important therapeutic area. Important discussed issues included the impact of age, lifestyle, and the genetic set-up of patients in the pathogenesis and development of infertility-causing disorders such as male reproductive dysfunction, polycystic ovary syndrome, and ovarian failure. New ovulation induction regimens that may optimize, reduce complications, and lower costs of ovarian stimulation procedures and of assisted reproduction in general were presented. This was the 5th Ferring Pharmaceuticals Conference in the area of reproductive medicine held in Florida.

FIVNAT. Influence of attempt rank in in vitro fertilization. / FIVNAT. Influence du rang de la tentative en FIV.

The French national register on in vitro fertilization (IVF) FIVNAT, which has collected most of the oocyte pick-ups realised in France since 1986 has allowed us to build a cohort of 35,714 couples, of which the first recovery took place between 1990 and 1994 and followed up to a pregnancy or to the 31st of december, 1996. The per recovery clinical pregnancy rate decreased from 20.2% on the first attempt to 17.4% on the second, and to less than 13% after the sixth. This evolution existed whatever the women's age class or the infertility diagnosis. The women's age remained the most important factor, since the cumulative pregnancy rate decreased from 60% for women aged less than 35 years to 17% for those aged more than 41 years. Among the indications, male infertility using spouse's semen had the poorest prognosis, especially for women aged more than 41 years (9.6%) whereas male infertility using donor's semen among women aged less than 35 years was associated to the best results (68%). It must be noticed than a high percentage of unpregnant women did not come again for a further recovery (40% to 50%). Then, the crude cumulative birth rate (24.4%) was far below the theoretical cumulative one(54.2%).

[Value of a genetic evaluation before an intracytoplasmic sperm injection procedure]. / Intérêt d'une évaluation génétique lors d'une procédure d'ICSI.

Intracytoplasmic sperm injection (ICSI) still needs to be validated as far as safety is concerned. Results concerning foetal karyotypes currently seem to show an increase in sexual chromosomal abnormalities. In view of the heterogeneity of publications concerning genetic tests, it seems necessary to define a protocol with a limited time span, which will allow the extensive collection of data. The analysis of the results will secondarily allow a common procedure to be established. We propose a protocol limited in time, aiming to evaluate the chromosomal status at birth by a systematic karyotype of umbilical cord blood.

[Poor responders followed for 3 years in an IVF program]. / Mauvaises répondeuses suivies sur 3 ans dans un programme FIV.

Our study consisted of a population of 100 women who represented an insufficient response to the induction of ovulation. We researched to find out which therapeutic approach, of the subsequent attempts to IVF would give greater hope to a better response. Two groups were individualized: in the first group (62 women) we obtained at least once, 3 oocytes (288 attempts), in the second group (38 women) we always obtained less than 3 oocytes. In the first group, in order to raise the pregnancy rate it was necessary to raise the rate of E2/oocyte. There fore raising the duration of stimulation and the quantity of ampullage of hMG. The long protocol, hMG, produced the best results. In the second group, the results were always worse it was more than a problem of protocol, it was a problem of the patients. In reality, the future of therapy for lower responsive patients is probably biological with hatching today and the possibilities with oocytary maturation in vitro in the near future.