[Single embryo transfer: is Scandinavian model valuable in France?]. / Faut-il systématiser le transfert de l'embryon unique ? Le modèle scandinave est-il applicable en France ?

The aim of infertility treatment is clearly to obtain one healthy baby. If the transfer of a top quality single embryo could provide a baby to all the patients, there would be no more discussion. The problem is that, nowadays, French pregnancy rates after fresh embryo or frozen embryo transfer are not the same as in Nordic countries. All studies show that in unselected patients, single embryo transfer decreases twin pregnancy rate but decreases pregnancy rate too. Pregnancy rate is dependent on embryo quality, women's age, rank of IVF attempt (clear data) but also on body mass index, ovarian reserve, smoking habits. All these data cannot be taken into account in a law. That is the reason why a flexible policy of transfer adapted to each couple is preferable. Each couple and each IVF team are unique and must keep the freedom to choose how many embryos must be transferred to obtain healthy babies, and to avoid twin pregnancies but without demonizing them.

[Intra-uterine insemination: ovarian stimulation or not?]. / Insémination intra-utérine: pourquoi continuer à stimuler l'ovulation?

Conflicting results have been published about intra-uterine insemination efficacy. In many studies, success rates is due to ovarian stimulation and number of follicles. In the present fight against multiple pregnancies, ovarian stimulation is discussed and present pregnancy rates are weak. Our aim is to demonstrate that there is a place for the association controlled ovarian hyperstimulation and intra-uterine insemination in the field of infertility treatments. It is possible to try and recognise women at high risk of multiple pregnancies, keeping the benefit of ovarian stimulation.

[Oocyte and embryo quality in polycystic ovary syndrome]. / Qualité des ovocytes et embryons dans le syndrome des ovaires polykystiques.

OBJECTIVE: To compare oocyte and embryo quality in women with Polycystic Ovary Syndrome (PCOS) and in women with normal ovulation. PATIENTS AND METHODS: Forty women with PCOS underwent a total of 67 In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) cycles. The control group consisted of women, of the same age, who underwent IVF (for tubal infertility) or ICSI (for male factor infertility) in the same period. RESULTS: The average number of oocytes recovered was higher in the PCOS group (12,1) than in the control group (9.6) as was the rate of immature oocytes (13.8% vs 5.8%; respectively). The fertilization rate was lower in PCOS patients (52% vs 61% in the controls). The cleavage rates, embryo morphology and pregnancy rates were similar in both groups. DISCUSSION AND CONCLUSIONS: Although more oocytes were recovered from PCOS patients, the number of good quality embryos, suitable for transfer or freezing was similar in the two groups as less of the oocytes were mature and the fertilization rate was lower in the PCOS group. IVF or ICSI (according to the indication) are therefore efficient in PCOS patients.

Blastocyst stage transfer: the real benefits compared with early embryo transfer.

With the development of commercially available sequential media it is now possible to grow human embryos to the blastocyst stage without feeder cells. The transfer of blastocysts offers several advantages, the most important being synchronization of the embryos with the uterine endometrium and selection of the best quality embryos with a high implantation potential. This study was conducted to compare the efficiency of day 2 and day 5 transfer in a prospective randomized trial involving patients for whom embryo selection was possible (i.e. those with more than three embryos on day 2 following insemination). We obtained equivalent clinical pregnancy rates per cycle for day 2 (41.7%) and day 5 (38.8%) transfer, but fewer embryos were transferred on day 5 (2.24 versus 3.03). The implantation rates were 18.9% on day 2 and 24.1% on day 5. Selected patients with a good response to gonadotrophins (at least eight good quality metaphase II oocytes) may therefore benefit from blastocyst transfer by a reduction in the multiple pregnancy rate, provided no more than two (or even one) blastocyst is transferred.

[Comparative randomized controlled study between human follicle- stimulating hormone (FSH-HP) and human menopausal gonadotropins (hMG) in in vitro fertilization]. / Essai contrôle randomisé comparatif entre l'hormone folliculostimulante humaine (FSH-HP) et les gonadotrophines ménopausiques humaines (hMG) en fécondation in vitro.

We present the results of a prospective randomized trial comparing the issue of IVF-ET and of ICSI when either highly purified human folliculostimulin (FSH-HP) or human menopausal gonadotrophin (hMG) is used. There seems to be a trend to a better rate of ongoing pregnancies when FSH-HP is used although not statistically significant. The study has been stopped due to the lack of hMG.

Results of planned in-vitro fertilization programming through the pre-administration of the oestrogen-progesterone combined pill.

The use of an oestrogen-progesterone combined pill permits the induction of ovulation in the absence of any developing follicle. Two treatments were compared. In the first, patients received no prior treatment before stimulation. In the second, combined oestrogen-progesterone treatment was given during approximately two menstrual cycles prior to stimulation. No differences between the two groups were found in relation to oocyte maturity, fertilization in vitro, cleavage, replacement and pregnancy. Fewer luteinizing hormone surges occurred in patients pre-treated with steroids. The utilization of the oestrogen-progesterone combined pill prior to induction of ovulation facilitates the forward planning of patients for in-vitro fertilization.

PIP: In order to facilitate the scheduling and management of cases for in vitro fertilization, a trial of pre-administration of a combined oral contraceptive was conducted. 103 women took 2 mg norethisterone acetate and 0.05 mg ethinyl estradiol for 45 to 70 days before induction of ovulation, allowing 5 days between treatments. This group then received either Clomid 100 mg for 6 days and HMG 225 IU on days 5, 7 and 9 (34 women), or HMG only (dose not specified, 69 women). The control groups were given identical ovulation induction regimens: Clomid and HMG (130 women) or HMG only (188 women). 70 of the patients selected for preliminary inhibition of ovulation had irregular menstrual cycles with normal prolactin; the others were picked for scheduling reasons only. No differences were documented between the groups in oocyte maturity, fertilization in vitro, cleavage, replacement and pregnancy. Pregnancy rates ranged from 10 to 16.6% in the 4 subgroups. Fewer LH surges occurred in patients pretreated with steroids. Thus the pretreatment of candidates for in vitro fertilization with ovulation blocking steroids has no quantitative effect on results, but does facilitate scheduling patients for the procedure.

[Results of preparatory surgery for in vitro fertilization with embryo transfer]. / Résultats de la chirurgie préparatoire à la F.I.V.E.T.E.

68 cases out of a total of 407 patients who were destined to have IVF (16.7%) had most adhesions in the pelvis which made the ovaries inaccessible for laparoscopic recovery, in the two years between September 1981 and September 1983. Using very severe criteria for selection we rejected 46 cases as unsuitable for surgery at that time. Only 22 therefore remained to have preparatory surgery. This surgery was particularly aimed at improving the local conditions for laparoscopic recovery as well as improving the quality of ovulation. The results are encouraging because those women who were operated on had about the same level of success in the three stages of IVF as women who were not operated on. This three-stage protocol of exploratory laparoscopy, operation and recovery laparoscopy does seem to be a heavy one and probably will be able to be replaced by a transvaginal ultrasound technique when this has been developed far enough to show that it has advantages.