[Is tubal and uterine surgery deleterious to ovarian reserve?]. / La chirurgie tubaire et utérine a-t-elle un effet délétère sur la fonction ovarienne?

Changes in menstrual pattern after tubal sterilisation have been reported for more than 50 years. Hence all tubal surgeries have been suspected of altering the ovarian reserve, by damage to the ovarian blood vessels. Recent studies showed that tubal surgery has no significant adverse effect on doppler flow indice and hormonal markers. Hysterectomy and uterine artery embolization seem to decrease ovarian reserve in perimenopausal women. Uterine artery embolization does not seem to have adverse effects on normally functioning ovaries.

[Endometriosis and surviving adolescence]. / Endométriose et vécu de l'adolescence.

Endometriosis is a recurrent and painful disease which sometimes disturbs severely the quality of life of women who suffer from it. It is then logical to include a psychological back-up to its medical and surgical treatment. Nevertheless this support is not often offered to patients. One can hypothesize another and completely different way of seeing the problem: the mood swings and depression of endometriotic patients could possibly be, at least in some of them, the cause of the graft of endometrial cells and not the effect of pain and infertility. The mechanism of the development of endometriotic lesions could be related to a lowering of immune defences due to an alteration of the psycho-neuro-endocrino-immunologic network, resulting from difficult life experiences which mostly happen during adolescence. This concept may have beneficial effects for the patient whose case would be more understood in depth. But very few medical teams consider it worthwhile to include in their practices.

[The ovary and insulin resistance]. / L'ovaire de l'insulinorésistance.

Insulin resistance appears to be responsible of approximately half of the cases of polycystic ovaries, the other half being probably provoked by an anomaly of the stimulation of ovaries by an excess of LH. Nevertheless, it is likely that in most cases the two factors conjugate. The excess of androgen production by the ovarian stroma is one of the major symptoms of this disease. Today, however, the diagnosis is carried mainly with the assistance of ultra-sounds which, besides the increased ovarian volume, have permitted to discover an increased ovarian stromal vascularity. Two essential datas derive from the whole works: the increased frequency of ovarian hyperstimulation syndrome and the great number of metabolic complications which requires an endocrinological supervision. But the most recent works focus on the extension to all ages of this form of pathology: from the intra-uterine life to the post menopause; and on the hereditary character of this disease. The mystery remains concerning the mechanism of the favourable effect in clomifene resistant PCOS, of surgical and laparoscopic methods of ovulation induction to which it may be useful to resort after mature consideration. More recently the benefit at the administration of metformine has been confirmed by several works.

[A case of cervico-isthmic pregnancy with delayed development]. / A propos d'un cas de grossesse cervico-isthmique à développement tardif.

This is the case of a para three, gravida three, who had a caesarean section for her first pregnancy and a normal delivery for the second one. During her third pregnancy the patient is hospitalised for first trimester bleeding. Ultrasounds show two liquid compartments separated by placenta. The lower one in cervico-isthmic position contains the foetus. During the 24th week gestation the pregnancy is complicated by severe metrorrhagia that leads to abdominal exploration and total hysterectomy. The pathology conclusions confirmed the per-operative impression of cervico-isthmic pregnancy. The authors emphasise the rarity of the cervico-isthmic pregnancy (1 for 10,000 pregnancies) and wonder about atypical evolution of this case and about the possibilities of saving the uterus by an earlier intervention in view of ultrasonographic data.

Comparison of transvaginal and transabdominal ultrasound for monitoring follicular development in an in-vitro fertilization programme.

Although nowadays most oocyte retrievals for in-vitro fertilization (IVF) are performed using a transvaginal, ultrasound-directed technique, monitoring of follicular development is still often performed via the abdominal route. On the bases of 106 sonographies carried out on 71 patients during ovulation monitoring within an IVF programme, we demonstrated that the number of follicles visualized endovaginally was significantly higher than that visualized by the abdominal route: n = 1124 versus n = 772 respectively, and that their size was significantly greater using the transvaginal approach: 20.8 mm versus 18.8 mm respectively, for the largest follicle. Consequently, if ovulation monitoring is carried out transvaginally, the follicular size criteria on which human chorionic gonadotrophin is administered must be reconsidered.

Delayed embryo transfer in an in-vitro fertilization programme: how to avoid working on Sunday.

It has previously been demonstrated that use of gonadotrophin releasing hormone analogues allows the administration of HCG to be delayed and makes it possible to avoid oocyte retrievals at weekends. In this study, we demonstrate that it is also possible to avoid embryo transfers on Sundays, by delaying transfers of Friday retrievals until Monday, without any apparent change in the results. This facility should improve the cost-effectiveness of assisted reproduction programmes.

An improved use of buserelin in ovarian stimulation for in-vitro fertilization.

In earlier IVF programmes, subcutaneous buserelin (Suprefact, Hoechst) was initially administered three times per day (200 micrograms x 3); then twice daily (300 micrograms x 2). We now suggest that a single administration of 600 micrograms daily may be equally effective. In a preliminary study, 20 patients were selected on the basis of tubal or idiopathic infertility and received 0.6 ml buserelin subcutaneously once a day, beginning on day 1 or 2 of the cycle. A sufficient pituitary desensitization was obtained on day 10 in 75% of patients and on day 16 for 100% and the ongoing pregnancy rate was 35% per treatment cycle. A randomized study comparing the effect of 600 micrograms of buserelin administered in one (n = 50) or two injections (n = 46), has been carried out and indicates that the results in terms of the ovarian suppression and pregnancy rates, were similar. Therefore, this protocol represents a simplification of the treatment with buserelin.

[A case of septic necrobiosis in leiomyoma of the uterus in the postpartum period. Clinical, echographic and x-ray computed tomography study]. / A propos d'un cas de nécrobiose septique d'un léiomyome utérin dans le post-partum. Etude clinique, échographique et tomodensitométrique.

The authors report a case of septic necrobiosis of leiomyoma uteri the first signs of which were seen at the eighth day after childbirth. After several episodes of discharge of Proteus into the blood, separated by a period of apparent resolution, the disorder was only resolved by hysterectomy carried out upon the request of intensive care staff, despite the desire of the patient for subsequent pregnancies. Bacteriological examination of the necrobiotic myoma showed the presence of Proteus morgani, the antibiotic resistance characteristics of which were the same as those of the Proteus seen in the blood.