[Are patients in the postpartum period potential egg donors?]. / Les accouchées sont-elles de potentielles donneuses d'ovocytes ?

OBJECTIVES: In France, oocyte donation program is still underdeveloped because of lack of donors and this situation entails an important wave of cross border medical tourism to different European countries mainly Spain and Greece. In 2011, the General inspection of social affairs report recommended to the biomedicine agency to promote spontaneous oocyte donation via different channels of information to develop this national program. The main objective of this study is to assess the knowledge of women after baby delivery about oocyte donation. The second objective is the identification of ways to assure better information and to promote oocyte donation. PATIENTS AND METHODS: We conducted a prospective study with anonymous questionnaire distribution to women after delivery at obstetrics/gynecology department of the Regional University Hospital and Maternity-Children Unit "Victor-Pauchet" of Amiens, from December 2012 to January 2013. RESULTS: Two hundred and fifty-five questionnaires were distributed and 242 of them were analyzed (94.9%). About oocyte donation knowledge: 28% did not know it was possible, 45% did not know it was legal in France, 54% did not know who was concerned and 36% know that a treatment is necessary, 9% think that oocyte donation is paid and 10% it is non-anonymous. If 67% seems to be favorable to this initiative, only 35% could accept to realize it. About information efficiency, 88% think not to receive enough information, 64% would like to have more information. The health care professional wanted to give this information is an obstetrician (51%), a midwife (37%) and a nurse (12%). DISCUSSION AND CONCLUSION: Oocyte donation program is misoriented due to a lack of information. Obstetricians and midwives have an important educational and informative role to support oocyte donation. Specific strategy of communication and valuable targeted information are needed to motivate potential donor and achieve the objectives of the program.

[Pregnancy predictive factors in case of double embryo transfer during "Top Quality" attempts]. / Facteurs prédictifs de grossesses en cas de transfert de deux embryons au cours de tentatives « Top Quality ¼

OBJECTIVES: To identify IVF±ICSI pregnancy predictive factors during "Top Quality" attempts in case of double embryo transfer. PATIENTS AND METHODS: Three years retrospective study (2007, 2008 and 2009) on parameters and results obtained during IVF±ICSI defined as "Top Quality" attempts: first or second attempts on less than 35years old women (age inferior or equal to) with one or two "Top Quality" embryo transfer. RESULTS: In case of double embryo transfer, pregnancy predictive factors are (OR [IC 95%], P): average endometrial thickness on start (4.6 [2.9-5.5], P<0.01), women smoking (4.2 [3.5-4.9], P<0.01), average stimulation duration (3.4 [2.7-3.9], P<0.01), average men age (2.2 [1.7-2.5], P<0.05), gonadotrophins total dose (2.1 [1.1-3.2], P<0.05) and first rank's attempts (1.6 [1.2-2.5], P<0.05). DISCUSSION AND CONCLUSION: Age patient, rank attempts and quality embryo are criteria, which used to guide to a single embryo transfer. Our results incite us to consider other parameters, in particular men age and women smoking status.

[How present ART' results: questions' list to French ART professionals and application on Amiens' ART results]. / Comment présenter les résultats des centres d'AMP : enquête auprès des professionnels des centres français et application aux résultats du centre d'AMP du CHU d'Amiens.

OBJECTIVES: ART transparency of results and ways to submit are in centre of present biologists and clinical cares. This work aims at identifying ART results' presentation pertinent tests. PATIENTS AND METHODS: At first time, we propose a questions' list to French ART professionals. Next, we apply results on Amiens' ART center 2006, 2007 and 2008 IVF parameters. RESULTS: One hundred and twenty questions' lists were analysed. Ninety percent of interrogated people were in favour of the results' center public communication. Most quoting criterions hold to define a reference population are (percentage of favourable opinions): IVF/ICSI treatment (96%), first of second rank's attempts (71%), women age less than 35 years old (68%), one or two top embryos quality transfer (60%). In 2007, 2008 and 2009, we made 1123 tentative IVF±ICSI in Amiens' ART center. Pregnancy rates were analysed for these years with criterions next quoting as most pertinent (women's age and rank's attempt), and in function of puncture retrieval oocytes number and indications. DISCUSSION AND CONCLUSION: Most of professionals are in favour of ART transparency of results. All would like that results presentation holds to special criterions to allow a fair comparison. Pregnancy predictive factors, which are women age, rank attempt, puncture retrieval oocytes number, seem to be main criterions for evaluation. These criterions pertinence has been shown thanks to Amiens ART center results.

[Do there still exist risk factors for breast cancer?]. / Existe-t-il encore des facteurs de risque de survenue d'un cancer du sein ?

OBJECTIVES: To evaluate the risk factors associated with a breast cancer, and to compare the proportion of women at high and low risk for developing breast cancer. PATIENTS AND METHODS: Retrospective study among 194 women with breast cancer between January 2007 and December 2008 in the Obstetrics, Gynaecology and Reproductive Medicine department of the Amiens' University hospital. RESULTS: Concerning all the series, only age, overweight and family antecedents seem risk factors of breast cancer. The proportion of women in the low-risk group (12.3%) is not significantly different from that of the high-risk group (18.5%). In the low-risk group, the factors which seem to influence a breast cancer are those in connection with high levels of estrogens (early age of the first menstruation, late age of the menopause and oral contraceptive use) and the smoke habitus; whereas in the high-risk group, the factors are the nulliparity and the absence of breast feeding. DISCUSSION AND CONCLUSIONS: One finds in this series a part only of the known risk factors of breast cancer; and the proportion of women at low risk (12.3%) is comparable with that at high risk (18.5%). This study shows the relative weight of the various risk factors of breast cancer, at a time when its prevalence reached 10%.

[Professional Practice Evaluation: How to improve quality management in procreation centers?]. / Évaluation des pratiques professionnelles dans un centre d'Assistance médicale à la procréation: comment améliorer la qualité des soins?

OBJECTIVES: The Professional Practice Evaluation (PPE) is at the heart of quality management in procreation centers. Hereby, we report 3 years of EPP in Cytogenetics and Reproduction laboratory in Amiens University Hospital. PATIENTS AND METHODS: This PPE is based upon prospective analysis of in vitro fertilization techniques regarding two major parameters: clinically in improving embryo transfer and biologically by determining fecundation levels. Clinical pregnancies in "Top Quality" trial is chosen as a major indicator of our results. RESULTS: Per transfer, there is an increase of 8% for clinical pregnancies and 31% in "Top quality" trials. DISCUSSION AND CONCLUSION: The improvement in our results allowed us to propose, in favourable conditions, single embryo transfer.

[Septate uterus: role of hysteroscopic metroplasty]. / Utérus cloisonné: place de la septoplastie hystéroscopique.

The uterus septum is the most frequently encountered uterine malformation. The prevalence of the uterine septa in the infertile patients is estimated at approximately 1%. On the other hand, it increases to reach 3,3% among women presenting repeated fetal losses. The objective of this article is to propose an updating of the data of the literature concerning the cure of uterine septa by hysteroscopic metroplasty. Operative hysteroscopy, with its simplicity, its reproducibility and its low morbidity between the hands of a trained operator, remains the gold standard treatment of the uterine partitions. The abortive disease always constitutes the main indication of the cure of septum. In the infertile patients, a metroplasty seems to be legitimate in the following situations: women more than 35 years old; unexplained infertility, resistant to any technique of assisted reproduction; discovery of a uterine septum at the time of the coelioscopy and the diagnostic hysteroscopy realized within the framework of an assessment of infertility; patients for whom it is assumed that Assisted reproductive technique (ART) is needed; women with past obstetrical history. The complications related to the hysteroscopic metroplasty are not very frequent. However, the hysteroscopic resection of a uterine septum could expose later to the risk of uterine rupture.