[Therapeutic hopes in excretory azoospermia and genetic risks in congenital aplasia of the vas deferens]. / Espoirs thérapeutiques dans les azoospermies excrétoires et risques génétiques dans l'asplasie congénitale des canaux déférents.

Therapeutical solutions now can be proposed to some excretory azoospermia, using in vitro-fertilization with epididymal sperm. The encouraging results obtained with this new approach should be analyzed with the genetic risk, sometimes encountered in the specific form of azoospermia due to the congenital absence of the vas deferens. This abnormality is to day supposed to represent a moderate form of cystic fibrosis (CF), corresponding to a genital phenotype of this disease. This suggestion has been firstly induced by similar anatomical findings in the male individuals presenting a classical form of CF. The hypothesis has mainly been confirmed by the real progress in the genetic analysis of this disease. So an abnormally high percentage of known mutations of CF has been demonstrated in the patients with congenital absence of vas deferens. Other arguments such as positive sweat chloride tests, high percentage of sinusitis or presence of anti-pseudomonas antibodies, reinforce this hypothesis. It is the reason why a clinical and biological check-up, prior to any decision of therapy for infertility, in this specific indication should be done in order to propose a genetic counselling to the couple.

[25 patients undergoing laparoscopy for pelvic pain]. / A propos de 25 patientes ayant subi une coelioscopie pour douleurs pelviennes.

25 patients have involved in this research, who have chronic gynecologic pelvic pain and each of them had normal gynecologic examination. Chronic pelvic pain has been found mostly between 30-39 years age group married, multipar females, associated with 44% dysmenorrhea, 36 p. cent dyspareunaie. Cultures and clinical examinations were all negative as a sign of infection. Experienced intra-abdominal operation or infection were causes of pelvic pain (48%), especially appendectomy has a prominent place (75%). Laparoscopic investigation showed: 16 p. cent adhesions, 28 p. cent chronic annexitis, 16 p. cent experienced pelvic inflammatory disease, 8 p. cent uterine leiomyoma, 4 p. cent each endometriosis, experienced parametritis and haemorrhagic lutein cysts. Instead of making group of lesions, we prefer to describe it, in numbers as infection importance coefficient (IIC), which is developed for this research. IIC 0-2 points presents insufficient organic causes, it does not represent the cause of pain. Non organic and non gynecologic reasons must be the cause of pain. Non organic and non gynecologic reasons must be investigated. IIC 3-5 points presents minor experienced intraabdominal infection. Secondary cases like myoma, ovarian cysts, chronic cervicitis should be considered first as reason. IIC 6 points and more presents direct organic deficiency suitable surgery is the treatment of choice of this group.

Motility and fertilizing capacity of epididymal human spermatozoa in normal and pathological cases.

OBJECTIVE: To investigate different factors involved in the outcome of in vitro fertilization (IVF) with epididymal spermatozoa in cases of vas deferens agenesis, with particular emphasis on sperm movement parameters. DESIGN: Prospective study in which sperm movement characteristics, level of puncture, and sperm preparation technique were studied relative to the outcome of IVF. SETTING: Département de Gynécologie, Oncologie Gynécologique, Sénologie, Médecine de la Reproduction, Hôpital Edouard-Herriot, Lyon France. PATIENTS: Thirteen couples underwent 15 IVF cycles. In 14 cycles (12 patients) epididymal spermatozoa could be recovered by surgical punctures. Epididymides were taken from 10 subjects in state of cerebral death to study epididymal spermatozoa under physiological status of the epididymis. RESULTS: The cleavage rate in IVF was low (25/158: 15.8%). In seven cases, embryo transfer was possible, leading to two twin pregnancies (4 infants born). Fertilization could be achieved with spermatozoa from the epididymis caput. Motility was paradoxically higher in the proximal epididymis than in the distal epididymis. In healthy epididymides, spermatozoa collected from the caput did not exhibit any progressive motility, whereas progressive motility was always present in the epididymis corpus. CONCLUSIONS: Our study showed that forward motility could be observed in the epididymis caput in patients with congenital absence of the vas deferens and that fertilization and ongoing pregnancies could be obtained from caput spermatozoa. On the other hand, in physiological status of the epididymis, forward motility was observed only as from the corpus area, confirming observations in other species.

[Infections by Mycoplasma hominis and Ureaplasma urealytycum in vaginal discharge. Incidence and treatment]. / Infections à Mycoplasmes hominis et Ureaplasma urealytycum dans les écoulements vaginaux. Fréquence et traitements.

This report summarizes the studies carried out on 100 patients who were examined for vaginal discharge. The following observations were made: Mycoplasma hominis in 13.59% of the cases, Ureaplasma urealytycum in 8.73% of the cases, that is, the presence of at least one of these microorganisms in 22.32 of the cases. All these infections were treated by tetracyclines administered in appropriate doses.

[Transplacental administration of diethylstilbestrol in the rat. I. Apropos of the fertility of its offspring]. / Administration transplacentaire de diéthylstilboestrol chez le rat. I. A propos de la fertilité des descendants.

To determine the effects of transplacental exposure to diethylstilboestrol (DES) on the fertility of the offsprings, timed pregnant Sprague Dawley OFA rats were treated with DES (10, 20, 50 and 100 micrograms/kg/d, subcutaneous) on days 10 to 18 of gestation (long time) or days 13 to 18 of gestation (short time). Only the lowest dosed groups (10 micrograms/kg/d, short and long times, and 20 micrograms/kg/d, short time) gave birth to living offsprings. The fertility of the male and female offsprings was determined postnatally by a breeding technique and appeared to be strongly decreased among females of all groups (70 to 100% of sterility) and moderately among males (11 to 18% of pathological fecundity). Fertility of offspring of these rats with pathological fecundity appeared to be normal.

[Transplacental administration of diethylstilbestrol in the rat. II. Effect on the hormonal receptors of the endometrium]. / Administration transplacentaire de diéthylstilboestrol chez le rat. II. Effets sur les récepteurs hormonaux de l'endomètre.

Transplacental exposure to diethylstilboestrol (DES) strongly decreases the fertility of the offsprings. Progesterone receptors concentrations are significantly decreased for treated group (0.40 and 0.44 pmol/mg cytosol proteins) versus control group (0.74 pmol/mg cytosol proteins) Estradiol receptor concentrations are significantly higher for long time treated groups (0.26 pmol/mg cytosol proteins) versus control or short time treated groups (0.15 and 0.13 pmol/mg cytosol proteins).

[Transplacental administration of diethylstilbestrol (DES) in the rat: effects on fertility and on hormonal receptors in the endometrium]. / Administration transplacentaire du diéthylstilbcestrol (des) chez le rat: effets sur la fertilité et les récepteurs hormonaux de l'endomètre.

To determine the effects of transplacental exposure to diethylstilboestrol (DES) on the fertility and endometrial hormonal receptors of the offsprings, timed pregnant OFA rats were treated with DES (10, 20, 50 and 100 micrograms/kg/day, subcutaneous) on days 10 to 18 of gestation (long time) or days 13 to 18 of gestation (short time). Only the lowest dosed groups (10 micrograms/kg/day, short and long times, and 20 micrograms/kg/day, short time) gave birth to living offsprings. The fertility of the male and female offsprings was determined postnatally by a breeding technique and appeared to be strongly decreased among females of all groups (70 to 100% of sterility) and slowly decreased among males (12 to 26% of pathological fecundity). Progesterone receptor concentrations were significantly decreased for treated group (0.40 and 0.44 pmol/mg cytosol proteins) versus control group (0.74 pmol/mg cytosol proteins). Estradiol receptor concentrations were significantly higher for long time treated groups (0.26 pmol/mg cytosol proteins) versus control or short time treated groups (0.15 and 0.13 pmol/mg cytosol proteins).

[Choice of suture material for surgery of female and male sterility. Is there an all-purpose suture?]. / Choix du fil de suture pour la chirurgie de la stérilité féminine et masculine. Existe-t-il un fil "passe-partout"?

In the field of infertility, surgeons choose their sutures according some criteria: handling, absence of side effects and toxicity for the tissues, adequate sterilization, availability in adequate calibers with needles suitable for the structures of Fallopian tube, vas deferens and epididymis. Today, it seems that Polyglactine 910 (treated and gained Vicryl*) is perfectly adapted to all the anatomical situations and can be selected as the "unique" suture for sterility surgery (calibers 7 X 0 or 8 X 0). Our opinion is based on: Experimental findings coming from a personal work concerning 60 anastomosis on the uterine horn of the female rate. Critical analysis of previous experimentations done by other authors. The results of our personal practice in more of 1.400 salpingoplasties and 150 operations in the seminal genital ductus.

[Distal tubal surgery]. / Chirurgie tubaire distale.

The author summarizes his extensive experience of surgical treatment of tubal sterility. He shows by analysis of statistics of 1968 to 1980, that microsurgery does not significantly improve the total of intrauterine pregnancies, but seems to reduce the number of extrauterine gestations. He states that the results of tubal surgery seem to have attained a plateau, whilst one can anticipate a considerable development of in vitro fertilisation in the coming years.

[Utero-ovarian implantation. Experimental study and critical evaluation of its use in women]. / L'implantation ovaro-utérine. Etude expérimentale et étude critique de son application humaine.

The authors studied experimentally ovario-uterine implantation in rats, an operation first performed many years ago yielding very rare and debatable results. This procedure is ineffective in the treatment of sterility due to endometrial proliferation over the ovary, which closes off rapidly the endometrial cavity and separates it from the implanted ovary. Much uncertainty surrounds the majority of previously reported successes, the few resultant pregnancies from ovario-uterine implantation considered due to hazard and completely unreliable. This operation has no place in the treatment of sterility.

[Postoperative crural paralysis in gynecologic surgery]. / Paralysie crurale postopératoire en chirurgie gynécologique.

The authors describe one case of crural paralysis following a microsurgical salpingoplasty. The three causes of this usually reversible complication are discussed: the type of incision, the type of retractor, and positioning of the retractor by the surgeons over a long period of time.

Habitual abortion and uterine malformations.

After a review of the main problems related to metroplastics (i.e. frequency of malformations, their importance in maintaining infertility, clinical classifications, diagnostic techniques, the Authors discuss the problem of their surgical treatment. The results obtained in 54 cases from a cooperative study (Audebert 17 cases; Cittadini 25 and Cognat 12) are presented. In 50 out of 54 cases the Bret-Palmer technique has been performed and in several cases complementary operations such as adhesiolysis, salpingoplastics, ligamentopexies, myomectomies, cystectomies, wedge resections of ovaries, were performed. On the basis of their experience, the Authors affirm that the results of metroplastics are better when their indications are strictly selective and they stress that the overall results may be considered as favourable.

Ovary-oviduct distance and fertility experimental study, clinical application.

As the importance of ovary and fimbria relationships is well admitted in the phenomenon of oocyte captation, it has seemed interesting to the authors to try and evaluate, on an experimental plane, how fertility varies in function of ovary-fimbria distance, in view of possible therapeutic applications.