[Electronic cigarettes and fertility: True or false friends?] / Cigarette électronique et fertilité : vrais ou faux amis ?

While electronic cigarettes have been on the rise in France for the past ten years, data on their prevalence, use patterns and safety have remained fragmented and controversial. Electronic cigarettes seem to not be a harmless product to use, because although they contain fewer harmful substances than traditional cigarettes, they still contain toxic products such as endocrine disruptors, which appear to have a negative impact on hormonal homeostasis, morphology and functioning of the animal reproductive system. Mostly presented as a harmless alternative to traditional cigarettes by industry lobbies, electronic cigarettes are often offered as an aid to smoking cessation in the same way as nicotinic substitutes. This strategy is especially proposed without knowledge of its effects on human reproductive health. Indeed, there are currently very few scientific publications, which study the impact of the use of electronic cigarettes, nicotine and the vapours it delivers on fertility and the functioning of the human female and male reproductive systems. Thus, the great majority of the data we have to date come from studies carried out in animal populations and show that electronic cigarettes exposure affect fertility. There is, to our knowledge, no scientific publication on the results in Assisted Reproductive Technology in case of use of electronic cigarettes, motivating the realization of the study IVF-VAP currently underway in the department of Medicine and Biology of Reproduction of the Amiens Picardie University Hospital.

In vitro maturation of oocytes from stimulated IVF-ICSI cycles using autologous cumulus cell co-culture: A preliminary study.

PURPOSE OF THE STUDY: In stimulated IVF-ICSI cycles, follicles at different stages of maturation can be aspirated during oocyte pickup. Nowadays, only mature oocytes (metaphase 2 stage) are used and immature oocytes (germinal vesicle and metaphase 1 stages), which are judged unfit for fertilization, are non-used at day 0. In our IVF center, the rate of immature oocytes recovered is around 25%. A significant number of this precious resource is therefore non-used every day in IVF laboratories. The objective of our study was to evaluate the competence of our in vitro maturation autologous coculture method on the maturation and developmental potential of immature oocytes obtained from stimulated IVF-ICSI cycles, in order to obtain additional embryos for the couple as a rescue system to increase the changes of cumulative pregnancy. PATIENTS AND METHODS: This is a prospective study, carried out in the Reproductive Medicine and Biology Unit of the Amiens-Picardy University Hospital (France). It was included 14 couples, managed in IVF-ICSI in our center, from January to March 2020. Thirty-eight oocytes, identified as immature after cumulus-oocyte complexes (COC) stripping for ICSI, were placed in our in vitro maturation medium with the addition of autologous cumulus cells. Oocytes that had reached the metaphase II stage after a maximum of 36 hours of maturation were microinjected. The fertilization and embryonic development potential of the in vitro matured oocytes were compared to those of 148 in vivo matured "siblings" oocytes from the same oocyte retrieval, and then also compared to those of 127 in vivo matured oocytes from different patients (control group). MAIN OUTCOME MEASURE(S): Maturation rate, fertilization rate, early cleavage rate and developmental activity to blastulation rate. SECOND OUTCOME MEASURE(S): Embryo quality at cleavage and blastocyst stages, blastulation rate, and useful blastulation rate. RESULTS: No significant difference was found in the main and secondary criteria of the study compared to the "siblings" in vivo matured oocytes from the same oocyte retrieval. However, a significant difference was obtained on the rate of early cleavage and useful blastulation when our cohort was compared to mature in vivo oocytes from different patients (control group). CONCLUSION: This study has shown that after incubation in our in vitro maturation autologous cumulus cell co-culture with cumulus-oocyte cells, immature oocytes recovered during stimulated cycles can give rise to competent oocytes, i.e., capable of being fertilized, of cleaving, and of developing into embryos up to the blastocyst stage. Our study therefore seems to be in the direction of a favorable use of these immature oocytes obtained after stimulated IVF-ICSI cycles. The continuation of this study by including a larger number of oocytes is necessary in order to evaluate the real contribution of this technique in routine.

[Contribution of array CGH in the management of fetal nuchal translucency]. / L'apport de l'ACPA dans la prise en charge des hyperclartés nucales.

OBJECTIVES: Increased nuchal translucency and cystic hygroma have a neonatal prognosis, when the karyotype is normal, which depends on the findings during the medical follow-up. Array comparative genomic hybridization (aCGH) has been systematically included in this follow-up by prenatal diagnosis teams. There are no guidelines and little information on the advantages of carrying out this test systematically. The aim of our study is to evaluate the contribution of the aCGH in the medical follow-up. METHODS: Fifty-one patients were included during 18 months and followed till the end of their pregnancy in prenatal diagnosis centers in Brest and Amiens. Inclusion criterion was a nuchal translucency above 3,5mm on the first trimester ultrasound. A fetal DNA ChromoQuant and aCGH analysis on chorionic villi sampling, and an ultrasound at 18 weeks of gestation were performed during the follow-up. RESULTS: The aCGH was decisive in only 2 cases. The ultrasound at 18 weeks gestation seemed to be more sensible in the detection of an abnormality. When the aCGH relieved an abnormality, the ultrasound permitted already to detect the presence of a deformity. In 10 cases, the aCGH could not be interpreted on the chorionic villi sampling. In 9 cases, an amniocentesis was performed in order to obtain this result. CONCLUSION: Given the results of this study, the aCGH was rarely determinant or decisive on the realization of a therapeutic abortion. These elements make us reflect on the necessity of maintaining this test before 14 weeks of gestation or propose it as a second-line test after the ultrasound shows signs at 18weeks of gestation.

Impact of alcohol and cigarette smoking consumption in male fertility potential: Looks at lipid peroxidation, enzymatic antioxidant activities and sperm DNA damage.

Alcohol intake and cigarette smoking are the major lifestyle factors with negative impact on fertility. We were interested to evaluate the negative impact of these factors on oxidative stress (OS), enzymatic antioxidant activity (EAO) of spermatozoa and on its DNA damage. This study included 108 male infertile patients with normal range of sperm conventional parameters but with unexplained infertility in assisted reproductive technologies programme. Firstly, OS was analysed based on lipid peroxidation (MDA) and EAO which included catalase (CAT), superoxide dismutase (SOD) and glutathione reductase (GR). Secondly, we evaluated DNA fragmentation by TUNEL assay and chromatin decondensation by aniline blue colouration. The whole lot was divided into four groups: control (nonalcoholic and nonsmoker patients), alcohol group, smoking group and alcohol-smoking group. The results showed, in three last groups compared to control an increased CAT, SOD and GR activities with high MDA level especially in smoking and alcohol-smoking group. The latter showed the highest values of DNA fragmentation and chromatin decondensation (31% and 39%) to exceed DNA damage normal range. Indeed, smoking and alcohol intake lead to increase EAO due to long-term unbalanced antioxidant/oxidation ratio with high OS which cause consequently sperm DNA damage calling in need by urgency to change the lifestyle behaviour.

Effect of semen preparation technique and its incubation on sperm quality in the Moroccan population.

In in vitro fertilisation (IVF), sperm preparation as critical part and influencing the sperm quality is especially dependent on the chosen technique itself and incubation parameters including temperature and CO2. In this study, we compared firstly density-gradient centrifugation technique (DGC) to the adapted DGC using the sperm pellet of 80% fraction (DGC/80P) in order to improve the sperm yield. Secondly, this study led to evaluate different sperm incubation conditions based on temperature effect (room temperature (RT = 23°C) versus 35°C) and in the other hand, with or without 5% CO2 during 24 hrs. Based on evaluating sperm conventional parameters and the DNA damage using TUNEL assay, our result showed that DGC/80P increased sperm quality compared to DGC with 25% of improvement. For temperature incubation effect after 24 hrs, 35°C increased the DNA damage and decreased the sperm quality while RT could improve sperm motility by 38%. Moreover, the sperm incubation with 5% CO2 after 24 hrs realised a negative impact on sperm parameters and its DNA damage. Indeed, for current IVF practice, a good sperm quality can be maintained for several hours at room temperature, while the sperm preparation is processed using the DGC/80P without CO2.

Detection of Loa loa Microfilariae in Follicular Fluid During Assisted Reproductive Technology: Case Report and Review of the Literature.

We report on a case of loiasis revealed during an assisted reproductive technology (ART) cycle. Loa loa could limit implantation outcome. We propose to focus on an ART strategy with frozen embryos to treat the patient before any transfer.

Sperm global DNA methylation level: association with semen parameters and genome integrity.

Sperm DNA methylation abnormalities have been detected in oligozoospermic men. However, the association between sperm DNA methylation defects, sperm parameters and sperm DNA, and chromatin integrity remains poorly understood. This study was designed to clarify this issue. We recruited a cohort of 92 men (62 normozoospermic and 30 oligoasthenozoospermic) presenting for infertility evaluation during a 1-year period. Sperm global DNA methylation was evaluated by an ELISA-like method, DNA fragmentation was evaluated by flow cytometry-based terminal transferase dUTP nick end-labeling (TUNEL) assay (reported as DNA fragmentation index or DFI), and sperm denaturation was evaluated by aniline blue staining (reported as sperm denaturation index or SDI, a marker of chromatin compaction). We found a significant positive association between sperm global DNA methylation level and conventional sperm parameters (sperm concentration and motility), supported by the results of methylation analysis on H19-DMR. We also identified significant inverse relationships between sperm global DNA methylation, and, both DFI and SDI. However, sperm global DNA methylation level was not related to sperm vitality or morphology. Our findings suggest that global sperm DNA methylation levels are related to conventional sperm parameters, as well as, sperm chromatin and DNA integrity.

[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.

[How far can we go to oocyte donation? Debates on the risks of late pregnancies]. / Jusqu'où peut-on aller en don d'ovocytes? Réflexions sur les risques des grossesses tardives.

In France, there is a decline in first-time motherhood influenced by many sociocultural factors thus leading to a reproductive age where fertility decreases and which increase the risks associated with late pregnancy. The oocyte donation in France is subject to The Bioethic law granting no support in infertility beyond past 43 years. Thus, to satisfy their need for maternity, the French use a gift abroad. Then we will report the case of a pregnancy obtained by an oocyte donation, after 42 years, which was complicated. We will discuss the importance of taking into account the risk factors before a support to ART, and the ethical issues raised by this case. After a brief review of French legislative framework governing the practice of oocyte donation, we will evoke ways to improve the coverage needs of it in France.

[Prognostic factors of pregnancy in intra-uterine insemination with sperm of donor: a review of 535 cycles over 7 years]. / Facteurs pronostiques de grossesse en insémination intra-utérine avec sperme de donneur: analyse sur 535 cycles.

AIM: To determine the pronostic factors of pregnancy in intra-uterine insemination using sperm of donor (IIU-D) by analysing female factors, data from the ovarian stimulation and even the characteristics of the donor selected for the recipient couple. MATERIAL AND METHODS: Retrospective study between January 2002 and December 2009. It took place at the University and Hospital of Amiens over 149 couples performing a total of 535 IIU-D cycles. Factors related to the pregnancy were defined thanks to uni and multivariate analysis. RESULTS: Female age was 30.6 ± 4.3 years old (6% of the cycles with women>38). The initiated pregnancy rate per cycle was 27.9%; the birth rate per cycle was 20.4% and the cumulative live birth rate over 63.4% for six cycles. In multivariate analysis prognostic factors of success were: day 3 of estradiol level less than 80 pg/mL (P<0.05), no tube defects (P=0.022), cured and benign womb pathology (P=0.005), a higher number of follicles greater than 16 mm the day of the ovulation triggering (P=0.0018) and a higher number of pregnancies already obtained by the donor in ART in the CECOS (P<0.001). Neither the female age nor the donor age was associated with a probability of success. DISCUSSION AND CONCLUSION: Classical pronostic factors concerning the female profile and the ovarian stimulation quality have been found. But the most interesting and original part is that the most significant factor concerns the donor and his history of pregnancy in Assisted Reproductive Technology (ART) in the center. This may be very useful to guide the choice of the donor for the recipients.

[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.

[Groenouw type II macular corneal dystrophy: case report]. / Dystrophie maculaire de Grœnouw II : à propos d'un cas.

Corneal dystrophies are relatively rare diseases of the young adult. We report a case of a Groenouw type II macular corneal dystrophy. A 34-year-old woman with no prior history was referred by her ophthalmologist for bilateral corneal dystrophy developing for several years. Physical examination revealed decreased visual acuity related to bilateral rounded corneal deposits. The patient underwent penetrating keratoplasty. The diagnosis of Groenouw type II macular corneal dystrophy was confirmed by pathological examination of the recipient cornea. The clinical, pathologic and therapeutic features are discussed.

[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.

[Embryo donation: why is there a delay in the implementation in France? A discussion on the practical, ethical and psychological dilemmas]. / Accueil d'embryon: pourquoi tant de retard à la mise en place en France ? Difficultés pratiques, éthiques et psychologiques.

Since 1999, French legislation has stipulated that embryo donation is one of the possibilities afforded to couples who have a surplus of cryopreserved embryos. Donation of embryos with no foreseeable future use by the genetic couple can therefore be given to infertile couples. In practice however, since the authorization of this novel Medically Assisted Reproduction technique, embryo donation is not widely performed in France even though it is not technically difficult. Why then is there reluctance towards the implementation of embryo donation in France? The aim of this article is to analyze the grounds for the delay in the realization of embryo donation in France. Our findings propose that a myriad of factors including organizational, ethical and psychological determinants have deterred the implementation of embryo donation in France.