[Infertility over forty: Pros and cons of IVF].

The population attempting pregnancy and having babies is ageing. The declining fertility potential and the late age of motherhood are increasing significantly the number of patients over forty consulting infertility specialists. Assisted reproductive technologies (ART) cannot compensate the natural decline in fertility with age.

[Social egg freezing: which problems?].

In today's society, many women push pregnancy further away from the "right" childbearing age. Assisted reproduction, except egg donation, is unable to fully overcome the effect of age on fertility loss. The effectiveness of oocyte vitrification is demonstrated, and oocyte vitrification is allowed in the French Bioethics law of 2011.

[Endometrial preparation in oocyte recipients].

Oocyte donation is offered to patients with premature ovarian failure to achieve pregnancy when no other assisted reproductive technology is possible. Some clinical and biological factors have been identified for influencing the outcome of oocyte donation cycles. Embryo implantation depends on embryo quality, method for the embryo transfer, and endometrial differentiation.

[Is it possible to avoid working on weekends in an Assisted Reproductive Technology program?].

Is it possible to safely avoid weekend oocyte retrievals and embryo transfers? It is possible to safely avoid Sunday oocyte retrieval and embryo transfers during GnRH agonist or antagonist cycles, to avoid oocyte retrievals 2 days seem also possible by delaying or advancing hCG administration in both analogs cycles but it is more difficult to avoid embryo transfers during two days. In intra uterine insemination programs, it is possible to avoid ovulation monitoring and inseminations by the use of GnRH antagonists. In IVF programs, ovulation monitoring could be avoid on weekends but the risk of ovarian hyperstimulation would exists in case of polycystic ovary or polycystic like ovary.

[Low circulating anti-Müllerian hormone and normal follicle stimulating hormone levels: which prognosis in an IVF program?].

Objective: To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL).

Patients And Methods: A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve).

[The place of ovarian drilling in the management of polycystic ovarian syndrome (PCOS)].

The surgical approach has been a long-lasting option for ovulation restoration in patients presenting with polycystic ovarian syndrome. It consists of ovarian drilling with monopolar, bipolar energy or laser through laparoscopic or vaginal hydrolaparoscopic route. It is intended to be used as a second line therapy as an alternative to gonadotropins in patients with resistance or failure after clomiphene citrate.

[In Vitro Fertilization: beware of oocyte retrieval without oocyte!].

A 30-year-old woman undergoing an In Vitro Fertilization (IVF) treatment for tubal infertility and for whom no oocyte was retrieved at the puncture ("white puncture") presented an ectopic pregnancy. The patient was asymptomatic except some bleeding events reported for several days prior to the puncture. The ovulation monitoring was normal throughout the stimulation by gonadotrophin and hCG was administered for the final oocyte maturation on the twelfth day of stimulation at a rate of 2771 pg/ml of estradiol with a perfect ultrasound follicular growth.

[Single embryo transfer: is Scandinavian model valuable in 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.

[Premature ovarian failure: which approaches?].

Premature ovarian failure (POF) occurs in one case of 10,000 in women below the age of 20, one case of 1000 below 30 and 1% in women before the age of 40. In 80% of POF cases, the etiology is unknown, except for Turner syndrome. Spontaneous fertility is very weak, only 3 to 10% of the patients will have natural conception.

[A study comparing previous induced abortion rates in populations of newly delivered women and infertile women].

Objective: For years, induced abortions (IA) have been deemed responsible for altered fertility. The implication of various mechanisms including tubal infertility, intra-uterine adhesions, spontaneous abortion, ectopic pregnancy, cervical incompetence, shortened gestations, and any psychological trouble leading to anovulation has been raised. Though many authors find no evidence of an increased risk on fertility for women, whose IA is not complicated by infection, it might sometimes be insinuated that infertility is the consequence of previous abortion.

[Is tubal and uterine surgery deleterious to ovarian reserve?].

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.

[Obstetrical prognosis improvement in patients exposed in utero to diethylstilbestrol with specific care management].

Objective: To define the interest of a specific care management of pregnancies in patients exposed in utero to diethylstilbestrol, with the intention of reducing the number of spontaneous miscarriage and prematurity.

Patients And Methods: One hundred and three pregnancies in 49 patients exposed in utero to diethylstilbestrol were followed during a 4-year study, while establishing a specific care management of pregnancies in those women.

Results: Spontaneous miscarriage rate was 18.

One year comparison between two add-back therapies in patients treated with a GnRH agonist for symptomatic endometriosis: a randomized double-blind trial.

Background: It has been proposed that hormonal supplementation during prolonged GnRH agonist therapy prevents hypoestrogenic side effects, including bone loss. The optimal combination for long-term treatments with safe metabolic profile remains questionable. A norprogesterone derivative, promegestone, was assessed for the first time in a double-blind trial.

[Oocyte and embryo quality in polycystic ovary syndrome].

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.

[Systematic hysteroscopy prior to in vitro fertilization].

Objective: To evaluate the benefits of a diagnostic hysteroscopy prior to in vitro fertilization.

Patients And Methods: We retrospectively studied 145 patients who underwent ICSI during a period of 6 months. Office hysteroscopy was systematically performed before the first stimulation cycle.

[Comparison of 2 therapeutic strategies in severe endometriosis, in young women consulting for sterility or pain. II. In the case of infertility, value of ovarian stimulation with intrauterine insemination after surgery].

Aim Of The Study: Define the best medico surgical strategy in infertile women with stage III-IV endometriosis.

Material And Methods: Two groups, A (N26) and B (N 37), treated for infertility associated or not with pelvic pain, due to stage AFS III or IV endometriosis, were compared. They had similar surgical procedure: operative laparoscopy including resection of endometriotic lesions, more particularly endometriomas and rectovaginal septum nodules.

[Comparison of 2 therapeutic strategies for severe endometriosis, in young women counsulting for sterility or pain. Results in cases of chronic pelvic pain].

Aim Of The Study: Compare two medical strategies associated to surgery in women requiring for chronic pelvic pain due to stage III-IV endometriosis.

Material And Methods: Two different patient groups, A (N 27) and B (N 41), requiring for chronic pelvic pain, associated with AFS stage III-IV endometriosis, operated on from 1992 to 1997, were compared. The medium age was 35 and 34 years, respectively.

[Intra-uterine insemination].

Artificial insemination has been proposed for a number of years in the treatment of unexplained or male factors related to infertility with very low results. In recent years, the association of intra-uterine insemination with gonadotropin ovulation induction has demonstrated its effectiveness and it is now the first treatment to propose in these cases before in vitro fertilization.

[Comparative randomized controlled study between human follicle- stimulating hormone (FSH-HP) and human menopausal gonadotropins (hMG) in in vitro fertilization].

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.