[Is gonadotropin releasing hormone (GnRH) agonist trigger beneficial or deleterious?].

Objectives: The undeniable asset of the antagonist protocols in in vitro fertilization is the decrease of the risks of ovarian hyperstimulation syndrome, by the use of a release by GnRH agonist. Nevertheless, questioning persist concerning the rates of clinical pregnancies, the oocyte quantity and the empty follicle syndrome. We thus studied these parameters in our center.

Sperm deoxyribonucleic acid fragmentation as assessed by the sperm chromatin dispersion test in assisted reproductive technology programs: results of a large prospective multicenter study.

Objective: To assess the value of sperm DNA fragmentation, measured by the sperm chromatin dispersion (SCD) test, in predicting fertilization rate, embryo quality, and pregnancy outcome.

Design: Prospective study.

Setting: Four French infertility centers, from January to August 2005.

Optimal management of extreme oligozoospermia by an appropriate cryopreservation programme.

Background: Severe oligozoospermia is characterized by sperm count fluctuations that may result in insufficient quantities of motile sperm for ICSI on the day of oocyte retrieval, thus necessitating testicular biopsy. To avoid this, we proposed that patients, with transient azoospermia or repeatedly low sperm counts, make a safety pool of frozen spermatozoa before ICSI attempts.

Methods: Seventy cryptozoospermic (<10(3) spermatozoa/ml) and 46 oligozoospermic patients (10(3)-10(5)/ml) were included.

[Embryo donation in France: practice and difficulties. Strasbourg's experience].

Objective: The aim of this study was to present the situation of embryo donation in France and around the world, to expound the difficulties of its practice and the results obtained in our centre 3 years after the introduction of this procedure.

Patients And Methods: Embryo donation in France is controlled by implemented decrees published between 1999 and 2004. The couples, who have stored frozen embryos since at least two years, were contacted for a pluridisciplinary medical consultation.

Encouraging results despite complexity of multidisciplinary care of HIV-infected women using assisted reproduction techniques.

Background: Assisted reproduction technologies can treat infertility for human immunodeficiency virus (HIV) seropositive women. We assessed the efficacy of these techniques in the results and difficulties encountered while conducting our assisted reproduction programme for 49 couples in which at least the woman had HIV infection that was currently under control.

Methods: Treatments included intrauterine insemination (IUI), IVF and ICSI, with ovarian stimulation.

Seminal haploid cell detection by flow cytometry in non-obstructive azoospermia: a good predictive parameter for testicular sperm extraction.

Background: Testicular sperm extraction (TESE) associated with ICSI gives patients suffering from non-obstructive azoospermia (NOA) the possibility of becoming a father. The success rate of TESE based on sperm recovery is approximately 50%, and the commonly used non-invasive parameters are not predictive enough. Only the invasive testis biopsy has a good prognostic value.

[Abnormal bacterial colonisation of the vagina and implantation during assisted reproduction].

Objective: To evaluate the efficiency of our treatment of vaginal infection for couples included in an IVF program.

Patients And Methods: Microbiologic screening of vaginal flora and semen has been performed one month prior to in vitro fertilization for 951 couples in 2000. Antibiotic treatment was prescribed in case of positive culture.

[Follow-up of children born by ICSI].

The debate concerning the health of children conceived by artificial reproduction technology (ART) continues. Among these techniques, intracytoplasmic sperm injection (ICSI) is the subject of most attention. Indeed, several studies have concentrated on the evaluation of risks associated with ICSI.

[Towards a single embryo transfer: predictive value of uterine and embryological parameters in assisted reproduction outcome].

Objective: The transfer of a single embryo would avoid obstetrical and neonatal complications due to multiple pregnancies. We studied the clinical value of both uterine and embryological parameters to define precise conditions allowing a single embryo transfer without decreasing pregnancy rates.

Patients And Methods: Endometrial parameters expressed by a uterine score together with biological criteria of 131 in vitro fertilization or intracytoplasmic sperm injection attempts were retrospectively analysed.

Assisted reproduction techniques for HIV serodiscordant couples: 18 months of experience.

Background: Assisted reproduction techniques can minimize the risk of infection and treat possible sterility associated with serodiscordant couples.

Methods: We assessed the efficacy of these techniques in 57 couples in which at least one partner had human immunodeficiency virus (HIV-1) infection that was currently under control (47 men and 10 women). The semen of seropositive men was prepared and tested for viruses.

Nitric oxide donors for patients undergoing IVF. A prospective, double-blind, randomized, placebo-controlled trial.

Background: Nitric oxide (NO) is involved in local control of the uterine cycle and in preparation of the uterus for pregnancy. NO donors, acting as vasodilating agents, may therefore have possible therapeutic uses, for example they may be of benefit to patients with a history of implantation failure. In a prospective, comparative, randomized, placebo-controlled study, we assessed the efficacy of nitroglycerin (NTG) administered to 138 IVF patients with a history of implantation failure.

[Evolution of homocysteine during ovarian stimulation for IVF or ICSI].

Objective: To determine the homocysteine evolution during ovarian stimulation in IVF or ICSI protocols and in, a second time, to evaluate the role of hyperhomocysteine as thrombotic risk factor for the treated patients.

Material And Methods: Plasma homocysteine was determined three times for each of 31 women included in an IVF/ICSI program. Dosages were realised before stimulation, after gonadotrophin-releasing hormone agonist treatment (GnRH) and on the day of hCG injection.

[Twin birth after preimplantation diagnosis for cystic fibrosis].

Objective: Cystic fibrosis is a common autosomal recessive disease most often caused by a deletion (delta F508) in the CFTR gene. It is the most common indication for preimplantaion genetic diagnosis which allows genetic analysis of embryos obtained after in vitro fertilization and transfer of unaffected embryos into the patient's uterus.

Patients And Methods: We report the first preimplantation genetic diagnosis performed in Strasbourg for a couple at risk of having a child affected by severe cystic fibrosis due to a homozygous delta F508 mutation.

Allele-specific amplification for preimplantation genetic diagnosis (PGD) of spinal muscular atrophy.

We have developed a new allele-specific amplification method for the preimplantation genetic diagnosis (PGD) of spinal muscular atrophy (SMA; Werdnig-Hoffmann disease) from a single cell. This method is based on the detection of the deletion of exon 7 of the telomeric copy of the survival motor neurone (SMN(t)) gene. An oligonucleotide was designed to be specific to the SMN(t) nucleotidic sequence with exonic mismatch G (for SMN(t))-->A (for SMN(c)) at its 3' end.

Does body mass index of infertile women have an impact on IVF procedure and outcome?

Purpose: The objective was to explore whether body mass index (BMI) of women related to the different parameters of the in vitro fertilization (IVF) procedure and outcome.

Methods: This retrospective study on 398 couples analyzed epidemiological features, characteristics of ovarian stimulation, number and quality of retrieved oocytes, as well as pregnancy outcome according to three groups of BMI values: BMI < 20, 20 < or = BMI < 25 and BMI > or = 25 kg/m2.

Results: The prevalence of underweight and overweight women was 21.

Zygote evaluation: an efficient tool for embryo selection.

One of the main problems concerning IVF units is the need to decrease the occurrence of multiple pregnancies in their practice without affecting the overall success rate. Different embryological parameters concerning every step of the early embryo development are known to have some predictive value for implantation potential. In this prospective study, a pronuclear scoring system was used to classify zygotes into six patterns from 0 to 5.

Histological and genetic analysis and risk assessment for chromosomal aberration after ICSI for patients presenting with CBAVD.

Intracytoplasmic sperm injection (ICSI) has opened a new field in the treatment of male infertility, leading to a debate concerning its genetic safety. In this study we present an analysis of 11 patients presenting congenital bilateral absence of the vas deferens (CBAVD). In all 11 cases, genetic counselling, histological analysis of testicular biopsies, cystic fibrosis transmembrane conductance regulator (CFTR) mutation screenings of both partners and spermatozoa three-colour fluorescent in-situ hybridization (FISH) analysis were performed.

[Future perspectives: oocyte cryopreservation and in vitro maturation].

After treatment for neoplasia, a young patient can nowadays hope to be pregnant. The aim of this paper is to establish a review of the literature about cryopreservation of oocytes and ovarian tissue, and in vitro maturation of oocytes. These studies also concern patients for which ovarian stimulation is difficult, such as PCOS.

A quantitative and morphological analysis of oocytes collected during 438 IVF cycles.

Purpose: Our purpose was to determine if the number of retrieved oocytes, oocyte maturity, morphology, and other embryological parameters are related to the outcome of treatment.

Methods: This retrospective study on 438 IVF cycles analyzes the numbers of retrieved oocytes, fractured zona oocytes, germinal vesical-stage oocytes, normally and abnormally fertilized oocytes, pregnancy rate, age of female partner, ovarian stimulation protocol, day of hCG injection, and serum estradiol concentration.

Results: (1) Pregnancy rate increases with an increase in the number of retrieved oocytes, (2) a high incidence of fractured zona pellucida oocytes has a negative effect on fertilization rate but none on pregnancy rate, (3) a high incidence of immature oocytes is associated with improved fertilization and pregnancy rates, and (4) an inverse relationship between the presence of immature oocytes and oocytes with fractured zona pellucida is suggested.

[Therapeutic strategies in azoospermia: management].

ICSI allows use of epididymal or testicular sperm in case of azoospermia. The aim of this study is to propose an algorithm for the management of the different situations of azoospermia according to our personal experience and according to data of literature. The following points are discussed: epididymal or testicular origin of sperm, retrieval technique, contribution of freezing, interest of in vitro culture, side effects and need of a preliminary biopsy.

Prognostic value of objective semen parameters in an in vitro fertilization program.

Purpose: The basic semen parameters seem to have a limited predictive value in male fertility. Could other objective sperm analyses be helpful in the choice of the most adapted assisted procreation technique?

Methods: This study concerns 78 infertile couples with insemination failures. For each semen, 21 objective parameters are analyzed in fresh semen and after sperm selection procedure.

[When the needle replaces the knife: first pregnancies obtained after percutaneous testicular aspiration and intracytoplasmic sperm injection].

Percutaneous testicular sperm aspiration and ICSI were performed in 5 cases of excretory azoospermia. Usable sperm have always been obtained, two pregnancies were initiated.

Could in vitro fertilization with a modified sperm preparation technique be an option to micromanipulations?

Purpose: This study evaluated the efficiency of in vitro fertilization with a modified sperm preparation technique for male infertility, to avoid systematic recourse to ICSI.

Methods: The sperm function stimulants pentoxifylline, 2-deoxyadenosine, and follicular fluid were used during the sperm preparation of IVF trials for two groups of patients: couples with long-standing infertility and previous IVF failures and couples with male-factor infertility scheduled for their first treatment.

Results: Forty-nine attempts were performed in the first group.

Identification of hyaluronic acid and chondroitin sulfates in human follicular fluid and their effects on human sperm motility and the outcome of in vitro fertilization.

This study measured glycosaminoglycans (GAGs) in human follicular fluid (hFF) obtained from patients undergoing hormonal stimulation with combined GnRH agonist followed by gonadotropin hormone (hMG or FSH) for in vitro fertilization (IVF). The GAGs were partially characterized through the use of various mucopolysaccharidases and then their effects tested on human sperm motility. In hFF, the GAG and protein concentrations were 4.