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Belaisch-Allart J. [Concerning the recommendations for good practice by the Afssaps. Medicines that induce ovulation: gonadotrophins (update, April 2007)]. ACTA ACUST UNITED AC 2007; 35:917-22. [PMID: 17766160 DOI: 10.1016/j.gyobfe.2007.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Belaisch-Allart J, Mayenga JM, Grefenstette I, Chouraqui A, Serkine AM, Abirached F, Plachot M, Kulski O. [Intra-uterine insemination: ovarian stimulation or not?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2007; 35:871-6. [PMID: 17707676 DOI: 10.1016/j.gyobfe.2007.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 07/10/2007] [Indexed: 05/16/2023]
Abstract
Conflicting results have been published about intra-uterine insemination efficacy. In many studies, success rates is due to ovarian stimulation and number of follicles. In the present fight against multiple pregnancies, ovarian stimulation is discussed and present pregnancy rates are weak. Our aim is to demonstrate that there is a place for the association controlled ovarian hyperstimulation and intra-uterine insemination in the field of infertility treatments. It is possible to try and recognise women at high risk of multiple pregnancies, keeping the benefit of ovarian stimulation.
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Belaisch-Allart J. [Results of assisted reproductive techniques in France: are we, really, so bad?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2007; 35:287-9. [PMID: 17392013 DOI: 10.1016/j.gyobfe.2007.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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de Mouzon J, Levy R, Mourouvin Z, Belaisch-Allart J, Bachelot A, Royère D. [Semen characteristics and quality of the conceptus in fertilization in vitro]. ACTA ACUST UNITED AC 2007; 35:216-23. [PMID: 17321779 DOI: 10.1016/j.gyobfe.2007.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 01/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Assisted reproductive technology (ART) is associated with increased risks for the neonate, compared to natural fertility, mainly because of multiple pregnancies and increased maternal age. On the opposite, the impact of paternal factors has been scarcely studied, except for the relationship between surgically retrieved sperms and genetic abnormalities. PATIENTS AND METHODS This study has been realized using the large French register on in vitro fertilization (FIVNAT) that collects information on 80% of French ART activity. For the study, all the pregnancies obtained from oocyte recoveries between January 1996 and December 2003, for which information on cycles could be linked to the pregnancy were included, i.e. 34223 pregnancies, resulting in 27025 deliveries and 33945 neonates. Sperm quality was defined either according to the semen origin (spouse's ejaculate, epididymis, testis, or donor), or according to the spermiogramme values for concentration, motility and morphology. The statistical analysis included the use of multivariate logistic models, with the main prognostic factors. RESULTS The delivery, spontaneous abortion and ectopic pregnancy rates were not influenced by semen origin nor by quality, all the 95% confidence intervals including 1. The neonates conceived through surgically retrieved sperms were at a slightly increased risk of hypotrophy (weight under the 10% centile of reference curves) and of malformation (OR=1.18, 95CI: 1.03-1.36 and OR=1.30 [0,95-1,84], respectively). On the opposite, when analysis was restrained to ejaculated semen, no risk was demonstrated. DISCUSSION AND CONCLUSION The semen quality has little impact on pregnancy issue. Only the semen origin seems to act on hypotrophy and malformation, but these results deserve to be further analyzed for confirmation.
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Belaisch-Allart J. [Reply of J. Belaisch-Allart to the editorial by J. Cohen. Procreative tourism as a last resort. Gynecol Obstet Fertil 2006;34:881-2]. ACTA ACUST UNITED AC 2007; 35:164-5; discussion 172-3. [PMID: 17239644 DOI: 10.1016/j.gyobfe.2006.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Belaisch-Allart J. [Ovarian stimulation and cancers. Zero risk is but a myth... yet, should we terrorize our patients in the name of the precaution principle?]. ACTA ACUST UNITED AC 2006; 35:1-2. [PMID: 17182268 DOI: 10.1016/j.gyobfe.2006.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Belaisch-Allart J, Mayenga JM, Castaing N, Allart JP. La chirurgie tubaire et utérine a-t-elle un effet délétère sur la fonction ovarienne? ACTA ACUST UNITED AC 2006; 34:1111-7. [PMID: 17118690 DOI: 10.1016/j.gyobfe.2006.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 10/10/2006] [Indexed: 11/22/2022]
Abstract
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. Hysterectomy and uterine artery embolization seem to decrease ovarian reserve in perimenopausal women. Uterine artery embolization does not seem to have adverse effects on normally functioning ovaries.
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Cedrin-Durnerin I, Belaisch-Allart J, Avril C, Pouly J. P-109. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Belaisch-Allart J. [Openness on results of assisted reproductive techniques: yes, but...]. ACTA ACUST UNITED AC 2006; 34:430-1; discussion 429. [PMID: 16630738 DOI: 10.1016/j.gyobfe.2006.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lambalk CB, Leader A, Olivennes F, Fluker MR, Andersen AN, Ingerslev J, Khalaf Y, Avril C, Belaisch-Allart J, Roulier R, Mannaerts B. Treatment with the GnRH antagonist ganirelix prevents premature LH rises and luteinization in stimulated intrauterine insemination: results of a double-blind, placebo-controlled, multicentre trial*. Hum Reprod 2005; 21:632-9. [PMID: 16361296 DOI: 10.1093/humrep/dei386] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study was designed to assess whether the use of ganirelix in women undergoing stimulated IUI could prevent the occurrence of premature LH rises and luteinization (LH+progesterone rises). METHODS Women of infertile couples, diagnosed with unexplained or male factor infertility, were randomized to receive either ganirelix (n=103) or placebo (n=100) in a double-blind design. All women were treated with an individualized, low-dose rFSH regimen started on day 2-3 of cycle. Ganirelix (0.25 mg/day) was started if one or more follicles>or=14 mm were visualized. Ovulation was triggered by HCG injection when at least one follicle>or=18 mm was observed and a single IUI was performed 34-42 h later. The primary efficacy outcome was the incidence of premature LH rises (+/-progesterone rise). RESULTS In the ganirelix group, four subjects had a premature LH rise (value>or=10 IU/l), one LH rise prior to the start of ganirelix and three LH rises during ganirelix treatment, whereas in the placebo group 28 subjects had a premature LH rise, six subjects prior to the start of placebo and 22 subjects during placebo treatment. The incidence of LH rises was significantly lower in ganirelix cycles compared to placebo cycles (3.9 versus 28.0%; P=0.003 for ITT analysis). When excluding subjects with an LH value>or=10 IU/l before the start of ganirelix/placebo the incidence of LH rises was also significantly lower in ganirelix cycles compared to placebo cycles (2.9 versus 23.4%; P=0.003 for ITT analysis). Premature luteinization (LH rise with concomitant progesterone rise>or=1 ng/ml) was observed in one subject in the ganirelix group and in 17 subjects in the placebo group of which three subjects had a premature spontaneous ovulation. Ongoing pregnancy rates per attempt were 12.6 and 12.0% for the ganirelix and placebo groups respectively. CONCLUSIONS Treatment with ganirelix effectively prevents premature LH rises, luteinization in subjects undergoing stimulated IUI. Low-dose rFSH regimen combined with a GnRH antagonist may be an alternative treatment option for subjects with previous proven luteinization or in subjects who would otherwise require insemination when staff are not working.
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Belaisch-Allart J. [Ovarian endometrioma and infertility: when not to treat?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2005; 33:1052-3. [PMID: 16316772 DOI: 10.1016/j.gyobfe.2005.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Belaisch-Allart J. [What is the validity limit of patient reimbursement? Is age a criterion for refusal? Yes....]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2005; 34:5S18-5S21. [PMID: 16340898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Selection is probably necessary for women undergoing ART (Assisted Reproductive Therapy), since cost of technique is very important. Furthermore, the right to try to achieve a pregnancy is a debatable issue, since the delivery rates are very low for ageing women. Success rates decrease strongly for women over 40, and women must be informed of it. Women 40 years or older are significantly less likely to achieve pregnancy with IUI as compared to women under age 35. The older women are also significantly less likely to achieve pregnancy with in vitro fertilization (IVF and IVF-ICSI). Costs per cycle were similar, however, for both groups. Moreover, older women utilizing assisted reproductive techniques are four to five times less likely to achieve normal delivery than the younger group, since pregnancy loss rate is greater. This poor prognosis for success in older women adds significantly to the mean cost per pregnancy as compared to younger women. Now, public institutions advocate and impose an age limit upon women who which to undergo ART. Ovulation induction should not be administrated for women over 45 years old (AFSSAPS, 2003). One should recommend not to propose to women over 42 years old and to men over 59 years old (Guidelines, 2004). Moreover, ART techniques cannot be reimbursed for women over 43 years old (CCAM, 2005).
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Belaisch-Allart J. [Against systematic ultrasound-guided embryo transfer]. ACTA ACUST UNITED AC 2005; 33:923-4. [PMID: 16256401 DOI: 10.1016/j.gyobfe.2005.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Belaisch-Allart J. [About the recommendations of the HAS for health professionals concerning information given to pregnant women (April 2005)]. ACTA ACUST UNITED AC 2005; 33:925. [PMID: 16243577 DOI: 10.1016/j.gyobfe.2005.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Belaisch-Allart J, de Mouzon J, Pouly JL, Ayel JP. Grossesses gémellaires après AMP. ACTA ACUST UNITED AC 2005; 33:602-4. [PMID: 16137908 DOI: 10.1016/j.gyobfe.2005.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
Abstract
From 1986 to 2002, 16,618 twin babies have been reported to FIVNAT. Mean length of gestation was 36.74 weeks. The mean weight was 2413 g and mean height 46 cm. The proportion of prematurity under 28 weeks of amenorrhea was 1.17% and under 33 weeks: 7.78%. These data are similar to those reported in the French AUDIPOG Report.
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Belaisch-Allart J. [The use of clomiphene citrate in ambulatory medicine practice in the Midi-Pyrénées area: compliance to national guidelines applicable to infertility diagnosis and to prescription and monitoring rules applicable to clomiphene citrate treatments]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2005; 33:454-5. [PMID: 15927516 DOI: 10.1016/j.gyobfe.2005.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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de Mouzon J, Belaisch-Allart J. [Consequences on women's fecundity and on assisted reproductive technology]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2005; 34 Spec No 1:3S112-8. [PMID: 15980779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Knowledge of the detrimental role of cigarette smoking on human reproduction is constantly improving. In natural fertility, time to pregnancy is longer, frequency of infertility is increased and fertility rate declines 10% to 20% with a dose-effect relationship. Moreover, women exposed in utero also have lower fertility. Cigarette smoking is also a risk factor for menstrual disorders and for early menopause. In assisted reproductive technology, where many parameters are controlled, the deleterious effects of smoking on fertility have been clearly demonstrated: lower estradiol levels, decreased pregnancy and implantation rates, and poorer oocyte morphology. The two published meta-analyses have concluded that the effects are the same in natural and assisted reproduction. These results are in accordance with biological hypotheses on the local and general effect of tobacco and other cigarettes components. In conclusion, women should be informed about the effect of cigarette smoking on their fertility. Education is very important since in many countries, like France, the percentage of smokers is increasing among women, especially among young women.
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de Mouzon J, Belaisch-Allart J. Conséquences sur la fertilité féminine et sur les procréations médicalement assistées. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0368-2315(05)82977-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Amour MC, Mokdad A, Mayenga JM, Belaisch-Allart J. Amélioration du pronostic obstétrical des femmes porteuses d’un utérus distilbène par une prise en charge adaptée. ACTA ACUST UNITED AC 2004; 32:942-9. [PMID: 15567682 DOI: 10.1016/j.gyobfe.2004.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 09/06/2004] [Indexed: 11/20/2022]
Abstract
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 18.5%, among which 16.5% before 15 weeks of pregnancy and 2% after 15 weeks of pregnancy. Premature birth rate was 41.9%, among which 10.8% of great premature birth (before 32 weeks of pregnancy), 13.5% of moderate premature birth (between 32 and 36 weeks of pregnancy), and 17.6% of minor prematurity (after 36 weeks of pregnancy). The patients' average delivery term was 36 +/-3.6 weeks. DISCUSSION AND CONCLUSION As compared with the literature data, our miscarriage and prematurity rates are found to be lower. Our specific care management seems thus to be effective.
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Belaisch-Allart J, Devaux A, Ayel JP, de Mouzon J. [Women of 40 and older in i.v.f. and i.c.s.i.: the FIVNAT data]. ACTA ACUST UNITED AC 2004; 32:730-6. [PMID: 15380754 DOI: 10.1016/j.gyobfe.2004.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 07/23/2004] [Indexed: 11/25/2022]
Abstract
The proportion of women over 40 in i.v.f. and in i.c.s.i. has been dramatically increasing to reach 12% in 2002. Tubal and unexplained infertility increases with age. Short protocols or protocols with GnRH antagonists are more and more often used for older women. Best results are nevertheless still obtained with long protocols! Up to 35 years, pregnancy rates are similar with two or three transferred embryos. Over 35, better results are observed with three embryos. However, the rate of twins only falls below 20% when the woman is over 38, in i.v.f. as well as in i.c.s.i. The decreasing pregnancy rate should be better known by patients and clinicians so that women are treated sooner for i.v.f.
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Antoine JM, Audebert A, Avril C, Belaisch-Allart J, Blondel B, Bréart G, Cohen J, Epelboin S, Fanchin R, L'Hélias LF, Garel M, Germond M, Hazout A, Hugues JN, Mandelbaum J, Montagut J, de Mouzon J, Olivennes F, Royère D. Traitements de la stérilité et grossesses multiples en France : analyse et recommandations. ACTA ACUST UNITED AC 2004; 32:670-83. [PMID: 15450270 DOI: 10.1016/j.gyobfe.2004.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Simon-Bouy B, Plachot M, Mokdad A, Lavaud N, Muti C, Bazin A, Vialard F, Belaisch-Allart J. Possible human chimera detected prenatally after in vitro fertilization: a case report. Prenat Diagn 2004; 23:935-7. [PMID: 14634982 DOI: 10.1002/pd.733] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chimerism is the coexistence of more than one cell line in an individual, due to the fusion of originally separate zygotes. It has been very rarely described in humans. METHODS A 36-year-old woman who was referred for in vitro fertilization (IVF) for unexplained infertility had three embryos transferred. RESULTS Four weeks and five days after the transfer, ultrasound examination detected a single fetus in the uterus. Ultrasound examination at 17 weeks for metrorrhagia showed severe intrauterine growth retardation. Amniocentesis revealed a mixture of 46,XY and 46,XX clones. Histopathologic examination showed a dysmorphic fetus with female phenotype and severe growth retardation. CONCLUSIONS Although demonstration by fingerprinting has not been possible, fusion of two of the three transferred embryos (one male and one female) seems to be the most probable mechanism that could explain both cytogenetic and histopathologic observations. No chimera has yet been described after IVF. It would be interesting to collect any such observations from other IVF centers.
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Simon-Bouy B, Plachot M, Mokdad A, Muti C, Bazin A, Vialard F, Belaisch-Allart J. Diagnostic prénatal d’une probable chimère humaine après fécondation in vitro. ACTA ACUST UNITED AC 2004; 32:143-6. [PMID: 15123138 DOI: 10.1016/j.gyobfe.2003.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Accepted: 12/22/2003] [Indexed: 11/23/2022]
Abstract
Chimerism is the coexistence of more than one cell line in an individual, due to the fusion of originally separate zygotes. It has been very rarely described in humans. A 36-year-old woman referred for in vitro fertilization (IVF) had three embryos transferred leading to a monofetal pregnancy. Ultrasound examination at 17 weeks showed severe intrauterine growth retardation. Amniocentesis revealed a mixture of 46,XY and 46,XX clones. Histopathologic examination showed a dysmorphic fetus with female phenotype and severe growth retardation. Fusion of two of the three embryos (one male and one female) seems to be the most probable mechanism that could explain both cytogenetic and histopathologic observations.
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Belaisch-Allart J. [A law to limit embryo transfer in ART?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2003; 31:872-3; discussion 875. [PMID: 14642947 DOI: 10.1016/j.gyobfe.2003.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
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Féghali J, Bakar J, Mayenga JM, Ségard L, Hamou J, Driguez P, Belaisch-Allart J. [Systematic hysteroscopy prior to in vitro fertilization]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2003; 31:127-31. [PMID: 12718985 DOI: 10.1016/s1297-9589(03)00007-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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. If pathological findings were revealed, appropriate medical or surgical treatment was given. RESULTS Pathological patterns were observed in 45% of hysteroscopies. Endometritis, polyps and myomas and mucosal diseases were the most frequently observed. The patients aged over 38 years didn't show higher rate of pathology (29% vs 27% for the younger patients). The treatment of pathologies gave the same pregnancy rate than the normal cavities. Patients with endometritis were treated with antibiotics and 40% of them became pregnant in the following cycle. DISCUSSION AND CONCLUSION Systematic hysteroscopy prior to IVF-ICSI showed to be an effective investigation that could improve the pregnancy rate.
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