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Niddam R, Netter A, Courbière B, Agostini A, Miquel L. Laparoscopic Multibipolar Radiofrequency Myolysis for Symptomatic Myomas in 10 Steps. J Minim Invasive Gynecol 2024:S1553-4650(24)00114-6. [PMID: 38493828 DOI: 10.1016/j.jmig.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE To describe a minimal invasive 10-step technique of laparoscopic multibipolar radiofrequency myolysis for symptomatic myomas. DESIGN A step-by-step video demonstration of the technique. SETTING A woman with symptomatic FIGO 5 myoma of 60 mm of diameter, confirmed by magnetic resonance imaging. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. INTERVENTIONS Approximately 30% of women of child-bearing age with myomas will present with symptoms [1] that include chronic pelvic pain, abnormal uterine bleeding or infertility [2,3]. Data regarding fertility preservation and obstetric outcomes suggest that radiofrequency myoma ablation may offer an alternative to existing treatments for women who desire future fertility [4]. The local institutional review board stated that approval was not required because the video describes a technique and not a clinical case. In our center, all radiofrequency indications are discussed during a monthly multidisciplinary myomas meeting. This video presents the procedure divided into the following 10 steps: planning of the surgery; materials; installation; laparoscopic exploration; transvaginal ultrasound examination; visual and transvaginal ultrasound guided transparietal puncture of the myoma; control of the applicators' position; radiofrequency myolysis; end of myolysis, applicators removal; final check and additional procedures. CONCLUSION Radiofrequency myolysis is a simple and reproductible procedure that can be offered as an alternative to myomectomy [5]. This video presents 10 steps to make the procedure easier to adopt and to reduce its learning curve. VIDEO ABSTRACT.
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Affiliation(s)
- Raphael Niddam
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France.
| | - Antoine Netter
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| | - Blandine Courbière
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France; Department of Biomarkers, Environment and Health (Dr. Courbière), Aix Marseille University, CNRS, IRD, Avignon University, IMBE, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
| | - Laura Miquel
- Department of Obstetrics, Gynecology, and Reproductive Medicine (all authors) Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, Marseille, France
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Rives N, Courbière B, Almont T, Kassab D, Berger C, Grynberg M, Papaxanthos A, Decanter C, Elefant E, Dhedin N, Barraud-Lange V, Béranger MC, Demoor-Goldschmidt C, Frédérique N, Bergère M, Gabrel L, Duperray M, Vermel C, Hoog-Labouret N, Pibarot M, Provansal M, Quéro L, Lejeune H, Methorst C, Saias J, Véronique-Baudin J, Giscard d'Estaing S, Farsi F, Poirot C, Huyghe É. What should be done in terms of fertility preservation for patients with cancer? The French 2021 guidelines. Eur J Cancer 2022; 173:146-166. [PMID: 35932626 DOI: 10.1016/j.ejca.2022.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
AIM To provide practice guidelines about fertility preservation (FP) in oncology. METHODS We selected 400 articles after a PubMed review of the literature (1987-2019). RECOMMENDATIONS Any child, adolescent and adult of reproductive age should be informed about the risk of treatment gonadotoxicity. In women, systematically proposed FP counselling between 15 and 38 years of age in case of treatment including bifunctional alkylating agents, above 6 g/m2 cyclophosphamide equivalent dose (CED), and for radiation doses on the ovaries ≥3 Gy. For postmenarchal patients, oocyte cryopreservation after ovarian stimulation is the first-line FP technique. Ovarian tissue cryopreservation should be discussed as a first-line approach in case of treatment with a high gonadotoxic risk, when chemotherapy has already started and in urgent cases. Ovarian transposition is to be discussed prior to pelvic radiotherapy involving a high risk of premature ovarian failure. For prepubertal girls, ovarian tissue cryopreservation should be proposed in the case of treatment with a high gonadotoxic risk. In pubertal males, sperm cryopreservation must be systematically offered to any male who is to undergo cancer treatment, regardless of toxicity. Testicular tissue cryopreservation must be proposed in males unable to cryopreserve sperm who are to undergo a treatment with intermediate or severe risk of gonadotoxicity. In prepubertal boys, testicular tissue preservation is: - recommended for chemotherapy with a CED ≥7500 mg/m2 or radiotherapy ≥3 Gy on both testicles. - proposed for chemotherapy with a CED ≥5.000 mg/m2 or radiotherapy ≥2 Gy. If several possible strategies, the ultimate choice is made by the patient.
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Affiliation(s)
- Nathalie Rives
- Normandie Univ, UNIROUEN, Team "Adrenal and Gonadal Physiopathology" Inserm U1239 Nordic, Rouen University Hospital, Biology of Reproduction-CECOS Laboratory, Rouen, France
| | - Blandine Courbière
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Thierry Almont
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Diana Kassab
- Methodology Unit, Association Française d'Urologie, Paris, Ile-de-France, France
| | - Claire Berger
- Department of Pediatric Hematology and Oncology, University-Hospital of Saint-Etienne, Hospital, Nord Saint-Etienne cedex 02, France 42055; Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint-Etienne, 15 rue Ambroise Paré, Saint-Etienne cedex 02, France 42023
| | - Michaël Grynberg
- Reproductive Medicine and Fertility Department, Hôpital Antoine-Beclère, Clamart, Île-de-France, France
| | - Aline Papaxanthos
- Reproductive Medicine and Biology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
| | - Christine Decanter
- Medically Assisted Procreation and Fertility Preservation Department, Centre Hospitalier Régional Universitaire de Lille, Lille, Hauts-de-France, France
| | - Elisabeth Elefant
- Reference Center for Teratogenic Agents, Hôpital Armand-Trousseau Centre de Référence sur les Agents Tératogènes, Paris, Île-de-France, France
| | - Nathalie Dhedin
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Virginie Barraud-Lange
- Reproductive Medicine and Biology Department, Hôpital Cochin, Paris, Île-de-France, France
| | | | | | - Nicollet Frédérique
- Information and Promotion Department, Association Laurette Fugain, Paris, France
| | - Marianne Bergère
- Human Reproduction, Embryology and Genetics Directorate, Agence de la biomédecine, La Plaine Saint-Denis, France
| | - Lydie Gabrel
- Good Practices Unit - Guidelines and Medicines Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Marianne Duperray
- Guidelines and Drug Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Christine Vermel
- Expertise Quality and Compliance Mission - Communication and Information Directorate, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Natalie Hoog-Labouret
- Research and Innovation, Institut National du Cancer, Billancourt, Île-de-France, France
| | - Michèle Pibarot
- OncoPaca-Corse Regional Cancer Network, Assistance Publique - Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Magali Provansal
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Laurent Quéro
- Cancerology and Radiotherapy Department, Hôpital Saint Louis, AP-HP, Paris, France
| | - Hervé Lejeune
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Charlotte Methorst
- Reproductive Medicine and Biology Department, Centre Hospitalier des Quatre Villes - Site de Saint-Cloud, Saint-Cloud, France
| | - Jacqueline Saias
- Reproductive Medicine and Biology Department, Assistance Publique Hôpitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Jacqueline Véronique-Baudin
- Cancerology, Urology, Hematology Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France; General Cancer Registry of Martinique UF1441, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France
| | - Sandrine Giscard d'Estaing
- Reproductive Medicine and Biology Department, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadila Farsi
- Regional Cancer Network, Réseau Espace Santé Cancer, Lyon, Rhône-Alpes, France
| | - Catherine Poirot
- Adolescents and Young Adults Unit, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, France
| | - Éric Huyghe
- Urology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, Université Toulouse 3 Paul Sabatier, Toulouse, France.
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Courbière B, Drikes B, Gros A, Hamidou Z, Bertrand Y, Gandemer V, Poiree M, Plantaz D, Plat G, Contet A, Ansoborlo S, Paillard C, Kanold J, Auquier P, Michel G. O-267 Uterine volume is dramatically decreased in Stem Cell Hematopoietic Transplantation childhood survivors whatever the conditioning regimen. A case-control MRI study in the L.E.A cohort. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
What is the impact of the type of myeloablative conditioning (MAC) regimen applied for hematopoietic stem cell transplantation (HSCT) on uterine volume of childhood leukemia survivors?
Summary answer
Uterine volume is significantly decreased after HSCT. Not only Total Body Irradiation (TBI), but also high-dose chemotherapy-based regimens containing alkylating agents induce uterine damage.
What is known already
Premature ovarian failure after HSCT is well known, as well as the uterine damage induced by TBI on uterine volume. A few studies have reported smaller uterus after HSCT in women treated with chemotherapy only. In these studies, uterus volume was assessed by a transabdominal and/or transvaginal ultrasonography, and primary diagnosis, age at treatment and chemotherapy regimen were heterogeneous. These preliminary results suggested that alkylating agents could induce uterine damage, as well as they induce fibrosis and vascular damage in ovarian stroma. The impact of chemotherapy on myometrium and uterus is still few investigated.
Study design, size, duration
A prospective multicentric national study was conducted between 2017, November and 2021, June in 16 University Teaching Hospitals that are following more than 4 500 childhood acute leukemia survivors enrolled in the L.E.A cohort. We included 88 adult women treated for a childhood acute leukemia with HSCT and who agreed a pelvic MRI assessment. Every case was matched 1:1 to control women who underwent MRI for benign ovarian cysts or benign pelvic pathology.
Participants/materials, setting, methods
Pelvic MRI scans were performed with a 1.5-T or 3T magnetic resonance scanner, including diffusion-weighted imaging sequences. Scans were centralized for a double-blinded lecture by two radiologists. The main outcome was the uterine volume. The secondary outcomes were uterine body-to-cervix ratio and apparent diffusion coefficient (ADC). Univariate and multivariate analyses have investigated the association of clinical and imaging variables with conditioning regimen and age at HSCT.
Main results and the role of chance
The mean age in HSCT group was 26.5 + 6.3 years. Mean age at HSCT was 9.1 + 0.3 years with a mean follow-up of 16.4 + 0.5 years. Among the 88 women included in HSCT group, two groups of conditioning regimens have been compared to the control group: a chemotherapy-only MAC regimen group with high dose of alkylating agents (n = 34) and one TBI-based regimen group (n = 52). Two MRI scans were not available. Among HSCT group, 75 women were considered as “normally impregnated” by estrogens, by hormone replacement therapy (HRT) for premature ovarian insufficiency (POI) or thanks to a residual ovarian function. Uterine volume was significantly decreased both after chemotherapy-only MAC regimen and after TBI, with respectively 45.3 + 5.6 and 19.6 + 1.9 mL Vs 79.7 + 3.3 mL in control population (p < 0.01). In chemotherapy-only MAC regimen group, uterine volume was dramatically decreased in POI women without HRT compared to those having a hormonal impregnation (15.2 + 2.6 Vs 49.3 + 6 mL, p < 0.05). In contrast, after TBI, uterine volume was similar in all women, with no positive effect of HRT on uterine volume (respectively 16.3 + 2.6 Vs 20.1 + 2.2 mL).
Limitations, reasons for caution
The number of pregnancies obtained spontaneously or after oocyte donation in our study population was too low to evaluate the obstetrical impact of uterine damage caused by non-TBI regimens.
Wider implications of the findings
Our results provide strong evidence that a MAC regimen containing high dose of alkylating agents could induce uterine damage. In these sub-group of women, HRT increases the volume of the uterus compared to non-treated women. After TBI, uterine volume is dramatically decreased, with no benefit of HRT on it.
Trial registration number
NCT 03583294
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Affiliation(s)
- B Courbière
- AP-HM Hôpital de la Conception / Aix Marseille University, gynecology-obstetrics and reproductive medicine , Marseille, France
| | - B Drikes
- AP-HM Hôpital de La Timone , Radiology, Marseille, France
| | - A Gros
- AP-HM Hôpital de La Timone , Radiology, Marseille, France
| | - Z Hamidou
- Hôpital de la Timone, CEReS Research Unit EA 3279- , Marseille, France
- Departmentof Public Health 3279- , Marseille, France
| | - Y Bertrand
- University Hospital of Lyon , Pediatric hematology , Lyon, France
| | - V Gandemer
- University Hospital of Rennes, Pediatric Hematology and Oncology , Rennes, France
| | - M Poiree
- University Hospital L'Archet , Pediatric Hematology and oncology , Nice, France
| | - D Plantaz
- University Hospital of Grenoble, Pediatric Hematology and Oncology , Grenoble, France
| | - G Plat
- University Hospital of Toulouse, Pediatric Hematology and Oncology , Toulouse, France
| | - A Contet
- Children's Hospital of Brabois , Pediatric Hematology and Oncology , Vandoeuvre-les-Nancy, France
| | - S Ansoborlo
- University Hospital of Bordeaux, Pediatric Hematology and Oncology , Bordeaux, France
| | - C Paillard
- University Hospital of Strasbourg, Pediatric Hematology and Oncology , Strasbourg, France
| | - J Kanold
- University Hospital of Clermont-Ferrand , Pediatric hematology and Oncology , Clermont-Ferrand, France
| | - P Auquier
- APHM Hôpital de la Timone / Aix Marseille University, CEReS Research Unit EA 3279 and Department of Public Health , Marseille, France
| | - G Michel
- La Timone Children's Hospital, Pediatric Hematology- Immunology and Oncology , Marseille, France
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Rodier C, Courbière B, Fernandes S, Vermalle M, Florence B, Resseguier N, Brue T, Cuny T. Metoclopramide Test in Hyperprolactinemic Women With Polycystic Ovarian Syndrome: Old Wine Into New Bottles? Front Endocrinol (Lausanne) 2022; 13:832361. [PMID: 35250884 PMCID: PMC8895271 DOI: 10.3389/fendo.2022.832361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Polycystic ovarian syndrome (PCOS) is the most frequent etiology of anovulation, hyperandrogenism and infertility in women. Its pathophysiology remains poorly elucidated. Hyperprolactinemia (hPRL) is common in women of reproductive age and may partially mimic the clinical phenotype of PCOS. The simultaneous finding of both conditions is therefore not rare, however there are conflicting studies on whether a link exists between them. MATERIALS AND METHODS We conducted a retrospective monocentric study between 2015 and 2021 and among women who were referred for possible PCOS, we selected those who met the ESHRE/Rotterdam definition criteria. hPRL was defined as two values above the upper limit of normal with at least one measurement in our centre. RESULTS A total of 430 women were selected, of whom 179 met the PCOS criteria. 50 out of 179 patients (27.9%) had at least one elevated value of PRL and 21 (11.7%) had hPRL according to our definition. Among the 21 women of the PCOS/hPRL cohort, 5 (23.8%) had a microprolactinoma and all of them had PRL level ≥ 60 ng/ml. The remaining cases were macroprolactinemia (n=5), iatrogenic hPRL (n=4), primary hypothyroidism (n=1) or unexplained (n=6) despite exhaustive investigations. The metoclopramide test resulted in an increase of basal PRL < 300% in all prolactinomas and ≥ 300% in all the other etiologies. CONCLUSION hPRL was a common finding in PCOS women, secondary to a microprolactinoma in a quarter of cases. Metoclopramide test performed in women with hPRL below 60 ng/ml appeared as a helpful tool 1) to discriminate pituitary causes from others etiologies, 2) to potentially avoid unnecessary pituitary MRI.
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Affiliation(s)
- Claire Rodier
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Blandine Courbière
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- CNRS, IRD, IMBE, Avignon Université, Aix Marseille Univ, Marseille, France
| | - Sara Fernandes
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Marie Vermalle
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Bretelle Florence
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, Marseille, France
| | - Noémie Resseguier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Service d’Epidemiologie et d’Economie de la Santé, Unité de Recherche Clinique, Direction de la Recherche en Santé, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Thierry Brue
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
| | - Thomas Cuny
- Aix Marseille Univ, APHM, Marseille Medical Genetics, Inserm U1251 and Hôpital de la Conception, Service d’Endocrinologie, Marseille, France
- *Correspondence: Thomas Cuny,
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5
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Courbière B, Roux EL, Mathie. D’Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigne M, Chavanaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. P–454 Oocyte vitrification for fertility preservation in women with benign gynecological disease: French national clinical guidelines with a modified Delphi consensus process. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is there consensual clinical practices about fertility preservation (FP) for benign gynecological diseases BGD)?
Summary answer
A consensus study using the modified Delphi method identified 28 consensual practices concerning oocyte vitrification for fertility preservation in women with benign gynecological disease.
What is known already
Clinical Practical international guidelines are still published in oncology for offering standardized information and care for adults and children with cancer. Recently, the ESHRE Female Fertility Preservation Guideline Development Group published recommendations for healthcare professionals involved in fertility preservation for post-pubertal women and transgender adolescents and young adults. However, benign gynecological indications weren’t distinctly individualized of malignant conditions. There’s a lack of large cohort studies assessing the risks and outcome of FP for benign gynecological diseases. Healthcare professionals need consensus for defining the “good” indications of FP for benign gynecological diseases that could impair fertility.
Study design, size, duration
A steering group composed by 14 healthcare professionals and a patient representative with lived experience of endometriosis identified 42 potential practices concerning fertility preservation for benign gynecological disease. Then, 114 key stakeholders including various healthcare professionals (n = 108) and patient representatives(n = 6) were asked to answer at two rounds of a modified Delphi via an online survey from February to September 2020.
Participants/materials, setting, methods
Participants had to score 42 items for the first round and 31 for the second round using a nine-point Likert scale. These statements were distributed into five categories: Information to deliver to age-reproductive women with a BGD (n = 9), technical aspect of fertility preservation for BGD (n = 6), indications of FP for endometriosis (n = 13), indications of FP for none-endometriosis BGD (n = 10), idiopathic diminished ovarian reserve in the absence of gynecologic and endocrinologic diseases (n = 4).
Main results and the role of chance
Survey response of stakeholders was 75% (86 out of 114) for the round 1 and 87% (75 out of 86) for the round 2. Consensus recommendations were achieved for 28 items, and no consensus between stakeholders was achieved in the remaining items. Stakeholders rated the importance of an age-specific information concerning the risk of diminished ovarian reserve after surgery and the necessity to inform about the benefice/ risk balance of oocyte vitrification, in particular about the chance of live-birth according to the age at the time of oocyte vitrification. They endorsed oocyte vitrification as the reference FP technique for those benign indications. Experts rejected to determine lower and upper age limits in women for fertility preservation. FP shouldn’t be offered in rAFS stages I and II endometriosis without endometriomas.
Limitations, reasons for caution
Experts were only French native speakers from France, and Belgium. It would have been interesting to conduct this survey with experts from other continents.
Wider implications of the findings: At our knowledge, we present here the first guideline s focusing on FP in women with BGD, following a designed scientific Delphi procedure. These guidelines could be useful for gynecologists to better inform women with benign gynecological diseases about the indication or not to offer a FP procedure.
Trial registration number
Not applicable
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Affiliation(s)
- B Courbière
- APHM Hôpital de la Conception / Aix Marseille Univ, Gynecology- Obstetrics and reproductive Medicine, Marseille, France
| | - E L Roux
- Hôpital Universitaire Robert Debré- AP-HP/ Inserm- Université de Paris, Unité d’épidémiologie clinique Inserm- CIC 1426 / ECEVE UMR 1123, Paris, France
| | - E Mathie. D’Argent
- APHP Hôpital Tenon /Université Pierre-et-Marie-Curie Paris 6, Department of Gynecology-Obstetric and Reproductive Medicine- Centre expert en endométriose C3E, Paris, France
| | - A Torre
- CHU Rouen, Department of Gynecology - Obstetric and Reproductive Medicine, Rouen, France
| | - C Patrat
- APHP centre – Université de Paris- site Cochin- Inserm U1016, Service de Biologie de la Reproduction – CECOS, Paris, France
| | - C Poncelet
- CH rené Dubos / Université Sorbonne Paris Nord - Université Paris 13, Gynecology - Obstetrics / UFR SMBH leonard de Vinci, Cergy-Pontoise, France
| | - J Montagut
- Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, Toulouse, France
| | - A S Gremeau
- University Hospital Clermont-Ferrand, Gynecologic surgery and IVF, Clermont-Ferrand, France
| | - H Creux
- Clinique Saint Roch, Gynecology-Obstetric and Reproductive Medicine, Montpellier, France
| | - M Peigne
- AP-HP Hôpital Jean Verdier / Université Sorbonne Paris Nord- Paris 13, Reproductive Medicine and Fertility Preservation, Bondy, France
| | | | - L Dirian
- EndoFrance, Association Française de lutte contre l’endométriose, Paris, France
| | - X Fritel
- CHU Poitiers, Gynecology- Obstetric and Reproductive Medicine / Inserm CIC-P 1402, Poitiers, France
| | - J L Pouly
- CH Moulins Yzeure, Gynecology-Obstetric, Moulins, France
| | - A Fauconnier
- CHI Poissy-Saint-Germain-en Laye / Paris -Saclay University, Gynecology and Obstetrics / Research Unit 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, Poissy, France
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Jourdain H, Flye Sainte Marie H, Courbière B, Lazaro G, Boukerrou M, Tran PL. Evaluation of physicians' practice patterns in France concerning fertility preservation in women with endometriosis. J Gynecol Obstet Hum Reprod 2020; 50:101985. [PMID: 33189944 DOI: 10.1016/j.jogoh.2020.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/03/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aim to evaluate the knowledge and physicians' practices concerning fertility preservation in women with endometriosis. DESIGN Descriptive, observational, national study using an online self-questionnaire, sent by email to French gynaecologists in October 2019 within 2 months. RESULTS We obtained 110 analyzable responses from mainly surgeons (54 %) and reproductive clinicians (19 %) with a good experience (average 15 years of practice). Amongst these practitioners, 91 % seemed aware of latest French recommendations on endometriosis issued in December 2017. The most commonly used surgical techniques for management of endometriomas were intra-peritoneal cystectomy (51 %), vaporization by plasma energy (29 %) and destruction by bipolar coagulation (8.5 %). Preoperative AMH was systematically or often prescribed by 78 % of the practitioners against 37.3 % who did it postoperatively. Furthermore, 74 % also considered and performed fertility preservation strategy to manage endometriosis. It was offered in situations of bilateral or recurrent endometrioma, but only 33 % offered it in unilateral endometrioma cases. In the cases recorded, vitrification of mature oocytes appears to be the most common fertility preservation technique (used by 87 % of the practitioners). CONCLUSION We observed in our population of sensitized practitioners a good and adequate knowledge concerning endometriosis physiopathology and recommendations for its management, with good information delivery to women. Operating techniques are adapted although information and education concerning fertility preservation indications seem necessary. The place of multidisciplinary concertation meeting in endometriosis appears essential both for discussion of surgical indications and for fertility preservation possibilities. Creation of dedicated structures should be encouraged.
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Affiliation(s)
- H Jourdain
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France.
| | - H Flye Sainte Marie
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France
| | - B Courbière
- Centre d'Assistance Médicale à la Procréation, AP-HM La Conception, 147 bd Baille, 13005, Marseille, France; Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France
| | - G Lazaro
- Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | - M Boukerrou
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France; Centre d'Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France; Unité de formation et de recherche santé de La Réunion, Faculté de Médecine, 97490, Saint Denis, La Réunion, France
| | - P L Tran
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France; Centre d'Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France
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7
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Graillon T, Cuny T, Castinetti F, Courbière B, Cousin M, Albarel F, Morange I, Bruder N, Brue T, Dufour H. Surgical indications for pituitary tumors during pregnancy: a literature review. Pituitary 2020; 23:189-199. [PMID: 31691893 DOI: 10.1007/s11102-019-01004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Surgical indications for pituitary tumors during pregnancy are rare, and are derived from a balance between expected benefits, particularly for maternal benefits, and anesthetic/surgical risks. METHODS A literature review was performed to define the optimal surgical indications for pituitary adenomas (PA) and other pituitary tumors during pregnancy. RESULTS Main benefits are expected in case of critical visual impairment and/or life-threatening endocrine disturbances. Multidisciplinary patient management is systematically required although nonobstetric surgery presents a reasonable risk during pregnancy. The risks of congenital malformation during the first trimester and those of premature birth during the third trimester make the second trimester the optimal period for surgery. In prolactin-secreting, nonsecreting, GH- and TSH-secreting PAs, transsphenoidal surgery (TS) is recommended in cases involving severe visual impairment, characterized by severe visual field deficit, visual acuity impairment, and abnormal optical coherence tomography findings, and when no other medical alternatives are possible and/or sufficient. Uncontrolled and severe Cushing's disease (CD) during pregnancy increases both maternal and fetal morbimortality, thus justifying TS or sometimes dopamine agonist therapy as a safer alternative. Finally, metyrapone, ketoconazole, or bilateral adrenalectomy could be recommended in certain cases after the failure of medical therapies and/or TS. Surgery is also required for suprasellar meningiomas, craniopharyngiomas, and pituitary cysts in the case of severe visual deficit. CONCLUSION Surgical indications for pituitary tumors are rare during pregnancy; therefore, surgery should be avoided when possible. Further, the second trimester should be considered as the optimal surgical period. Severe visual disturbance and uncontrolled CD are the main surgical indications during pregnancy.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France.
- Aix-Marseille Univ, INSERM, MMG, Marseille, France.
| | - Thomas Cuny
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Frédéric Castinetti
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Blandine Courbière
- Centre Clinico-Biologique d'AMP, Pôle Femmes-Parents-Enfants, Hôpital de La Conception, AP-HM, Marseille/Aix Marseille Univ, Avignon Univ, CNRS, IRD, IBME, Marseille, France
| | - Marie Cousin
- Cabinet d'Ophtalmologie, Saint-Rémy de Provence, France
| | - Frédérique Albarel
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Isabelle Morange
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Nicolas Bruder
- Anesthesiology-Intensive Care Department, Aix-Marseille Univ, APHM, CHU Timone, Marseille, France
| | - Thierry Brue
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille Univ, APHM, CHU Conception, Marseille, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille Univ, APHM, CHU Timone, La Timone Hospital, 264 rue Saint-Pierre, 13005, Marseille, France
- Aix-Marseille Univ, INSERM, MMG, Marseille, France
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8
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Elkhatib RA, Paci M, Longepied G, Saias-Magnan J, Courbière B, Guichaoua MR, Lévy N, Metzler-Guillemain C, Mitchell MJ. Homozygous deletion of SUN5 in three men with decapitated spermatozoa. Hum Mol Genet 2018; 26:3167-3171. [PMID: 28541472 DOI: 10.1093/hmg/ddx200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/22/2017] [Indexed: 12/23/2022] Open
Abstract
A recent study of 17 men with decapitated spermatozoa found that 8 carried two rare SUN5 alleles, and concluded that loss of SUN5 function causes the acephalic spermatozoa syndrome. Consistent with this, the SUN5 protein localises to the head-tail junction in normal spermatozoa, and SUN proteins are known to form links between the cytoskeleton and the nucleus. However, six of the ten SUN5 variants reported were missense with an unknown effect on function, and only one man carried two high confidence loss-of-function (LOF) alleles: p.Ser284* homozygozity. One potential exonic splice mutation, homozygous variant p.Gly114Arg, was not tested experimentally. Thus, definitive proof that loss of SUN5 function causes the acephalic spermatozoa syndrome is still lacking. Based on these findings, we determined the sequence of the SUN5 gene in three related men of North African origin with decapitated spermatozoa. We found all three men to be homozygous for a deletion-insertion variant (GRCh38 - chr20:32995761_32990672delinsTGGT) that removes 5090 base pairs including exon 8 of SUN5, predicting the frameshift, p.(Leu143Serfs*30), and the inactivation of SUN5. We therefore present the second case where the acephalic spermatozoa syndrome is associated with two LOF alleles of SUN5. We also show that the p.Gly114Arg variant has a strong inhibitory effect on splicing in HeLa cells, evidence that homozygozity for p.Gly114Arg causes acephalic spermatozoa syndrome through loss of SUN5 function. Our results, together with those of the previous study, show that SUN5 is required for the formation of the sperm head-tail junction and male fertility.
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Affiliation(s)
| | - Marine Paci
- Aix Marseille Univ, INSERM, GMGF, Marseille, France.,Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, Pôle Femmes-Parents-Enfants, APHM Hôpital La Conception, Marseille, France
| | | | - Jacqueline Saias-Magnan
- Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, Pôle Femmes-Parents-Enfants, APHM Hôpital La Conception, Marseille, France
| | - Blandine Courbière
- Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, Pôle Femmes-Parents-Enfants, APHM Hôpital La Conception, Marseille, France.,Aix Marseille Univ, Univ Avignon, CNRS, IRD, IMBE, UMR7263, Marseille, France
| | - Marie-Roberte Guichaoua
- Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, Pôle Femmes-Parents-Enfants, APHM Hôpital La Conception, Marseille, France.,Aix Marseille Univ, Univ Avignon, CNRS, IRD, IMBE, UMR7263, Marseille, France
| | - Nicolas Lévy
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
| | - Catherine Metzler-Guillemain
- Aix Marseille Univ, INSERM, GMGF, Marseille, France.,Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, Pôle Femmes-Parents-Enfants, APHM Hôpital La Conception, Marseille, France
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9
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Paci M, Elkhatib R, Longepied G, Hennebicq S, Bessonat J, Courbière B, Bourgeois P, Levy N, Mitchell MJ, Metzler-Guillemain C. Abnormal retention of nuclear lamina and disorganization of chromatin-related proteins in spermatozoa from DPY19L2-deleted globozoospermic patients. Reprod Biomed Online 2017; 35:562-570. [PMID: 28882431 DOI: 10.1016/j.rbmo.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/21/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to characterize the nuclear lamina (NL) and lamin chromatin-partners in spermatozoa from four DPY19L2-deleted globozoospermic patients. We tested for spermatid transcripts encoding lamins and their chromatin-partners emerin, LAP2α, BAF and BAF-L, by reverse transcriptase-PCR using spermatozoa RNA. We also determined the localization of lamin B1, BAF and BAF-L by immunofluorescent analysis of spermatozoa from all patients. In RNA from globozoospermic and control spermatozoa we detected transcripts encoding lamin B1, lamin B3, emerin, LAP2α and BAF-L, but not A-type lamins. In contrast, BAF transcripts were detected in globozoospermic but not control spermatozoa. The NL was immature in human globozoospermic spermatozoa: lamin B1 signal was detected in the nuclei of globozoospermic spermatozoa in significantly higher proportions than the control (P < 0.05; 56-91% versus 40%) and was predominantly observed at the whole nuclear periphery, not polarized as in control spermatozoa. Conversely, BAF and BAF-L were detected in control, but not globozoospermic spermatozoa. Our results strongly emphasize the importance of the NL and associated proteins during human spermiogenesis. In globozoospermia, the lack of maturation of the NL, and the modifications in expression and location of chromatin-partners, could explain the chromatin defects observed in this rare phenotype.
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Affiliation(s)
- Marine Paci
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France; APHM Hôpital La Conception, Pôle Femmes-Parents-Enfants, Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, 13385 Marseille, Cedex 5, France
| | - Razan Elkhatib
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France
| | - Guy Longepied
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France
| | - Sylviane Hennebicq
- CHU de Grenoble, Centre d'Assistance Médicale à la Procréation-CECOS, BP217, Grenoble Cedex 9, France
| | - Julien Bessonat
- CHU de Grenoble, Centre d'Assistance Médicale à la Procréation-CECOS, BP217, Grenoble Cedex 9, France
| | - Blandine Courbière
- APHM Hôpital La Conception, Pôle Femmes-Parents-Enfants, Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, 13385 Marseille, Cedex 5, France
| | - Patrice Bourgeois
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France
| | - Nicolas Levy
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France
| | - Michael J Mitchell
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France
| | - Catherine Metzler-Guillemain
- Aix Marseille University, Inserm, GMGF, 13385 Marseille, Cedex 5, France; APHM Hôpital La Conception, Pôle Femmes-Parents-Enfants, Centre Clinico-Biologique d'Assistance Médicale à la Procréation-CECOS, 13385 Marseille, Cedex 5, France.
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10
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Ben Charif A, Bouhnik AD, Courbière B, Rey D, Préau M, Bendiane MK, Peretti-Watel P, Mancini J. Sexual health problems in French cancer survivors 2 years after diagnosis—the national VICAN survey. J Cancer Surviv 2015; 10:600-9. [DOI: 10.1007/s11764-015-0506-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/06/2015] [Indexed: 01/23/2023]
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11
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Ould Hamouda S, Perrin J, Achard V, Courbière B, Grillo JM, Sari-Minodier I. [Association between sperm abnormalities and occupational environment among male consulting for couple infertility]. ACTA ACUST UNITED AC 2015; 45:1-10. [PMID: 26387599 DOI: 10.1016/j.jgyn.2015.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 08/02/2015] [Accepted: 08/25/2015] [Indexed: 11/26/2022]
Abstract
Alteration of sperm parameters related to occupational exposures is the subject of several studies, often on a case-control approach. The study populations usually comprise men consulting in infertility clinics for couple infertility. The objective of this review is to identify, from these case-control studies, the main occupational factors that may be associated with altered sperm parameters. We selected 13 articles in the PubMed database. Participation in these studies varied from 61 to 2619 subjects, with great methodological heterogeneity, particularly in the characterization of exposure. The main occupations that appear significantly associated with a risk of altered sperm parameters are workmen, painters, farmers, welders, plumbers and technicians. When analysis focuses on occupational exposures, a significant result is reported for solvents, heavy metals, heat, vibrations and non-ionizing radiation. None of the selected studies has found a link with exposure to pesticides.
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Affiliation(s)
- S Ould Hamouda
- Service de médecine et santé au travail, pôle de santé publique, Assistance publique-Hôpitaux de Marseille (AP-HM) la Timone, 13005 Marseille, France; CECOS-laboratoire de biologie de la reproduction, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France
| | - J Perrin
- CECOS-laboratoire de biologie de la reproduction, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Centre clinico-biologique d'assistance médicale à la procréation, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Institut méditerranéen de biodiversité et d'écologie (IMBE UMR 7263), équipe biogénotoxicologie, santé humaine et environnement, faculté de médecine, Aix Marseille université, CNRS, IRD, université Avignon, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - V Achard
- CECOS-laboratoire de biologie de la reproduction, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Centre clinico-biologique d'assistance médicale à la procréation, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Institut méditerranéen de biodiversité et d'écologie (IMBE UMR 7263), équipe biogénotoxicologie, santé humaine et environnement, faculté de médecine, Aix Marseille université, CNRS, IRD, université Avignon, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - B Courbière
- Centre clinico-biologique d'assistance médicale à la procréation, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Institut méditerranéen de biodiversité et d'écologie (IMBE UMR 7263), équipe biogénotoxicologie, santé humaine et environnement, faculté de médecine, Aix Marseille université, CNRS, IRD, université Avignon, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - J-M Grillo
- CECOS-laboratoire de biologie de la reproduction, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Centre clinico-biologique d'assistance médicale à la procréation, pôle de gynécologie obstétrique et reproduction (Gynépôle), Assistance publique-Hôpitaux de Marseille (AP-HM) la Conception, 13005 Marseille, France; Institut méditerranéen de biodiversité et d'écologie (IMBE UMR 7263), équipe biogénotoxicologie, santé humaine et environnement, faculté de médecine, Aix Marseille université, CNRS, IRD, université Avignon, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - I Sari-Minodier
- Service de médecine et santé au travail, pôle de santé publique, Assistance publique-Hôpitaux de Marseille (AP-HM) la Timone, 13005 Marseille, France; Institut méditerranéen de biodiversité et d'écologie (IMBE UMR 7263), équipe biogénotoxicologie, santé humaine et environnement, faculté de médecine, Aix Marseille université, CNRS, IRD, université Avignon, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France.
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12
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Greco F, Courbière B, Rose J, Orsière T, Sari-Minodier I, Bottero JY, Auffan M, Perrin J. Reprotoxicité des nanoparticules. ACTA ACUST UNITED AC 2015; 43:49-55. [DOI: 10.1016/j.gyobfe.2014.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/17/2014] [Indexed: 01/27/2023]
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13
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Dinelli L, Courbière B, Achard V, Jouve E, Deveze C, Gnisci A, Grillo JM, Paulmyer-Lacroix O. Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles. Fertil Steril 2014; 101:994-1000. [PMID: 24534285 DOI: 10.1016/j.fertnstert.2014.01.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify the prognostic factors for pregnancy after intrauterine insemination with the husband's sperm (IUI-H). DESIGN Retrospective study. SETTING A single university medical center. PATIENT(S) 851 couples, for 2,019 IUI-H cycles. INTERVENTION(S) After controlled ovarian stimulation, IUI-H performed 36 hours after ovulation triggering or 24 hours after a spontaneous luteinizing hormone (LH) surge. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate per cycle (PR) and delivery rate per cycle (DR). RESULT(S) The overall PR was 14.8% and DR 10.8%. Higher PR and DR were observed for patients presenting with ovulation disorders (particularly polycystic ovary syndrome) or with male infertility. Secondary infertility in the woman appeared to be a positive prognostic factor as did a basal follicle-stimulating hormone (FSH) level ≤ 7 IU/L and ovulation triggering over spontaneous LH rise. The other parameters influencing the results were the women's age, the number of mature follicles obtained (≥ 2), the endometrial thickness (10-11 mm), and the number of progressive motile spermatozoa inseminated (>1 million). CONCLUSION(S) In women aged ≤ 38 years, IUI-H should be considered as an option, particularly in cases of female infertility from ovulation disorders, in cases of a normal ovarian reserve, in cases of secondary infertility, or when ≥ 1 million progressive sperm are inseminated. Bifollicular stimulation is required. In other cases, in vitro fertilization should be discussed as the first-line treatment.
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Affiliation(s)
- Laka Dinelli
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France
| | - Blandine Courbière
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France; IMBE, Biogénotoxicologie, Santé Humaine & Environnement UMR 6116, Aix-Marseille Université, Marseille FR CNRS 3098, ECCOREV, Aix-en-Provence, France
| | - Vincent Achard
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France; Department of Histology-Embryology, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Elisabeth Jouve
- CIC-CPCET, Data Management and Biostatistics, AP-HM, Marseille, France
| | - Carole Deveze
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France
| | - Audrey Gnisci
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France
| | - Jean-Marie Grillo
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France; Department of Histology-Embryology, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Odile Paulmyer-Lacroix
- Department of Gynecology-Obstetric and Reproduction, Gynepôle, AP-HM La Conception, Marseille, France; Department of Histology-Embryology, Faculty of Medicine, Aix-Marseille University, Marseille, France.
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Ramiandrasoa C, Castinetti F, Raingeard I, Fenichel P, Chabre O, Brue T, Courbière B. Delayed diagnosis of Sheehan's syndrome in a developed country: a retrospective cohort study. Eur J Endocrinol 2013; 169:431-8. [PMID: 23864341 DOI: 10.1530/eje-13-0279] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Little is known about Sheehan's syndrome (SS), even though it is believed that its incidence is low. The aims of this study were to determine the clinical features and diagnostic delay of SS and to ascertain whether early signs could have allowed earlier diagnosis. SUBJECTS AND METHODS All patients with SS diagnosed in reference units in the southeast of France between 1980 and 2011 were recruited for this study. Data on obstetrical history, clinical symptoms suggestive of hypopituitarism, early signs, hormone analysis, and magnetic resonance imaging were collected. RESULTS Of the 40 women found to have SS, 39 were studied. Mean delay in the diagnosis of SS was 9 ± 9.7 years. We found that four of the 35 assessable patients were diagnosed with agalactia, 16 of the 29 assessable ones with amenorrhea, 19 of the 39 with hypothyroidism, eight with acute adrenal insufficiency, and 15 with asthenia. Among the patients for whom there was a diagnostic delay of more than 1 year (n=28), seven had headaches during the postpartum period, all assessable patients had agalactia, six of the 22 assessable ones had amenorrhea, seven of 28 had hypothyroidism, and 12 of 28 had asthenia. CONCLUSION Most signs of SS are aspecific and classical signs such as agalactia and amenorrhea are often difficult to detect, which can explain the long diagnostic delay. We suggest that all women failing to lactate after postpartum hemorrhage (PPH) should be evaluated by measuring prolactin levels and women with signs such as amenorrhea and asthenia, even several years after PPH, should undergo a blood test including assessment of thyroxine, TSH, 0800 h ACTH-cortisol, and IGF1 levels.
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Affiliation(s)
- Cynthia Ramiandrasoa
- Department of Gynaecology, Obstetrics and Reproduction, AP-HM La Conception, 147 boulevard Baille, 13005 Marseille, France
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15
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Saias-Magnan J, Perrin J, Metzler-Guillemain C, Delotte J, Courbière B, Fatfouta I, Lattes S, Grillo JM, Thibault E. Préservation de la fertilité masculine. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2286-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Delotte J, Thibault E, Fatfouta I, Saias-Magnan J, Pibarot M, Courbière B. Préservation de la fertilité féminine en oncologie. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Préaubert L, Poggi P, Pibarot M, Delotte J, Thibault E, Saias-Magnan J, Courbière B. [Fertility preservation among patients with cancer: report of a French regional practical experience]. ACTA ACUST UNITED AC 2013; 42:246-51. [PMID: 23453919 DOI: 10.1016/j.jgyn.2013.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/02/2013] [Accepted: 01/23/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Improvement in cancer treatments has led to reconsider the importance of quality of life after cancer, especially concerning maintening the potential of fertility since it is often altered after healing. Our objective was to estimate the knowledge and practices of the physicians in the field of Oncology in a French Region (Provence Alpes- Côte d'Azur). PATIENTS AND METHOD Prospective survey, conducted between January and April 2012, amongst oncologists working in Provence Alpes Côte d'Azur region, through questionnaires distributed during multidisciplinary meetings in oncology. RESULTS Among 225 replies, 54% of the physicians had sent no patient to any oncofertility consultation during the previous six months (n=120). Besides, 33% of the oncologists (n=68) declared they had difficulties in addressing their patients to oncofertility consultation, and 58% of them (n=39) considered they lacked information on techniques and indications of fertility preservation. CONCLUSION This study provides an estimation of the current practices in PACA region concerning oncofertility and underlines the physicians' need of information. In this context, the regional oncology network has set up a regional network « cancer and fertility » in order to facilitate the access to fertility preservation prior to any potentially sterilizing treatment for all patients.
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Affiliation(s)
- L Préaubert
- Pôle de gynécologie-obstétrique et reproduction (Pr-Gamerre), hôpital de La Conception, AP-HM, 147, boulevard Baille, 13385 Marseille, France.
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Geoffroy-Siraudin C, Loundou AD, Romain F, Achard V, Courbière B, Perrard MH, Durand P, Guichaoua MR. Decline of semen quality among 10 932 males consulting for couple infertility over a 20-year period in Marseille, France. Asian J Androl 2012; 14:584-90. [PMID: 22522503 DOI: 10.1038/aja.2011.173] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille (France) between 1988 and 2007. After 3-6 days of abstinence, semen samples were collected. Measurements of seminal fluid volume, pH, sperm concentration, total sperm count, motility and detailed morphology of spermatozoa were performed. Sperm parameters were analysed on the entire population and in men with normal total numeration (≥40 million per ejaculate). The whole population demonstrated declining trends in sperm concentration (1.5% per year), total sperm count (1.6% per year), total motility (0.4% per year), rapid motility (5.5% per year) and normal morphology (2.2% per year). In the group of selected samples with total normal sperm count, the same trends of sperm quality deterioration with time were observed. Our results clearly indicate that the quality of semen decreased in this population over the study period.
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Desparoir A, Capelle M, Banet J, Noizet A, Gamerre M, Courbière B. Does the experience of the provider affect pregnancy rates after embryo transfer? J Reprod Med 2011; 56:437-443. [PMID: 22010530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To study the influence of provider experience in a university hospital where resident physicians need to learn how to perform embryo transfer (ET). STUDY DESIGN A cohort prospective study was conducted in a tertiary care university medical center between March 2008 and August 2009. A total of 443 women undergoing fresh ET after in vitro fertilization were studied. ET with Frydman catheter or tight difficult transfer (TDT), conducted by three groups of providers of varying experience were studied: attending physicians with > 20 years of experience, assistant physicians with 2-5 years of experience and resident physicians with < 6 months of experience. The main outcomes were clinical pregnancy and implantation rates. RESULTS The provider's experience had an impact on the pregnancy rate: 29.9% for attending physicians, 28.2% for assistant physicians and 19.1% for resident physicians (p < 0.05). Resident physicians used TDT catheter more often than attending physicians: 42% vs. 21.3% (p < 0.05). CONCLUSION Resident physicians must be better monitored to avoid the lower pregnancy rates. ET should be further standardized. In this study, the ET protocol was modified in our assisted reproductive technology unit.
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Affiliation(s)
- Anne Desparoir
- Department of Gynecology and Obstetrics, Unit of Reproductive Medicine, CHU La Conception, 147 Boulevard Baille, 13005 Marseille Cedex, France.
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Perrin J, Tassistro V, Paulmyer-Lacroix O, Courbière B, Botta A, Sari-Minodier I. In smokers, swim-up and discontinuous gradient centrifugation recover spermatozoa with equally lower amounts of DNA damage than spermatozoa obtained from neat semen. Fertil Steril 2011; 95:2680-2. [DOI: 10.1016/j.fertnstert.2011.04.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 04/27/2011] [Accepted: 04/28/2011] [Indexed: 11/24/2022]
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Berthelot-Ricou A, Lacroze V, Courbière B, Guidicelli B, Gamerre M, Simeoni U. Morbidité respiratoire des nouveau-nés, de 34 a 37 SA, issus de césariennes avant travail. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70959-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Courbière B, Baudot A, Mazoyer C, Salle B, Lornage J. La vitrification : technique d’avenir pour la cryoconservation ovarienne ? Bases physiques de cryobiologie, avantages et limites. ACTA ACUST UNITED AC 2009; 37:803-13. [DOI: 10.1016/j.gyobfe.2009.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 07/15/2009] [Indexed: 11/29/2022]
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Provansal M, Courbière B, Estrade JP, Agostini A, Gamerre M. Torsion tubaire isolée : à propos de trois cas. ACTA ACUST UNITED AC 2008; 36:173-175. [DOI: 10.1016/j.gyobfe.2007.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Accepted: 12/05/2007] [Indexed: 10/22/2022]
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Courbière B, Agostini A, Cravello L, Gamerre M. Comment je fais… pour réaliser une ovariectomie pour cryoconservation ovarienne en vue d'une autogreffe orthotopique de cortex ovarien. ACTA ACUST UNITED AC 2007; 35:684-5. [PMID: 17596990 DOI: 10.1016/j.gyobfe.2007.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 05/24/2007] [Indexed: 10/23/2022]
Affiliation(s)
- B Courbière
- Service de Gynécologie-Obstétrique et Centre d'Assistance Médicale à la Procréation (AMP), Hôpital de La Conception, 147 Boulevard Baille, 13385 Marseille cedex 05, France.
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Bretelle F, Provansal M, Courbière B, Mazouni C. [Management of placenta accreta. Gynecol Obstet Fertil 2007;35:186-92]. Gynecol Obstet Fertil 2007; 35:710. [PMID: 17573225 DOI: 10.1016/j.gyobfe.2007.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Bretelle F, Courbière B, Mazouni C, Agostini A, Cravello L, Boubli L, Gamerre M, D'Ercole C. Management of placenta accreta: Morbidity and outcome. Eur J Obstet Gynecol Reprod Biol 2007; 133:34-9. [PMID: 16965851 DOI: 10.1016/j.ejogrb.2006.07.050] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 07/17/2006] [Accepted: 07/18/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate our results in the management of placenta accreta. STUDY DESIGN In a retrospective study we reviewed cases of placenta accreta diagnosed in two university teaching hospitals between 1993 and 2003. For a subgroup of patients a conservative approach was attempted. In this procedure placenta was left in place until spontaneous resorption. RESULTS Fifty cases (0.12%) of placenta accreta were observed in 41, 119 deliveries during the study period. Of the 50 cases, 24 patients (48%) were managed by the standard approach and 26 patients (52%) underwent conservative treatment. Additional surgical or medical treatment was performed in 35 of the 50 patients (70%). There was no maternal death. Overall hysterectomy rate was 40%, 10 patients were transferred to intensive care unit (20%), 7 had fever (14%), 5 had endometritis (10%) and 19 patients had blood transfusion (38%). Conservative treatment did not lead to hysterectomy in 21 cases (80.7%) and failed in 5 (19.3%). During the follow-up period, 3 women had successful pregnancy. CONCLUSION Analysis of management of placenta accreta shows that for a subgroup of selected patients a conservative approach could preserve subsequent fertility without evident increase in morbidity.
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Affiliation(s)
- Florence Bretelle
- Department of Obstetrics and Gynecology, Conception Hospital, University of Mediterranee, Pr Gamerre, Marseille, France.
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Courbière B, Provansal M, Saias-Magnan J, Guillemain C, Noizet A, Grillo JM, Gamerre M. [What are at present the real hopes of pregnancy after ovarian cryopreservation?]. ACTA ACUST UNITED AC 2007; 35:666-77. [PMID: 17590374 DOI: 10.1016/j.gyobfe.2007.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Accepted: 05/16/2007] [Indexed: 11/19/2022]
Abstract
Survival rates for cancers that occur in childhood and adolescence have improved over the last decades, and preservation of future fertility in these patients has become a relevant issue. Premature ovarian failure is a consequence of exposing women to chemotherapeutic drugs and ionizing radiation. Ovarian cryopreservation is an alternative to cryopreservation of embryos or oocytes for theses patients. Ovarian cryopreservation aims to reimplant ovarian tissue after complete remission into the pelvic cavity (orthotopique site) or a heterotopic site like the abdominal wall or the forearm. In vitro folliculogenesis, that aims at the maturation of ovarian cortex primordial follicles cryopreserved for a FIV, is still in an experimental research stage. In this review, the objective was to evaluate the real hopes of pregnancy after ovarian cryopreservation. Indeed, many teams offer ovarian cryopreservation at present time, although only two pregnancies have been achieved to date. In both cases, it can be discussed whether the fertilized oocyte originated from the transplant or from the native ovary. Furthermore, the potential for reintroduction of cancerous cells may limit this technique in cancers that are known to have a risk of ovarian dissemination. The hopes engendered by ovarian cryopreservation, but also its limits, must be explained to the patients before an ovarian surgery for cryopreservation.
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Affiliation(s)
- B Courbière
- Service de Gynécologie-Obstétrique et Centre d'Assistance Médicale à la Procréation (AMP), Hôpital de La Conception, 147 Boulevard Baille, 13385 Marseille cedex 05, France.
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Lornage J, Courbière B, Mazoyer C, Odagescu V, Baudot A, Bordes A, Poirel MT, Franck M, Salle B. [Ovarian tissue vitrification: Cortex and whole ovary in sheep]. ACTA ACUST UNITED AC 2006; 34:746-53. [PMID: 16962812 DOI: 10.1016/j.gyobfe.2006.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 07/26/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate a cryopreservation technique by vitrification of cortex or whole ovaries in sheep, using two cryoprotectant solutions: VS1 and VS4 and to study their physical properties to avoid ice crystallisation by vitrification of whole sheep ovaries permeated with a cryoprotectant solution. ANIMALS AND METHODS From 6-month-old ewes, whole sheep ovaries with their vascular pedicles were collected at the slaughterhouse or at the veterinary school and prepared for cryoprotectant toxicity tests and freezing procedure. Follicle viability was measured by trypan blue test and histological examination of ovary. The hemi-ovarian cortex was stored in liquid nitrogen. Four to six weeks after the first laparotomy, the controlateral ovary was removed and the vitrified-warmed hemi-ovary was sutured. Thermal properties of a cryoprotectant solution called VS4 (critical cooling rates [Vccr], vitreous transition temperature [Tg], end of melting temperature [Tm]) were measured by differential scanning calorimetry. RESULTS No significant difference in follicle viability or normal follicle rates was observed between ovarian cortex exposed or non-exposed to cryoprotectant solutions. Nor was any significant difference observed before and after vitrification. Three pregnancies occurred, from which four lambs were born after autografts of vitrified ovarian cortex. With whole ovary, the decrease in the number of normal follicles was lower when frozen-thawed ovaries were treated with VS4 (P = 0.04). There were less nuclear anomalies (P = 0.02). The Vccr of VS4 has been estimated to be 14.3+/-1.1 degrees C/min and Tg was -125.0+/-0.2 degrees C. Because the penetration of cryoprotectants was very low, Vccr was very high and the cooling speed did not allow cortex to vitrify. DISCUSSION AND CONCLUSIONS Cryopreservation of cortex or whole ovary by vitrification seems a promising technique in reproductive medicine. The best histologic results were obtained with the VS4 cryoprotectant when whole ovary was vitrified.
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Affiliation(s)
- J Lornage
- Unité Inserm 418, hôpital Debrousse, 29, rue Soeur-Bouvier, 69322 Lyon cedex 05, France.
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Courbière B, Porcu G, Saias-Magnan J, Guillemain C, Noizet A, Michel G, Grillo JM, Gamerre M. [Ovarian cryopreservation: clinical and ethical problems arisen further to study on cases of ovarian cryopreservation]. Gynecol Obstet Fertil 2006; 34:607-14. [PMID: 16798049 DOI: 10.1016/j.gyobfe.2006.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 05/18/2006] [Indexed: 05/10/2023]
Abstract
OBJECTIVE An early ovarian failure and sterility, on patients often still young, may result from some of the anticancerous treatments. Ovarian cryopreservation is a research way for fertility restoration on patients who will have gonadotoxic treatment. The aim of our work was to study the cases of ovarian tissue preserved in our Department, enabling us to assess the clinical and ethical problems of this technique. PATIENTS AND METHODS A retrospective study was conducted from January 2001 onwards up to October 2005, on 14 patients, whose ovarian cortex was frozen our the University Fertility Center (Hôpital de la Conception, Marseille, France). RESULTS In our study, the patients' average age was 17+/-5.5 and the median was 14 years [13-24]. Eight patients were under 18 (11+/-3-years-old). The cryopreservation indications were especially haematological (N = 9). More than half of the patients (N = 8) had undergone a gonadotoxic treatment before ovarian cryopreservation. DISCUSSION AND CONCLUSION Ovarian cryopreservation is still a recent technology in reproductive medicine. The future of ovarian tissue after thawing, with its different techniques of autograft, is still not consensual. Experimental research remains essential to improve the freezing protocols and ovarian transplant in human medicine.
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Affiliation(s)
- B Courbière
- Centre d'Assistance médicale à la procréation, hôpital de la Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France.
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Shojai R, Desbrière R, Dhifallah S, Courbière B, Ortega D, d'Ercole C, Boubli L. Le misoprostol par voie rectale dans l'hémorragie de la délivrance. ACTA ACUST UNITED AC 2004; 32:703-7. [PMID: 15380748 DOI: 10.1016/j.gyobfe.2004.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 05/24/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate a post-partum hemorrhage treatment guideline, using rectally administered misoprostol. PATIENTS AND METHODS A descriptive study was carried out in a tertiary referral center from January 2002 to March 2003. During this period, 2670 patients delivered and 41 (1.5%) with severe post-partum hemorrhage unresponsive to oxytocin received 1000 microg of misoprostol (five tablets) rectally while awaiting sulprostone. Twenty-eight had delivered by the vaginal route and 13 by cesarean section. RESULTS Hemorrhage was controlled among 63% (26/41) of the patients within 10 min of the administration of rectal misoprostol. Fifteen (37%) patients received both misoprostol and sulprostone and no major adverse effects were noted when combining these two prostaglandins. Overall, hemorrhage was controlled among 87% (36/41) of the patients when oxytocics were combined with misoprostol and sulprostone. Five patients (12%) did not respond to the combination of uterotonics and required a conservative surgical treatment. DISCUSSION AND CONCLUSION Rectal misoprostol may be an effective second line treatment for the management of post-partum hemorrhage unresponsive to oxytocin. We did not observe major side effects when combining misoprostol with sulprostone. Our findings encourage further research on rectal misoprostol in the treatment of postpartum hemorrhage.
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Affiliation(s)
- R Shojai
- Service de gynécologie-obstétrique, CHU Nord, 15, chemin des Bourrely, 13015 Marseille, France.
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Courbière B, Bretelle F, Porcu G, Gamerre M, Blanc B. [Conservative treatment of placenta accreta]. J Gynecol Obstet Biol Reprod (Paris) 2003; 32:549-54. [PMID: 14593301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Examination of modalities and results of conservative treatment of placenta accreta. MATERIAL AND METHOD Ten-year hospital records were reviewed, with analysis of patients who had diagnosis of placenta accreta associated with conservative treatment. RESULTS During the study period, 21259 deliveries were registered, with an incidence of placenta accreta of 1 per 1 000 deliveries (n=23). Conservative treatment was applied in 13 patients. All of them had factors commonly associated with placenta accreta: prior cesarean sections (7/13), prior curettage or endouterine surgery (11/13), placenta praevia (11/13). Antenatal diagnosis was performed in only 64% of the cases (n=7). In our conservative strategy, placenta accreta was always left in situ, with an associated treatment in most of cases (n=10): Bilateral hypogastric artery ligation (n=7), medical treatment with methotrexate (n=5), uterine artery embolization (n=2). There was no case of maternal mortality. Conservative treatment was successful in 11 patients. It failed in 2 cases: hysterectomy was performed in one case for life-threatening hemorrhage, and in the other case for post-embolization uterine necrosis. The morbidity described was blood transfusion (n=7), endometritis (n=1), and one late hemorrhage with expelling necrotic tissue. Afterwards, 2 women became pregnant: one miscarriage and one normal term delivery. CONCLUSION Conservative treatment of placenta accreta appears to be a efficient way to preserve fertility. Antepartum diagnosis should be improved among patients with a high risk of placenta accreta in order to optimize conservative strategy.
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Affiliation(s)
- B Courbière
- Service de Gynécologie-Obstétrique, CHU La Conception, 147, boulevard Baille, 13385 Marseille Cedex
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Porcu G, Courbière B, Sakr R, Carcopino X, Gamerre M. Spontaneous rupture of a first-trimester gravid uterus in a woman exposed to diethylstilbestrol in utero. A case report. J Reprod Med 2003; 48:744-6. [PMID: 14562644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Poor reproductive outcome was well documented in several studies of women exposed to diethylstilbestrol in utero. Spontaneous rupture of an unscarred uterus is rare and very uncommon in the first trimester of pregnancy. CASE Spontaneous rupture of the uterus was diagnosed in a 28-year-old nullipara who developed acute abdominal pain at 12 weeks' gestation. She was known to have been exposed to diethylstilbestrol in utero. Laparotomy revealed the rupture in the anterior fundal area of the uterus. Both tubes were normal. CONCLUSION Several spontaneous ruptures have been described, but this is the first case of first-trimester spontaneous rupture of an unscarred uterus in a diethylstilbestrol-exposed woman.
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Affiliation(s)
- Géraldine Porcu
- Department of Obstetrics and Gynecology, Hôpitaux de Marseille, Marseille, France.
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