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Morel O, Brun JL, Huissoud C, Belaisch-Allart J. [Medical demography: Maternities are in danger. How to prepare for the future?]. Gynecol Obstet Fertil Senol 2022; 50:567-569. [PMID: 35752389 DOI: 10.1016/j.gofs.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Indexed: 06/15/2023]
Affiliation(s)
- O Morel
- Pôle de gynécologie-obstétrique, CHRU de Nancy,10 rue Heydenreich, 54000 Nancy, France.
| | - J-L Brun
- Service de chirurgie gynécologique, centre Aliénor-d'Aquitaine, CHU de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - C Huissoud
- Service de gynécologie-obstétrique de La Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4-Villes, rue Lauer, 92210 Saint-Cloud, France
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Belaisch-Allart J. [The new Bioethics law in France]. Gynecol Obstet Fertil Senol 2021; 49:649-650. [PMID: 34488990 DOI: 10.1016/j.gofs.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Affiliation(s)
- M Dap
- Pôle de gynécologie obstétrique, maternité universitaire, CHRU de Nancy, Nancy, France
| | - C Bertholdt
- Pôle de gynécologie obstétrique, maternité universitaire, CHRU de Nancy, Nancy, France
| | - J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4 villes Saint-Cloud, Saint-Cloud, France
| | - C Huissoud
- Maternité de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - O Morel
- Pôle de gynécologie obstétrique, maternité universitaire, CHRU de Nancy, Nancy, France.
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Belaisch-Allart J. [J. Belaisch-Allart in answer to the article by D. Raudrant, P. Madelenat and B. Salle: "Uterus transplant or gestational surrogact: Is there a possible choice?". Gynecol Obstet Fertil Senol 2018; 46:385-387]. ACTA ACUST UNITED AC 2018; 46:615. [PMID: 29908839 DOI: 10.1016/j.gofs.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Indexed: 10/28/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4-Villes, rue Lauer, 92210 Saint-Cloud, France.
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Belaisch-Allart J. [Oocyte cryopreservation: Why the National Consultative Ethics Committee (CCNE) is wrong]. ACTA ACUST UNITED AC 2017; 45:582-583. [PMID: 29100821 DOI: 10.1016/j.gofs.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 11/27/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4-Villes, rue Lauer, 92210 Saint-Cloud, France.
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Belaisch-Allart J, Ouazana M, Bailly M, Selva J, Kulski O, Boitrelle F. Âge du père en assistance médicale à la procréation : faut-il une limite ? ACTA ACUST UNITED AC 2016; 44:712-715. [DOI: 10.1016/j.gyobfe.2016.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
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Belaisch-Allart J, Maget V, Mayenga JM, Grefenstette I, Chouraqui A, Belaid Y, Kulski O. [Infertility over forty: Pros and cons of IVF]. Gynecol Obstet Fertil 2015; 43:599-603. [PMID: 26297163 DOI: 10.1016/j.gyobfe.2015.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The population attempting pregnancy and having babies is ageing. The declining fertility potential and the late age of motherhood are increasing significantly the number of patients over forty consulting infertility specialists. Assisted reproductive technologies (ART) cannot compensate the natural decline in fertility with age. In France, in public hospital, ART is free of charge for women until 43 years, over 43, social insurance does not reimburse ART. Hence, 43 years is the usual limit, but between 40 and 42 is ART useful? The answer varies according to physicians, couples or society. On medical level, the etiology of the infertility must be taken into account. If there is an explanation to infertility (male or tubal infertility) ART is better than abstention. If the infertility is only due to age the question is raised. In France, the reimbursement by the society of a technique with very low results is discussed. However efficacy is not absolutely compulsory in Medicine. On the opposite to give false hopes may be discussed too. To obtain a reasonable consensus is rather difficult.
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Affiliation(s)
- J Belaisch-Allart
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France.
| | - V Maget
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France
| | - J-M Mayenga
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France
| | - I Grefenstette
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France
| | - A Chouraqui
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France
| | - Y Belaid
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France
| | - O Kulski
- Centre hospitalier des 4 Villes, rue Lauer, 92210 Saint-Cloud, France
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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4 Villes, site de Sèvres, 141, Grande-Rue, 92318 Sèvres cedex, France.
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Conard J, Belaisch-Allart J, Creusvaux H, Galanaud J, Lamy C, Laporte S, Larue L, Merlet F, Mottier D, Pariente-Khayat A, Plu-Bureau G. C0575: Guidelines for the Prevention of Arterial and Venous Thrombosis During Assisted Reproductive Technologies. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50105-3] [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: 10/25/2022]
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Belaisch-Allart J, Brzakowski M, Chouraqui A, Grefenstette I, Mayenga JM, Muller E, Belaid Y, Kulski O. [Social egg freezing: which problems?]. ACTA ACUST UNITED AC 2013; 41:518-20. [PMID: 23972923 DOI: 10.1016/j.gyobfe.2013.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 06/02/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
In today's society, many women push pregnancy further away from the "right" childbearing age. Assisted reproduction, except egg donation, is unable to fully overcome the effect of age on fertility loss. The effectiveness of oocyte vitrification is demonstrated, and oocyte vitrification is allowed in the French Bioethics law of 2011. In the French law, oocyte' s cryopreservation is proposed to oocyte donors without child. Social egg freezing for non-medical reason is already legal in some countries, but leads to new debates and discussions.
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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4-Villes, site de Sèvres, 141, Grande-Rue, 92318 Sèvres cedex, France.
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Grzegorczyk-Martin V, Mayenga JM, Kulski O, Belaid Y, Grefenstette I, Belaisch-Allart J. Préparation endométriale chez les receveuses dans un programme de don d’ovocytes. ACTA ACUST UNITED AC 2012; 40:507-10. [DOI: 10.1016/j.gyobfe.2012.07.013] [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] [Received: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 11/29/2022]
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Ballester M, d'Argent EM, Morcel K, Belaisch-Allart J, Nisolle M, Darai E. Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study. Hum Reprod 2012; 27:1043-9. [DOI: 10.1093/humrep/des012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Caballero P, Alonso J, Cortes S, Caballero Campo M, Gago M, Nunez-Calonge R, Ricciarelli E, Gomez Palomares JL, Bruna Catalan I, Hernandez ER, Grzegorczyk-Martin V, Belaisch-Allart J, Mayenga JM, Kulski O, Plachot M, Darby HC, Florensa Bargallo M, Perals Vazquez N, Esbert Algam M, Belles Fernandez M, Ballesteros Boluda A, Calderon de Oya G, Alegre de Miquel M, Choudhary M, Ramineni A, Stewart J, Cabello Y, Ricciarelli E, Fernandez-Shaw S, Mercader A, Herrer R, Arroyo G, Del Rio F, Carrera M, Fernandez Sanchez M, Sumimoto T, Kataoka N, Ogata H, Mizuta S, Tokura Y, Yamada S, Ogata S, Mizusawa Y, Matsumoto Y, Okamoto E, Kokeguchi S, Shiotani M, Nagai Y, Otsuki J, Maeda K, Momma Y, Takahashi K, Chuko M, Miwa A, Nagai A, Seggers J, Haadsma ML, La Bastide-van Gemert S, Heineman MJ, Kok JH, Middelburg KJ, Roseboom TJ, Schendelaar P, Van den Heuvel ER, Hadders-Algra M, Schendelaar P, Hadders-Algra M, Heineman MJ, Jongbloed-Pereboom M, La Bastide-Van Gemert S, Middelburg KJ, Van den Heuvel ER, Heineman KR, Schendelaar P, Middelburg KJ, Bos AF, Heineman MJ, Kok JH, La Bastide-Van Gemert S, Seggers J, Van den Heuvel ER, Hadders-Algra M, Kondapalli LA, Shaunik A, Molinaro TA, Ratcliffe SJ, Barnhart KT, Haadsma M, Seggers J, Bos AF, Heineman MJ, Keating P, Middelburg KJ, Van Hoften JC, Veenstra-Knol HE, Kok JH, Cobben JM, Hadders-Algra M, Pirkevi C, Atayurt Z, Yelke H, Kahraman S, Desmyttere S, Verpoest W, Haentjens P, Verheyen G, Liebaers I, Bonduelle M, Winter C, Van Acker F, Desmyttere S, De Schrijver F, Bonduelle M, Nekkebroeck J, Pariente-Khayat A, de Laubier A, Fehily D, Lemardeley G, Merlet F, Creusvaux H, Nakajo Y, Sakamoto E, Doshida M, Toya M, Nasu I, Kyono K, Schats R, Vergouw CG, Kostelijk EH, Doejaaren E, Hompes PGA, Lambalk CB, Nakamura Y, Takisawa T, Shibuya Y, Sato Y, Sato K, Kyono K, Berard A, Chaabane S, Sheehy O, Blais L, Fraser W, Bissonnette F, Monnier P, Tan SL, Trasler J, Subramaniam A, Chiappetta R, Mania A, Trew G, Lavery SA, van den Akker O, Purewal S, Bunnell C, Lashen H, Terriou P, Giorgetti C, Porcu-Buisson G, Roger V, Chinchole JM, Hamon V, Allemand-Sourieu J, Cravello L, Moreau J, Chabert-Orsini V, Belva F, Roelants M, De Schepper J, Roseboom TJ, Bonduelle M, Devroey P, Painter RC, Machin L, Fearon K, Morishima K, Fujimoto A, Oishi H, Hirata T, Harada M, Hasegawa A, Osuga Y, Yano T, Kozuma S, Taketani Y. QUALITY AND SAFETY OF ART THERAPIES. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.86] [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: 11/14/2022] Open
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Mayenga JM, Grzegorczyk Martin V, Belaisch-Allart J. Place actuelle du drilling ovarien dans la prise en charge du syndrome des ovaires polykystiques (SOPK). ACTA ACUST UNITED AC 2011; 39:518-20. [DOI: 10.1016/j.gyobfe.2011.07.007] [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] [Received: 06/17/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022]
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Abstract
Advanced maternal age, obesity and cigarette smoking are associated with decreased fertility, adverse Assisted Reproductive Technologies (ART) outcomes and fetal and neonatal complications. IVF failures increase dramatically in women aged between 42-43 years. Advanced paternal age is associated with fetal and neonatal adverse outcomes. However, it remains uncertain that advanced paternal age could impair IVF results. Obesity (Body mass index more than 30 kg/m(2)) is associated with lower fecundity, pregnancy complications and adverse ART results. The rate of complications is increasing with higher BMI. Cigarette smoking is associated with longer time to conceive and decreased IVF results. In case of infertility associated with obesity or cigarette smoking, physicians have to inform their patient about the benefits of smoking cessation and weight loss. However, maternal age had to be considered as the main prognosis factor before delaying ART because of dietary or smoking cessation program.
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Affiliation(s)
- C Dechanet
- Hôpital Arnaud de Villeneuve, Département de médecine de la reproduction, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier cedex, France.
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Belaisch-Allart J. [Saving embryo freezing]. Gynecol Obstet Fertil 2011; 39:191-192. [PMID: 21450509 DOI: 10.1016/j.gyobfe.2011.02.011] [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: 05/30/2023]
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Abstract
To elaborate guidelines for the use of different treatment and different protocols for ovarian stimulation. SEARCHED STRATEGY: We searched for all publications which described randomised controlled trial evaluating different ovarian stimulation protocols and different indications on PubMed, Medline and Cochrane Database. The keywords were: ovulation induction, citrate of clomiphene, gonadotropin, metformin, anti estrogens, anti aromatase, pulsatile GnRH administration, cancer, ovarian hyperstimulation, thrombosis, multiple pregnancies, and complications. Randomised controlled trials were first considered. Then was considered recent meta analysis and cohort study. We mentioned when literature was weak.
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Affiliation(s)
- L Jacquesson
- Centre de médecine de la reproduction, 17 rue de la Pompe, 75116 Paris, France.
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Amar-Hoffet A, Hédon B, Belaisch-Allart J. [Assisted reproductive technologies place]. J Gynecol Obstet Hum Reprod 2010; 39:S88-S99. [PMID: 21185490 DOI: 10.1016/s0368-2315(10)70034-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There are three kinds of infertility treatment: medical treatment, surgical treatment and assisted reproductive technology (ART). ART includes intra uterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). ART technologies made a lot of progress last years and their field of applications extended. Through literature reviews, IUI is recommended for unexplained infertility and discussed for male or cervical infertility. IVF is recommended for tubal and unexplained infertility. Limits between IVF and ICSI in case of male infertility remains unclear. In non mal infertility ICSI is not recommended.
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Affiliation(s)
- A Amar-Hoffet
- Hôpital Saint Joseph, Unité de médecine de la reproduction, 26 bd de Louvain, 13008 Marseille, France
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Cédrin-Durnerin I, Belaisch-Allart J, Avril C, Pouly JL. [Predictive factors of success in ovulation induction with recombinant FSH: results of Indigo study]. Gynecol Obstet Fertil 2010; 38:105-113. [PMID: 20106707 DOI: 10.1016/j.gyobfe.2009.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 12/14/2009] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Although ovulation induction is commonly used to treat infertility, few data are available concerning this treatment. Therefore, the aim of this prospective observational study was to describe medical practices and to identify predictive outcome factors of ovarian stimulation by recombinant FSH (r-hFSH), administrated with a self-injector pen. PATIENTS AND METHODS At the time of the prescription of ovarian stimulation followed by sexual intercourse (SI) or artificial insemination (HAI) with a normal husband sperm, 370 gynaecologists consecutively sent from January to November 2005, for a maximum of six patients (1398 patients in total), a form dealing with the assessment of infertility factors prior to stimulation (n=1340), then a monitoring form of the treated cycle (n=1227) and when a pregnancy was obtained, a follow-up form at 12 weeks of amenorrhea (n=254). Each patient had to complete an autoquestionnaire about the use of the pen (n=1044). RESULTS Seventy percent of the contributing gynaecologists had only a private practice. The mean age of patients was 31.9+/-4.8 years. Dealing with infertility exploration prior to stimulation, 9% did not have tubal assessment. Although it was the first stimulation attempt for 52% of cases, 91% of patients found the pen easy to manipulate. The mean duration of r-hFSH administration was 8.8+/-3.7 days and the mean daily dose was 75.4+/-29.4 IU. Ultrasound and hormonal monitoring was performed for 88% of patients. The cycle cancellation rate was 11%. The hCG administration was performed on cycle day 13+/-3. An HAI was programmed in 60% of patients and SI in 40%. The pregnancy rates for positive betahCG, ongoing and multiple pregnancies were, respectively, 22.7, 18 and 16% (twins 14%; 2% of triplets or more 2%). Three prognosis factors were independently related to ongoing pregnancy rate: age<35 years, previous pregnancy obtained by treatment and presence of ovulatory disorders. DISCUSSION AND CONCLUSION This observatory of ovarian stimulation out of FIV allowed to describe medical practices of gynaecologists: infertility assessment prior to ovarian stimulation, used FSH doses, ultrasound and hormonal monitoring, and it outlined three predictive factors of outcome: age, previous pregnancy obtained by treatment and presence of ovulatory disorders.
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Affiliation(s)
- I Cédrin-Durnerin
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93143 Bondy cedex, France.
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Rossin B, Pouly JL, Belaisch-Allart J, de Mouzon J. [Ovarian stimulation for IVF in France: choice and results according to protocols and gonadotrophin]. Gynecol Obstet Fertil 2009; 37:864-72. [PMID: 19833539 DOI: 10.1016/j.gyobfe.2009.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The study objective was to analyze the ovarian stimulation practice in Assisted Reproductive Technology (ART) in France, to determine the factors influencing this practice and to analyze its impact on ART results. MATERIALS AND METHODS The study included all the cycles forms transmitted by the centres to the Agence de la biomédicine on FIVNAT forms and then transmitted from the agency to FIVNAT. All cycles with missing data or inconsistencies on ovarian stimulation and spontaneous cycles were excluded, leaving 18,601 cycles for analysis. The protocols were classified in four groups: agonists with short protocol, with long protocol, antagonists and cycles without GnRH agonists. Gonadotropins were regrouped in four groups: recombinant FSH, urinary FSH, HMG, and association of FSH (urinary or recombinant) and HMG. RESULTS If the basal protocol usually combines GnRH agonists with long protocol and recombinant FSH, the study shows that some patients characteristics, particularly women's age, ovulation status and previous failures have a large influence on other choices for protocol (short protocol, antagonists) and gonadotropins. Concerning the impact on ART outcome, if short protocols remain associated to the worse results, there was little difference between long protocol and antagonists and according to the gonadotropin choice. DISCUSSION AND CONCLUSION This study allows to know better on ovarian stimulation practice in ART in France.
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Affiliation(s)
- B Rossin
- SMBR, hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France.
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Belaisch-Allart J, Merviel P, Frydman R, Bresson JL, Nicollet B, Jouannet P, Sedbon E, Le Lannou D, Montagut J, Hédon B, Barrière P, Nisand I, Lévy R, Pouly JL, Cohen-Bacrie P. Les professionnels et la révision des lois de bioéthique (compte rendu de la Journée d’experts du 1er octobre 2008). ACTA ACUST UNITED AC 2009; 37:104-8. [DOI: 10.1016/j.gyobfe.2008.12.007] [Citation(s) in RCA: 5] [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: 12/08/2008] [Indexed: 11/30/2022]
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Belaisch-Allart J, Mayenga JM, Grefenstette I, Chouraqui A, Serkine AM, Abirached F, Kulski O. [Single embryo transfer: is Scandinavian model valuable in France?]. ACTA ACUST UNITED AC 2008; 36:1151-7. [PMID: 18922732 DOI: 10.1016/j.gyobfe.2008.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 08/11/2008] [Indexed: 11/25/2022]
Abstract
The aim of infertility treatment is clearly to obtain one healthy baby. If the transfer of a top quality single embryo could provide a baby to all the patients, there would be no more discussion. The problem is that, nowadays, French pregnancy rates after fresh embryo or frozen embryo transfer are not the same as in Nordic countries. All studies show that in unselected patients, single embryo transfer decreases twin pregnancy rate but decreases pregnancy rate too. Pregnancy rate is dependent on embryo quality, women's age, rank of IVF attempt (clear data) but also on body mass index, ovarian reserve, smoking habits. All these data cannot be taken into account in a law. That is the reason why a flexible policy of transfer adapted to each couple is preferable. Each couple and each IVF team are unique and must keep the freedom to choose how many embryos must be transferred to obtain healthy babies, and to avoid twin pregnancies but without demonizing them.
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Affiliation(s)
- J Belaisch-Allart
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier des Quatre-Villes, Site de Sèvres, 92318 Sèvres cedex, France.
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Belaisch-Allart J, Mayenga JM, Grefenstete I, Mokdad A, Moumin H. [Premature ovarian failure: which approaches?]. ACTA ACUST UNITED AC 2008; 36:882-5. [PMID: 18657462 DOI: 10.1016/j.gyobfe.2008.06.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 06/18/2008] [Indexed: 11/25/2022]
Abstract
Premature ovarian failure (POF) occurs in one case of 10,000 in women below the age of 20, one case of 1000 below 30 and 1% in women before the age of 40. In 80% of POF cases, the etiology is unknown, except for Turner syndrome. Spontaneous fertility is very weak, only 3 to 10% of the patients will have natural conception. If the diagnosis is confirmed, ovarian stimulation usually fails. When fertility is desired, the alternative treatments are oocyte and/or embryo donation or adoption and "learn to be happy just in couple". Psychological management is always necessary.
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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier des Quatre-Villes, Site-de-Sèvres, 141, Grande-Rue, 92318 Sèvres cedex, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et médecine de la reproduction humaine, centre hospitalier des Quatre-Villes, CHI Jean-Rostand, site de Sèvres, 141, Grande-Rue, 92318 Sèvres cedex, France.
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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?]. Gynecol Obstet Fertil 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et médecine de la reproduction, CHI Jean-Rostand, centre hospitalier des Quatre-Villes, site de Sèvres, 141, Grande-Rue, 92311 Sèvres cedex, France.
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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et de reproduction humaine, CHI Jean-Rostand, centre hospitalier des Quatre-Villes, site de Sèvres, 141, Grande-Rue, 92318 Sèvres Cedex, France.
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHI Chaville, Saint-Cloud, Sèvres, Ville-d'Avray, 141, Grande-Rue, 92318 Sèvres cedex, France.
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et reproduction humaine, CHI de Chaville, Saint-Cloud, Sèvres, Ville d'Avray, site de Sèvres, 141, Grande-Rue, 92318 Sèvres cedex, France.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- J Belaisch-Allart
- Service de Gynécologie-Obstétrique et Reproduction Humaine, CHI Jean-Rostand, Sèvres, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- C B Lambalk
- Department of Reproductive Medicine, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands, and Civic Parkdale Clinic, Ottawa, Ontario, Canada.
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Belaisch-Allart J. [Ovarian endometrioma and infertility: when not to treat?]. Gynecol Obstet Fertil 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] [What about the content of this article? (0)] [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....]. J Gynecol Obstet Biol Reprod (Paris) 2005; 34:5S18-5S21. [PMID: 16340898] [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: 05/05/2023]
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et reproduction humaine, CHI Jean-Rostand, 141, Grande-Rue, 92318 Sèvres cedex, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et reproduction humaine, CHI Jean-Rostand, 141, Grande-Rue, 92318 Sèvres cedex, France.
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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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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et reproduction humaine, CHI Jean-Rostand, 141, Grande-Rue, 92311 Sèvres cedex, France.
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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]. Gynecol Obstet Fertil 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] [What about the content of this article? (0)] [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]. J Gynecol Obstet Biol Reprod (Paris) 2005; 34 Spec No 1:3S112-8. [PMID: 15980779] [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: 05/03/2023]
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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Affiliation(s)
- J de Mouzon
- INSERM U569, Hôpital de Bicêtre, 82, rue du Général-Leclerc, 94276 Le Kremlin-Bicêtre
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- M-C Amour
- Service de gynécologie-obstétrique, CHI Jean-Rostand, 141, Grande-Rue, 92311 Sèvres, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- J Belaisch-Allart
- FIVNAT, CHU Bicêtre, 82, avenue du Général Leclerc, 94276 Le Kremlin-Bicêtre, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J-M Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, 4, rue de la Chine, 75970 Paris cedex 20, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- B Simon-Bouy
- Laboratoire SESEP, Université de Versailles, Versailles, France.
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48
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- B Simon-Bouy
- Laboratoire SESEP, université de Versailles, 45, avenue des Etats-Unis, 78000 Versailles, France.
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Belaisch-Allart J. [A law to limit embryo transfer in ART?]. Gynecol Obstet Fertil 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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique, CHI Jean-Rostand, Sèvres, France.
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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]. Gynecol Obstet Fertil 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- J Féghali
- Service de gynécologie-obstétrique, centre hospitalier intercommunal Jean-Rostand, 141, Grande-Rue, 92318 cedex, Sèvres, France
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