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Hesters L, Sermondade N, Lambert C, Pouly JL, Pereira B, Lucas C, Levy R, Brugnon F. Is large for gestational age in singletons born after frozen embryo transfer associated with freezing technique or endometrial preparation protocol? A longitudinal national French study. Hum Reprod 2024; 39:724-732. [PMID: 38384249 DOI: 10.1093/humrep/deae027] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 01/28/2024] [Indexed: 02/23/2024] Open
Abstract
STUDY QUESTION Is large for gestational age (LGA) observed in babies born after frozen embryo transfer (FET) associated with either the freezing technique or the endometrial preparation protocol? SUMMARY ANSWER Artificial cycles are associated with a higher risk of LGA, with no difference in rate between the two freezing techniques (vitrification versus slow freezing) or embryo stage (cleaved embryo versus blastocyst). WHAT IS KNOWN ALREADY Several studies have compared neonatal outcomes after fresh embryo transfer (ET) and FET and shown that FET is associated with improved neonatal outcomes, including reduced risks of preterm birth, low birthweight, and small for gestational age (SGA), when compared with fresh ET. However, these studies also revealed an increased risk of LGA after FET. The underlying pathophysiology of this increased risk remains unclear; parental infertility, laboratory procedures (including embryo culture conditions and freezing-thawing processes), and endometrial preparation treatments might be involved. STUDY DESIGN, SIZE, DURATION A multicentre epidemiological data study was performed through a retrospective analysis of the standardized individual clinical records of the French national register of IVF from 2014 to 2018, including single deliveries resulting from fresh ET or FET that were prospectively collected in fertility centres. Complementary data were collected from the participating fertility centres and included the vitrification media and devices, and the endometrial preparation protocols. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected from 35 French ART centres, leading to the inclusion of a total of 72 789 fresh ET, 10 602 slow-freezing FET, and 39 062 vitrification FET. Main clinical outcomes were presented according to origin of the transferred embryos (fresh, slow frozen, or vitrified embryos) and endometrial preparations for FET (ovulatory or artificial cycles), comparing five different groups (fresh, slow freezing-ovulatory cycle, slow freezing-artificial cycle, vitrification-ovulatory cycle, and vitrification-artificial cycle). Foetal growth disorders were defined in live-born singletons according to gestational age and sex-specific weight percentile distribution: SGA and LGA if <10th and ≥90th percentiles, respectively. Analyses were performed using linear mixed models with the ART centres as random effect. MAIN RESULTS AND THE ROLE OF CHANCE Transfers led to, respectively, 19 006, 1798, and 9195 deliveries corresponding to delivery rates per transfer of 26.1%, 17.0%, and 23.5% after fresh ET, slow-freezing FET, and vitrification FET, respectively. FET cycles were performed in either ovulatory cycles (n = 21 704) or artificial cycles (n = 34 237), leading to 5910 and 10 322 pregnancies, respectively, and corresponding to pregnancy rates per transfer of 31.6% and 33.3%. A significantly higher rate of spontaneous miscarriage was observed in artificial cycles when compared with ovulatory cycles (33.3% versus 21.4%, P < 0.001, in slow freezing groups and 31.6% versus 21.8%, P < 0.001 in vitrification groups). Consequently, a lower delivery rate per transfer was observed in artificial cycles compared with ovulatory cycles both in slow freezing and vitrification groups (15.5% versus 18.9%, P < 0.001 and 22.8% versus 24.9%, P < 0.001, respectively). Among a total of 26 585 live-born singletons, 16 413 babies were born from fresh ET, 1644 from slow-freezing FET, and 8528 from vitrification FET. Birthweight was significantly higher in the FET groups than in the fresh ET group, with no difference between the two freezing techniques. Likewise, LGA rates were higher and SGA rates were lower in the FET groups compared with the fresh ET group whatever the method used for embryo freezing. In a multivariable analysis, the risk of LGA following FET was significantly increased in artificial compared with ovulatory cycles. In contrast, the risk of LGA was not associated with either the freezing procedure (vitrification versus slow freezing) or the embryo stage (cleaved embryo versus blastocyst) at freezing. Regarding the vitrification method, the risk of LGA was not associated with either the vitrification medium used or the embryo stage. LIMITATIONS, REASONS FOR CAUTION No data were available on maternal context, such as parity, BMI, infertility cause, or maternal comorbidities, in the French national database. In particular, we cannot exclude that the increased risk of LGA observed following FET with artificial cycles may, at least partially, be associated with a confounding effect of some maternal factors. No information about embryo culture and incubation conditions was available. Most of the vitrification techniques were performed using the same device and with two main vitrification media, limiting the validity of a comparison of risk for LGA according to the device or vitrification media used. WIDER IMPLICATIONS OF THE FINDINGS Our results seem reassuring, since no potential foetal growth disorders following embryo vitrification in comparison with slow freezing were observed. Even if other factors are involved, the endometrial preparation treatment seems to have the greatest impact on LGA risk following FET. FET during ovulatory cycles could minimize the risk for foetal growth disorders. STUDY FUNDING/COMPETING INTEREST(S) This work has received funding from the French Biomedicine Agency (Grant number: 19AMP002). None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Laetitia Hesters
- Department of Reproductive Biology CECOS, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Nathalie Sermondade
- Department of Reproductive Biology CECOS, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Céline Lambert
- Biostatistics Unit, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- Department of Reproductive Biology CECOS, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécily Lucas
- Department of Reproductive Biology CECOS, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
| | - Rachel Levy
- Department of Reproductive Biology CECOS, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florence Brugnon
- Department of Reproductive Biology CECOS, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France
- University of Clermont Auvergne, IMoST, INSERM 1240, Faculté de Médecine, Clermont-Ferrand, France
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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe E, Dupuis HGA, Lefevre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00037-0. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [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] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Eric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefevre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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Matsuzaki S, Chauffour C, Pouly JL. Impaired secretion of C-X-C motif chemokine ligand 10 by stimulation with a Toll-like receptor 4 ligand in endometrial epithelium of infertile patients with minimal-to-mild endometriosis. J Reprod Immunol 2023; 159:103989. [PMID: 37473583 DOI: 10.1016/j.jri.2023.103989] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
Successful embryo implantation requires transient, well-controlled inflammation in decidualizing cells. In mice, Toll-like receptor (TLR) 4 signaling in endometrial epithelial cells (EECs) by stimulation with factors present in seminal fluids has been shown to be a key upstream driver of a controlled inflammatory response. Clinical evidence supports that exposure of the female reproductive tract to seminal plasma promotes implantation success. We investigated the response of EECs to TLR2 (Pam3Csk4), TLR 3 (Poly I:C), and TLR4 (lipopolysaccharides [LPS]) ligands with respect to secretion of C-X-C motif chemokine ligand (CXCL) 10 (CXCL10) and interleukin-6 (IL-6) in infertile patients with minimal-to-mild endometriosis (EECs-endo) (n = 38) and those of healthy, fertile women (EECs-healthy) (n = 30). Stimulation with either Pam3Csk4, Poly I:C or LPS, significantly induced CXCL10 and IL-6 in EECs-healthy (p < 0.05). In EECs-endo, either Pam3Csk4 or Poly I:C significantly induced CXCL10 (p < 0.05), whereas no significant response was observed after stimulation with LPS. Neither LPS, Poly I:C, nor Pam3Csk4 significantly induced IL-6 secretion in EECs-endo. Secretion of CXCL10 in EECs-healthy after stimulation with LPS was significantly higher (p < 0.05) than that in EECs-endo. CXCL10 decreased cell proliferation of EECs from both groups. Activation of nuclear factor kappa light chain enhancer of activated B cells and signal transducer and activator of transcription 3 signalings was not impaired, but activation of p38 mitogen-activated protein kinases signaling by LPS stimulation was impaired in EECs-endo. The present findings suggested that an insufficient response of EECs to a TLR4 ligand may be involved in molecular mechanisms of endometriosis-associated infertility.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Chirurgie Gynécologique, Clermont-Ferrand, France; Université Clermont Auvergne, Institut Pascal, UMR6602, CNRS/UCA/SIGMA, Clermont-Ferrand, France.
| | - Candice Chauffour
- CHU Clermont-Ferrand, Chirurgie Gynécologique, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- CHU Clermont-Ferrand, Chirurgie Gynécologique, Clermont-Ferrand, France
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Matsuzaki S, Pouly JL, Canis M. IL-10 is not anti-fibrotic but pro-fibrotic in endometriosis: IL-10 treatment of endometriotic stromal cells in vitro promotes myofibroblast proliferation and collagen type I protein expression. Hum Reprod 2023; 38:14-29. [PMID: 36413036 DOI: 10.1093/humrep/deac248] [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: 08/01/2022] [Revised: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
STUDY QUESTION Is interleukin-10 (IL-10) anti-fibrotic in endometriosis? SUMMARY ANSWER IL-10 is not anti-fibrotic but pro-fibrotic in endometriosis, because IL-10 treatment of endometriotic stromal cells in vitro promotes myofibroblast proliferation and collagen type I protein expression. WHAT IS KNOWN ALREADY We previously showed that persistent activation of signal transducer and activator of transcription 3 (STAT3) via IL-6 trans-signaling promotes fibrosis of endometriosis. Studies showed marked anti-fibrotic effects of IL-10 via the STAT3 signaling pathway, which is generally considered to be anti-inflammatory, in various organs. STUDY DESIGN, SIZE, DURATION Endometrial and/or endometriotic samples of 54 patients who had histological evidence of deep endometriosis, and endometrial samples from 30 healthy fertile women were analyzed. PARTICIPANTS/MATERIALS, SETTING, METHODS The effects of IL-10/STAT3 signaling as well as inhibition of STAT3 activation by knockdown of STAT3 gene on the pro-fibrotic phenotype in endometrial and endometriotic stromal cells in vitro were investigated. Then, the effects of various time points of IL-10 treatment in combination with transforming growth factor (TGF)-β1 and/or IL-6/soluble IL-6 receptor (sIL-6R) on the profibrotic phenotype of endometrial and endometriotic stromal cells were investigated. MAIN RESULTS AND THE ROLE OF CHANCE IL-10 induced pro-fibrotic phenotype (cell proliferation, collagen type I synthesis, α-smooth muscle actin positive stress fibers and collagen gel contraction) of endometriotic stromal cells. Knockdown of STAT3 gene decreased the IL-10 induced pro-fibrotic phenotype of endometriotic stromal cells. In contrast, IL-10 had no significant effects on pro-fibrotic phenotype of endometrial stromal cells of healthy women. Sequential IL-10 treatment with or without TGF-β1 and/or IL-6/sIL-6R induced persistent activation of STAT3 and significantly increased proliferation of myofibroblasts (cells with α-smooth muscle actin positive stress fibers) and protein expression of collagen type I in endometriotic stromal cells. TGF-β1 and/or IL-6/sIL6RIL-6/sIL6R treatment significantly increased tissue inhibitor of metalloproteinase 1 (TIMP1) protein expression, whereas IL-10 had no significant effects. Knockdown of STAT3 gene significantly decreased the TGF-β1 and/or IL-6/sIL6R induced TIMP1 protein expression. In contrast, pre-treatment with IL-10 before TGF-β1 and/or IL-6/sIL-6R treatment and sequential IL-10 treatment with or without TGF-β1 and/or IL-6/sIL-6R significantly decreased proliferation of fibroblasts (cells without α-smooth muscle actin positive stress fibers) and collagen type I protein expression in endometrial stromal cells of healthy women. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Given the large number of complex interactions and signaling pathways of pro- and anti-inflammatory mediators that are involved in the pathophysiology of endometriosis, the present study investigated only a very small portion of the whole. Further in vivo studies are required to validate the present findings. WIDER IMPLICATIONS OF THE FINDINGS Inflammatory mediators in the pathophysiology of endometriosis have been extensively investigated as potential therapeutic targets. However, the present study showed that anti-inflammatory signals of IL-10 and IL-6 through persistent STAT3 activation may promote endometriosis fibrosis. Therapeutic strategies, such as suppression of 'inflammation', might dysregulate the cross-regulation of 'pro- and anti-inflammatory mediators', leading to detrimental effects in patients with endometriosis, such as fibrosis. To develop new, but not deleterious, therapeutic strategies, studies are required to investigate whether, how and what 'anti-inflammatory mediators' along with pro-inflammatory mediators are involved in individual patients with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by KARL STORZ SE & Co. KG (Tuttlingen, Germany). The authors have no conflict of interest to disclose.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Chirurgie Gynécologique, Clermont-Ferrand, France.,Université Clermont Auvergne, Institut Pascal, UMR6602, CNRS/UCA/SIGMA, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- CHU Clermont-Ferrand, Chirurgie Gynécologique, Clermont-Ferrand, France.,Université Clermont Auvergne, Institut Pascal, UMR6602, CNRS/UCA/SIGMA, Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, Chirurgie Gynécologique, Clermont-Ferrand, France.,Université Clermont Auvergne, Institut Pascal, UMR6602, CNRS/UCA/SIGMA, Clermont-Ferrand, France
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Barrière P, Hamamah S, Arbo E, Avril C, Salle B, Pouly JL, Jenkins J. A real-world study of ART in France (REOLA) comparing a biosimilar rFSH against the originator according to rFSH starting dose. J Gynecol Obstet Hum Reprod 2023; 52:102510. [PMID: 36403900 DOI: 10.1016/j.jogoh.2022.102510] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/25/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since the first launch of a biosimilar recombinant follicle stimulating hormone (rFSH), Bemfola®, in Europe in 2014, it has been possible to study in routine clinical care throughout France the effectiveness of a biosimilar rFSH including according to different rFSH starting doses. METHODS REOLA was a non-interventional, retrospective, real world study using anonymized data from 17 Assisted Reproductive Technology (ART) centres' data management systems across France including 2,319 ART ovarian stimulation cycles with Bemfola® and 4,287 ART ovarian stimulation cycles with Gonal-f®. For both products, four populations were studied according to starting dose of rFSH: < 150 IU, 150 - 224 IU, 225 - 299 IU and ≥ 300 IU. The primary endpoint was the cumulative live birth rate (cLBR) per commenced ART ovarian stimulation cycle including all subsequent fresh and frozen-thawed embryo transfers starting during a follow up period of at least 1 year following oocyte retrieval. RESULTS A direct relationship of increasing rFSH starting dose with increasing age, increasing basal FSH, decreasing AMH and increasing body mass index was noted. No clinically relevant differences were seen in all outcomes reported, including the cLBR, between Bemfola® and Gonal-f®, but for both drugs, an association was seen with increasing rFSH starting dose and decreasing cLBR. CONCLUSIONS The REOLA study demonstrates that the cLBR with Bemfola® is very similar to Gonal-f® across all patient subpopulations. The cLBR is inversely related to the rFSH starting dose irrespective of the drug used, and the REOLA study provides reassurance of the clinical effectiveness of a biosimilar rFSH used in a real world setting.
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Affiliation(s)
- Paul Barrière
- Femme-Maternité, Centre Hospitalier Universitaire Nantes, Nantes University, INSERM CRTI U 1064, Nantes, France
| | - Samir Hamamah
- Arnaud de Villeneuve Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, INSERM U 1203, France
| | - Elisangela Arbo
- Gedeon Richter France, Medical Affairs Department, Paris, France
| | | | | | - Jean-Luc Pouly
- Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Courbiere B, Le Roux E, Mathieu d’Argent E, Torre A, Patrat C, Poncelet C, Montagut J, Gremeau AS, Creux H, Peigné M, Chanavaz-Lacheray I, Dirian L, Fritel X, Pouly JL, Fauconnier A. Oocyte Vitrification for Fertility Preservation in Women with Benign Gynecologic Disease: French Clinical Practice Guidelines Developed by a Modified Delphi Consensus Process. J Clin Med 2021; 10:jcm10173810. [PMID: 34501257 PMCID: PMC8432013 DOI: 10.3390/jcm10173810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 01/28/2023] Open
Abstract
International guidelines are published to provide standardized information and fertility preservation (FP) care for adults and children. The purpose of the study was to conduct a modified Delphi process for generating FP guidelines for BGD. A steering committee identified 42 potential FP practices for BGD. Then 114 key stakeholders were asked to participate in a modified Delphi process via two online survey rounds and a final meeting. Consensus was reached for 28 items. Among them, stakeholders rated age-specific information concerning the risk of diminished ovarian reserve after surgery as important but rejected proposals setting various upper and lower age limits for FP. All women should be informed about the benefit/risk balance of oocyte vitrification—in particular about the likelihood of live birth according to age. FP should not be offered in rASRM stages I and II endometriosis without endometriomas. These guidelines could be useful for gynecologists to identify situations at risk of infertility and to better inform women with BGDs who might need personalized counseling for FP.
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Affiliation(s)
- Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, AP-HM, Hôpital La Conception, 13005 Marseille, France
- Aix-Marseille Université, IMBE, CNRS, IRD, Avignon Université, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-38-37-11
| | - Enora Le Roux
- Unité d’Epidémiologie Clinique, Hôpital Universitaire Robert Debré, AP-HP Nord-Université de Paris, Inserm, CIC 1426, 75019 Paris, France;
- ECEVE UMR 1123, Université de Paris, Inserm, 75019 Paris, France
| | - Emmanuelle Mathieu d’Argent
- Department of Gynecology-Obstetric and Reproductive Medicine, GRC6-UPMC, Centre Expert en Endométriose (C3E), Université Pierre-et-Marie-Curie Paris 6, Hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France;
| | - Antoine Torre
- Department of Gynecology-Obstetric and Reproductive Medicine, CHU Rouen, 37 bd Gambetta, 76000 Rouen, France;
| | - Catherine Patrat
- Service de Biologie de la Reproduction—CECOS, APHP Centre—Université de Paris, Site Cochin, Inserm U1016, 75014 Paris, France;
| | - Christophe Poncelet
- Department of Gynecology-Obstetric, UFR SMBH Leonard de Vinci, CH René Dubos, 95000 Cergy-Pontoise, France;
- Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France;
| | - Jacques Montagut
- Institut Francophone de Recherche et d’Etudes Appliquées à la Reproduction, Ifreares Toulouse, 31000 Toulouse, France;
| | - Anne-Sophie Gremeau
- Department of Gynecologic Surgery and IVF, Clermont-Ferrand, University Hospital Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Hélène Creux
- Clinique Saint Roch, Department of Gynecology-Obstetric and Reproductive Medicine, 34000 Montpellier, France;
| | - Maëliss Peigné
- Université Sorbonne Paris Nord—Paris 13, 93200 Saint-Denis, France;
- Department of Reproductive Medicine and Fertility Preservation, AP-HP Hôpital Jean Verdier, 93143 Bondy, France
| | | | - Lara Dirian
- EndoFrance, Association Française de lutte contre l’Endométriose, 70190 Tresilley, France;
| | - Xavier Fritel
- Department of Gynecology-Obstetric and Reproductive Medicine, CHU Poitiers, 86000 Poitiers, France;
- Inserm CIC-P 1402, 86021 Poitiers, France
| | - Jean-Luc Pouly
- Department of Gynecology-Obstetric, CH Moulins Yzeure, 03000 Moulins, France;
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, CHI Poissy-Saint-Germain-en Laye, 78300 Poissy, France;
- Research Unit 7285 Risk and Safety in Clinical Medicine for Women and Perinatal Health, Paris-Saclay University, 78300 Poissy, France
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7
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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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Béguinot M, Botchorishvili R, Comptour A, Curinier S, Campagne-Loiseau S, Chauvet P, Pereira B, Pouly JL, Rabischong B, Canis M, Bourdel N. Minilaparoscopic Total Hysterectomy in Current Practice Feasibility and Benefits: A Unicentric, Randomized Controlled Trial. J Minim Invasive Gynecol 2019; 27:673-680. [PMID: 31173939 DOI: 10.1016/j.jmig.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/09/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To investigate whether mini-instrumentation may be used for hysterectomy (HT) by all surgeons (assistants and seniors) without increasing the operative time or altering surgeon working conditions. DESIGN A unicenter, randomized controlled, single blind, parallel, noninferiority trial comparing 2 surgical techniques. SETTING A tertiary referral center. PATIENTS Thirty-two patients undergoing HT for a benign gynecologic disease were enrolled in this study in our center between April 2, 2015, and June 1, 2018. Sixteen patients were randomized in group A and 16 patients in group B. INTERVENTIONS HT with bilateral annexectomy or ovarian conservation using 3-mm instruments (group A) or conventional 5-mm instruments (group B). MEASUREMENTS AND MAIN RESULTS Concerning the primary outcome, the operative time for the HT 3-mm group was 128 minutes (range, 122-150 minutes) versus 111 minutes (range, 92-143 minutes) for the HT 5-mm group (i.e., δ = 17 [90% confidence interval, -6 to 39]), with rejection of the noninferiority threshold at 35 minutes. Thirty-one percent of HTs initially performed using 3-mm instruments were completed with conventional instruments. HTs performed with mini-instruments required more concentration (p = .02) with surgeons reporting higher levels of frustration (p = .009) and sense of failure (p = .006). Patients tend to experience greater satisfaction regarding scars with a significant difference noted during the postoperative visit both for scar pain (1 vs 4 patients with moderate pain [30-50 mm on the Patient Scar Assessment Scale) in the HT 3-mm group and the HT 5-mm group, respectively) and scar firmness (p = .021; 3 vs 7 patients with moderate firmness [30-50 mm on the Patient Scar Assessment Scale] in the HT 3-mm group and the HT 5-mm group, respectively). CONCLUSION Total minilaparoscopic HT appears inferior to standard laparoscopy in terms of operative time and surgeon working conditions; only the short-term cosmetic appearance was in favor of the 3-mm approach.
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Affiliation(s)
- Marie Béguinot
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel); Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France, and Department of Surgery, Jean Perrin Comprehensive Center, Clermont-Ferrand, France (Dr. Béguinot)
| | - Revaz Botchorishvili
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Aurélie Comptour
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Sandra Curinier
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Sandrine Campagne-Loiseau
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Pauline Chauvet
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Bruno Pereira
- Biostatistics Division (Direction de la Recherche Clinique et de l'Innovation) (Dr. Pereira)
| | - Jean-Luc Pouly
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Benoit Rabischong
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Michel Canis
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel)
| | - Nicolas Bourdel
- Department of Gynecologic Surgery (Drs. Béguinot, Botchorishvili, Comptour, Curinier, Campagne-Loiseau, Chauvet, Pouly, Rabischong, Canis, and Bourdel).
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9
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Comptour A, Chauvet P, Canis M, Grémeau AS, Pouly JL, Rabischong B, Pereira B, Bourdel N. Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2019; 26:717-726. [DOI: 10.1016/j.jmig.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022]
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Tharwat D, Trousselard M, Balès M, Sutter-Dallay AL, Fromage D, Spitz E, Dallay D, Harvey T, Welter E, Coatleven F, Cherier L, Teissèdre F, Pouly JL, Dutheil F, Duffaud AM. Chronic Stress protection for postnatal dEpREssioN prEvention (SERENE): a protocol for an exploratory study. BMJ Open 2018; 8:e018317. [PMID: 29724735 PMCID: PMC5942420 DOI: 10.1136/bmjopen-2017-018317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The prevalence of postnatal depression (PND) is significant: reaching up to 20% in the general population. In mechanistic terms, the risk of PND lies in an interaction between a maternal psychophysiological vulnerability and a chronic environmental context of stress. On the one hand, repetition of stressor during pregnancy mimics a chronic stress model that is relevant to the study of the allostatic load and the adaptive mechanisms. On the other hand, vulnerability factors reflect a psychological profile mirroring mindfulness functioning (psychological quality that involves bringing one's complete and non-judgemental attention to the present experience on a moment-to-moment basis). This psychological resource is linked to protective and resilient psychic functioning. Thus, PND appears to be a relevant model for studying the mechanisms of chronic stress and vulnerability to psychopathologies.In this article, we present the protocol of an ongoing study (started in May 2017). METHODS AND ANALYSIS The study is being carried out in five maternities and will involve 260 women. We aim to determine the predictive psychobiological factors for PND emergence and to provide a better insight into the mechanisms involved in chronic stress during pregnancy. We use a multidisciplinary approach that encompasses psychological resources and biophysiological and genetic profiles in order to detect relevant vulnerability biomarkers for chronic stress and the development of PND. To do so, each woman will be involved in the study from her first trimester of pregnancy until 12 months postdelivery. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ile de France III Ethics Committee, France (2016-A00887-44). We aim to disseminate the findings through international conferences and international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03088319; Pre-results.
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Affiliation(s)
| | - Marion Trousselard
- Unité de Neurophysiologie du Stress, Département Neurosciences et Contraintes Opérationnelles, Institute de Recherche Biomédicale des Armées, Brétigny Sur Orge, France
| | - Mélanie Balès
- INSERM 1219, EPS Charles Perrens et Centre de RecherchE, Bordeaux, France
| | | | - Dominique Fromage
- Unité de Neurophysiologie du Stress, Département Neurosciences et Contraintes Opérationnelles, Institute de Recherche Biomédicale des Armées, Brétigny Sur Orge, France
| | - Elisabeth Spitz
- Apemac, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Dominique Dallay
- Centre Aliénor d'Aquitaine, CHU Pellegrin, University Hospital of Bordeaux, Bordeaux, France
| | | | - Eric Welter
- CHR Mercy, Regional Hospital of Metz, Metz, France
| | - Frédéric Coatleven
- Centre Aliénor d'Aquitaine, CHU Pellegrin, University Hospital of Bordeaux, Bordeaux, France
| | - Lydie Cherier
- Centre Aliénor d'Aquitaine, CHU Pellegrin, University Hospital of Bordeaux, Bordeaux, France
| | - Frédérique Teissèdre
- Department of In-Vitro Fecondation, Gynecologia, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- Université Clermont Auvergne, UMR CNRS 6024, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Faculty of Health, Australian Catholic University, Melbourne, Victoria, Australia
| | - Anaïs M Duffaud
- Unité de Neurophysiologie du Stress, Département Neurosciences et Contraintes Opérationnelles, Institute de Recherche Biomédicale des Armées, Brétigny Sur Orge, France
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11
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Matsuzaki S, Pouly JL, Canis M. In vitro and in vivo effects of MK2206 and chloroquine combination therapy on endometriosis: autophagy may be required for regrowth of endometriosis. Br J Pharmacol 2018; 175:1637-1653. [PMID: 29457968 DOI: 10.1111/bph.14170] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/18/2017] [Accepted: 01/31/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE A high recurrence rate after medical treatment is a major clinical problem for patients with endometriosis. Here, we have evaluated the in vitro effects of combined treatment with MK2206 (an AKT inhibitor) + chloroquine on cell growth and regrowth of endometriotic stromal cells and the in vivo effects on endometriotic implants in a mouse xenograft model of endometriosis. EXPERIMENTAL APPROACH We evaluated the effects of autophagy inhibition by knockdown of the ATG13, Beclin-1 and ATG12 genes and pharmacological agents (chloroquine, bafilomycin A1 or 3-methyalanine) individually and in combination with MK2206 on cell growth and/or cell regrowth of endometriotic stromal cells in vitro. Furthermore, we evaluated treatment with MK2206 + chloroquine on endometriotic implants in a mouse xenograft model of endometriosis. KEY RESULTS Combined treatment with MK2206 and chloroquine markedly reduced cell growth and regrowth after discontinuation of treatment in endometriotic stromal cells compared with cells treated with either drug alone. Autophagy inhibition by ATG13, Beclin-1 or ATG12 gene knockdown only affected regrowth of endometriotic stromal cells, but not endometrial stromal cells from the same patients, after a 72 h discontinuation of the combined treatment. Furthermore, combined treatment reduced the size of endometriotic implants, whereas no effects on endometriotic implants treated with either drug alone were observed in a mouse xenograft model of endometriosis. CONCLUSIONS AND IMPLICATIONS The present findings suggest that a novel strategy for treatment of endometriosis may involve decreasing the number of endometriotic cells that can survive treatment and then preventing regrowth by autophagy inhibition.
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Affiliation(s)
- Sachiko Matsuzaki
- Chirurgie Gynécologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Pascal, UMR6602, Université Clermont Auvergne, CNRS/UCA/SIGMA, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- Chirurgie Gynécologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Pascal, UMR6602, Université Clermont Auvergne, CNRS/UCA/SIGMA, Clermont-Ferrand, France
| | - Michel Canis
- Chirurgie Gynécologique, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Pascal, UMR6602, Université Clermont Auvergne, CNRS/UCA/SIGMA, Clermont-Ferrand, France
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12
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Rabischong B, Botchorishvili R, Bourdel N, Curinier S, Campagne-Loiseau S, Pouly JL, Canis M. [Nerve sparing techniques in deep endometriosis surgery to prevent urinary or digestive functional disorders: Techniques and results: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:309-313. [PMID: 29551299 DOI: 10.1016/j.gofs.2018.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/08/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the feasibility and functional urinary and digestive results of nerve sparing techniques in endometriosis surgery. METHODS A research on the medline/pubmed database using specific keywords (nerve sparing, endometriosis, pelvic nerves) identified 7 publications among about 50 whose purpose was to describe the feasibility, the techniques and the functional results of nerve preservation in this indication. Among them there are: 2 uncontrolled retrospective studies, 3 prospective non-randomized studies, a meta-analysis and a review of the literature. RESULTS Nerve preservation requires a perfect knowledge of the anatomy of the pelvic autonomic system. The laparoscopic approach is preferred by the different authors due to its anatomical advantage. The feasibility of this technique seems to be demonstrated despite certain limitations in the different studies and depending of the retroperitoneal extension of the lesions. When feasible, it is likely to significantly improve postoperative urinary function (urinary retention) compared to a conventional technique. It is observed no difference regarding digestive function. CONCLUSIONS Nerve sparing in this indication is a technique the feasibility of which has been demonstrated and is subject to the topography and extent of the disease. In the absence of invasion or entrapment of pelvic autonomic nerves by endometriosis, this technique improves postoperative voiding function (NP3). During pelvic surgery for endometriosis, it is recommended to identify and preserve autonomic pelvic nerves whenever possible (GradeC).
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Affiliation(s)
- B Rabischong
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - R Botchorishvili
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - N Bourdel
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - S Curinier
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - S Campagne-Loiseau
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J L Pouly
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Mathieu d'Argent E, Cohen J, Chauffour C, Pouly JL, Boujenah J, Poncelet C, Decanter C, Santulli P. [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:357-367. [PMID: 29544710 DOI: 10.1016/j.gofs.2018.02.006] [Citation(s) in RCA: 3] [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: 01/18/2018] [Indexed: 01/27/2023]
Abstract
Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.
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Affiliation(s)
- E Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - J Cohen
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Chauffour
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J L Pouly
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Boujenah
- Service de gynécologie obstétrique, CHU de Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - C Poncelet
- Service de gynécologie obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; UFR SMBH, université Paris 13, Sorbonne Paris-Cité, 93022 Bobigny, France
| | - C Decanter
- EA 4308 Gamétogenèse et qualité du gamète, service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU de Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris-Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
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Santulli P, Collinet P, Fritel X, Canis M, d'Argent EM, Chauffour C, Cohen J, Pouly JL, Boujenah J, Poncelet C, Decanter C, Borghese B, Chapron C. [Management of assisted reproductive technology (ART) in case of endometriosis related infertility: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:373-375. [PMID: 29503237 DOI: 10.1016/j.gofs.2018.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/31/2017] [Indexed: 11/17/2022]
Abstract
The management of endometriosis related infertility requires a global approach. In this context, the prescription of an anti-gonadotropic hormonal treatment does not increase the rate of non-ART (assisted reproductive technologies) pregnancies and it is not recommended. In case of endometriosis related infertility, the results of IVF management in terms of pregnancy and birth rates are not negatively affected by the existence of endometriosis. Controlled ovarian stimulation during IVF does not increase the risk of endometriosis associated symptoms worsening, nor accelerate the intrinsic progression of endometriosis and does not increase the rate of recurrence. However, in the context of IVF management for women with endometriosis, pre-treatment with GnRH agonist or with oestrogen/progestin contraception improve IVF outcomes. There is currently no evidence of a positive or negative effect of endometriosis surgery on IVF outcomes. Information on the possibilities of preserving fertility should be considered, especially before surgery.
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Affiliation(s)
- P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétiques et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France.
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France; Inserm, U1189-ONCO Thai-image assisted laser therapy for oncology, CHU de Lille, 59000 Lille, France
| | - X Fritel
- Inserm CIC 1402, service de gynécologie - obstétrique et médecine de la reproduction, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France
| | - M Canis
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - E M d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, France; GRC6-UPMC : centre expert en endométriose (C3E), hôpital Tenon, Paris, France
| | - C Chauffour
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Cohen
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, France; GRC6-UPMC : centre expert en endométriose (C3E), hôpital Tenon, Paris, France
| | - J L Pouly
- Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Boujenah
- Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - C Poncelet
- Service de gynécologie-obstétrique, centre hospitalier de Renée-Dubos, 6, avenue de l'Ile-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France
| | - C Decanter
- Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308, gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France
| | - B Borghese
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétiques et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | - C Chapron
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétiques et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
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Chaput L, Grémeau AS, Vorilhon S, Pons H, Chabrot C, Grèze V, Pouly JL, Brugnon F. Préservation de la fertilité en cancérologie. Bull Cancer 2018; 105:99-110. [DOI: 10.1016/j.bulcan.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 11/17/2022]
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Bourdel N, Comptour A, Bouchet P, Gremeau AS, Pouly JL, Slim K, Pereira B, Canis M. Long-term evaluation of painful symptoms and fertility after surgery for large rectovaginal endometriosis nodule: a retrospective study. Acta Obstet Gynecol Scand 2017; 97:158-167. [PMID: 29143306 DOI: 10.1111/aogs.13260] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/09/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Optimal surgical treatment of rectovaginal endometriosis remains a controversial topic. The objective of this study was to evaluate long-term postoperative outcomes after rectal shaving or colorectal resection for rectovaginal endometriosis. MATERIAL AND METHODS 195 patients underwent surgery (172 managed by shaving, 23 by colorectal resection) between January 2000 and June 2013 for rectovaginal endometriosis (>2 cm) involving at least the serosa of the rectum. Primary outcome measures were pain and fertility. Secondary outcome measures were complications, recurrence rates and quality of life. RESULTS Mean follow-up was 60 ± 42 months in the shaving group and 67 ± 47 months in the resection group. The mean VAS score for pelvic pain between the pre and postoperative period decreased from 5.5 ± 3.5 (shaving group) and 7.3 ± 2.9 (resection group) to 2.3 ± 2.4 (p < 0.001) and 2.0 ± 1.8 (p < 0.001), respectively. For dysmenorrhea, the mean baseline VAS score fell postoperatively from 7.7 ± 2.8 (shaving group) and 8.2 ± 2.6 (resection group) to 3.3 ± 2.9 (p < 0.001) and 2.7 ± 2.7 (p < 0.001), respectively. Pregnancy rates were 73% for shaving and 69% for resection. Major complications occurred in 4% of patients in the shaving group and in 26% in the resection group (p = 0.001). Thirteen patients (7.6%) from the shaving group and none from the resection group were reoperated for suspicion of endometriosis recurrence (p = 0.37). Postoperative quality of life scores revealed no differences between the two groups. CONCLUSION Our study demonstrates that rectal shaving, when feasible for rectovaginal nodule (>2 cm) infiltrating the digestive serosa, has equal impact on pain and pregnancy rates compared with colorectal resection at long-term follow-up, with low complication and favorable pregnancy rates.
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Affiliation(s)
- Nicolas Bourdel
- Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Comptour
- Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Paméla Bouchet
- Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne-Sophie Gremeau
- Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Karem Slim
- Service of Hepato Gastro Enterology, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Units (DRCI), CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Canis
- Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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Matsuzaki S, Pouly JL, Canis M. Effects of U0126 and MK2206 on cell growth and re-growth of endometriotic stromal cells grown on substrates of varying stiffness. Sci Rep 2017; 7:42939. [PMID: 28218307 PMCID: PMC5317159 DOI: 10.1038/srep42939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/17/2017] [Indexed: 12/28/2022] Open
Abstract
Endometriosis is a common gynecological disorder responsible for infertility and pelvic pain. A complete cure for patients with endometriosis awaits new targets and strategies. Here we show that U0126 (a MEK inhibitor) and MK2206 (an AKT inhibitor) synergistically inhibit cell growth of deep endometriotic stromal cells (DES) grown on polyacrylamide gel substrates (PGS) of varying stiffness (2 or 30 kilopascal [kPa]) or plastic in vitro. No significant differences in cell proliferation were observed among DES, endometrial stromal cells of patients with endometriosis (EES) from the proliferative phase (P), EES-S (secretory phase) and EES-M (menstrual phase) compared to cells grown on a substrate of the same stiffness at both higher (U0126 [30 μM] and MK2206 [9 μM]) and lower (U0126 [15 μM] and MK2206 [4.5 μM]) combined doses. However, cell re-growth of DES after drug discontinuation was higher than that of EES-P and EES-S when cells were grown on rigid substrates at both combined doses. Combination U0126 and MK2206 treatment is more effective than each drug alone in cell growth inhibition of DES. However, further studies are required to investigate the mechanisms underlying high cell survival and proliferation after drug discontinuation for developing target therapies that prevent recurrence.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, Clermont-Ferrand, France.,Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France.,CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, Clermont-Ferrand, France.,Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France.,CNRS, ISIT UMR6284, Clermont-Ferrand, France
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Canis M, Curinier S, Campagne-Loiseau S, Kaemerlen Rabischong AG, Rabischong B, Pouly JL, Grémeau AS, Botchorishvili R, Bourdel N. [Information to patients in endometriosis: We must stop the frightening machine!]. ACTA ACUST UNITED AC 2016; 44:618-619. [PMID: 27765429 DOI: 10.1016/j.gyobfe.2016.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- M Canis
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France.
| | - S Curinier
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - S Campagne-Loiseau
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - A G Kaemerlen Rabischong
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - B Rabischong
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - J L Pouly
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - A S Grémeau
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - R Botchorishvili
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - N Bourdel
- Department of gynecologic surgery, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
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Matsuzaki S, Canis M, Pouly JL, Darcha C. Soft matrices inhibit cell proliferation and inactivate the fibrotic phenotype of deep endometriotic stromal cells in vitro. Hum Reprod 2016; 31:541-53. [PMID: 26762314 DOI: 10.1093/humrep/dev333] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 09/02/2015] [Accepted: 12/11/2015] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION Can deep infiltrating endometriotic stromal cells (DES) sense changes in extracellular matrix (ECM) stiffness and respond to them? SUMMARY ANSWER Soft matrices inhibit cell proliferation and inactivate the fibrotic phenotype of DES in vitro. WHAT IS KNOWN ALREADY Deep infiltrating endometriosis (DIE) is characterized histologically by dense fibrous tissue. Tissue stiffening is a hallmark of fibrosis. Studies show that matrix stiffness is involved in the progression of numerous diseases, including cancer and fibrosis. However, no studies to date have investigated whether tissue stiffening could influence cell behavior in DIE. Previous in vitro studies typically analyzed cells grown on rigid plastic or glass substrates with stiffness in the gigapascal (gPa) range, which is much stiffer than that occurring in vivo. To investigate how changes in ECM stiffness affect the behavior of DES, it is critical to model in vivo tissue compliance conditions in vitro. STUDY DESIGN, SIZE, DURATION For this laboratory study, paired endometrial and endometriotic samples from 40 patients who had histological evidence of DIE and endometrial samples from 23 patients without endometriosis were analyzed (uterine fibroma: n = 10, tubal infertility: n = 13). PARTICIPANTS/MATERIALS, SETTING, METHODS All participants were 20-37 years old and had regular menstrual cycles of 26-32 days. The abundance of F-actin, alpha smooth muscle actin (αSMA), Ki67, and procollagen type I in DES and endometrial stromal cells (EES) on polyacrylamide gel substrates of varying stiffness (2, 4, 8, 16 and/or 30 kPa) was determined by immunofluorescence confocal microscopy. mRNA level of type I collagen, matrix metalloproteinase-1 (MMP-1), MMP-14 and cyclin D1 was measured by real-time PCR. The cellular proliferation index (CPI), assessed as the percentage of Ki67-positive cells among the total number of nuclei stained by 4',6-diamidino-2-phenylindole (DAPI) was determined. MAIN RESULTS AND THE ROLE OF CHANCE Increased matrix stiffness induced F-actin stress fiber formation in both EES and DES, whereas αSMA-containing stress fibers were induced only in DES. Furthermore, increased stiffness increased the CPI in both EES (16 or 30 kPa versus 2 kPa, P < 0.05) and DES (16 or 30 kPa versus 2, 4 or 8 kPa, P < 0.05). Increased stiffness increased the percentage of procollagen I-positive cells as well as mRNA levels of type I collagen in both EES and DES in a matrix stiffness-dependent manner (2, 8 and 30 kPa) (P < 0.05). Increased stiffness also increased MMP-14 mRNA levels in EES (30 versus 2 kPa, P < 0.05), but decreased MMP-1 mRNA levels in DES in a matrix stiffness-dependent manner (2, 8 and 30 kPa; P < 0.05). Treatment with transforming growth factor (TGF)-β1 further increased type I collagen mRNA levels in both EES and DES when compared with cells grown on a substrate of the same stiffness (2, 8 or 30 kPa, with versus without TGF-β1, P < 0.05). Treatment with TGF-β1 also increased MMP-1 (8 or 30 kPa, P < 0.05 versus no TGF-β1) and MMP-14 mRNA levels (2, 8 or 30 kPa, P < 0.05 versus no TGF-β1) in EES, but decreased MMP-1 mRNA levels (2, 8 or 30 kPa, P < 0.05 versus no TGF-β1) in DES. On a soft substrate (2 kPa), both EES and DES exhibited a small rounded morphology with diffuse labeling for F-actin. No F-actin-positive stress fibers were observed in either EES or DES grown on 2 kPa substrates. There were more Ki67-positive EES when grown on 2, 4 or 8 kPa compared with Ki67-positive DES (P < 0.05). LIMITATIONS, REASONS FOR CAUTION A tremendous gap exists between the present in vitro model and in vivo deep endometriotic tissues. Cell culture systems that more closely mimic the cellular complexity typical of in vivo endometriotic tissues are required to develop novel strategies for treatment of DIE. A disadvantage of polyacrylamide is its cytotoxicity but in the two-dimensional culture models used here, where cells are seeded above the polyacrylamide gel, this should not have a major impact. Finally, the soft substrates we used in vitro (2 and 4 kPa) may represent the elasticity of the endometrium in vivo, however, currently there are no data regarding tissue stiffness in DIE in vivo. WIDER IMPLICATIONS OF THE FINDINGS Hormonal suppressive therapy is not usually effective for treating DIE. Interrupting the mechanical interactions between endometriotic fibroblasts and aberrant ECM may be a novel strategy for treatment of DIE. STUDY FUNDING/COMPETING INTERESTS This study was supported in part by Karl Storz Endoscopy & GmbH (Tuttlingen, Germany). No competing interests are declared.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France Clermont Université, Université d'Auvergne, ISIT UMR6284, Clermont-Ferrand, France CNRS, ISIT UMR6284, Clermont-Ferrand, France
| | - Jean-Luc Pouly
- CHU Clermont-Ferrand, CHU Estaing, Chirurgie Gynécologique, 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - Claude Darcha
- CHU Clermont-Ferrand, Service d'Anatomie et Cytologie Pathologiques, Clermont-Ferrand, France
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Janny L, Pouly JL, Gremeau AS, Brugnon F. [Preserving fertility and future death]. J Int Bioethique 2015; 26 Spec no:111-117. [PMID: 26638327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Janny L, Pouly JL, Gremeau AS, Brugnon F. [PRESERVING FERTILITY AND FUTURE DEATH]. J Int Bioethique Ethique Sci 2015; 26:111-265. [PMID: 27356349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The fertility preservation when it is threatened is a right enshrined in the french law on bioethics. It is most often performed before gonadotoxic treatments for cancers with a long survival. When the patient has a limited life expectancy, is the preservation of fertility lawful? The authors present the arguments for and against the preservation of fertility in this particular situation and give driving they adopt in their team.
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Desvignes F, Pouly JL, Janny L, Canis M, Sanfilippo S, Kanold J, Lebouedec G, Brugnon F. [Cryoconservation of ovarian tissue: indications and outcome of the patients]. ACTA ACUST UNITED AC 2014; 42:334-42. [PMID: 24792707 DOI: 10.1016/j.gyobfe.2014.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/09/2013] [Accepted: 11/04/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Ovarian Tissue Cryopreservation (OTC) is a very promising approach of fertility preservation for women and young patients who have to follow gonadotoxic treatments (chemotherapy, radiotherapy…). The aim of this study was to analyse the indications and the outcomes of the patients who had OTC in our center during the last 17 years. PATIENTS AND METHODS The study is retrospective. Forty-six patients, who underwent OTC in the Laboratory of Reproductive Biology of the University Hospital of Clermont-Ferrand, between January 1997 and December 2009, were included. RESULTS The average age on the day of ovarian tissue harvesting was 19.5 years. Fifty-two percent of the patients were minor. In order of decreasing frequency, the diseases for which OTC has been proposed were hematologic, ovarian tumors, sarcoma ou PNET and breast neoplasia. In 93.5 %, the harvesting of ovarian cortex was performed by laparoscopy. After OTC, 82.6 % of the patients were treated by chemotherapy. A bone marrow transplant was performed for 48 % of the study patients. At the time of data collection, 57 % of the patients who had evaluation of their ovarian function presented premature ovarian failure. Eight patients had one or more pregnancies after treatment. It was a natural pregnancy for five of them. The three others were obtained by medically assisted procreation (in vitro fertilization and oocyte donation). DISCUSSION AND CONCLUSION We report a long-term follow-up of patients treated in our center for OTC. The originality of our study is to evaluate all aspects of OTC from the decision to propose the patients an OTC to their outcomes several years after the ovarian tissue harvesting. It is therefore a multidisciplinary approach both oncology, gynecological and pediatric whereas OTC is often considered restrictively in the literature. Finally, it seems to be essential to establish a specific medical care for these patients. This monitoring will allow an adequate assessment of pubertal development and ovarian function, management of estrogen deficiency and secondary infertility, supporting patients in their desire for motherhood.
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Affiliation(s)
- F Desvignes
- Pôle de gynécologie-obstétrique-reproduction humaine, médecine de la reproduction, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - J L Pouly
- Pôle de gynécologie-obstétrique-reproduction humaine, médecine de la reproduction, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - L Janny
- Laboratoire AMP, CECOS, pôle de gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - M Canis
- Pôle de gynécologie-obstétrique-reproduction humaine, médecine de la reproduction, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - S Sanfilippo
- Laboratoire AMP, CECOS, pôle de gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - J Kanold
- Centre régional de cancérologie et thérapie cellulaire pédiatrique, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - G Lebouedec
- Département de chirurgie oncologique, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - F Brugnon
- Laboratoire AMP, CECOS, pôle de gynécologie-obstétrique-reproduction humaine, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
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Pouly JL. [In vitro fertilization and intracystoplasmic sperm injection]. Rev Prat 2014; 64:92-96. [PMID: 24649557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In vitro fertilization with or without microinjection has revolutionized the treatment of infertility. It is useful in almost all causes of sterility. But these results are still modest and far from the expectations of couples since 25% patients deliver after an attempt and 40 to 50% after several attempts. There is a risk of immediate complications but it is today well control. The long-term studies on the children development and the women health are very reassuring.
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Sanfilippo S, Canis M, Romero S, Sion B, Déchelotte P, Pouly JL, Janny L, Smitz J, Brugnon F. Quality and functionality of human ovarian tissue after cryopreservation using an original slow freezing procedure. J Assist Reprod Genet 2012; 30:25-34. [PMID: 23263820 DOI: 10.1007/s10815-012-9917-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the efficiency of an original slow freezing protocol on the quality and function of human ovarian cortex. METHODS Human ovarian tissues were cryopreserved using a freezing medium supplemented with propanediol and raffinose as cryoprotectants and antioxidants (L-glutamine, taurine). Samples were then frozen using a faster cooling rate than the usual one. Viability and morphology of follicles, DNA fragmentation in follicles and stroma as well as histology of the vascular endothelium were analyzed before and after freezing/thawing. Moreover, a functional analysis was performed based on the evaluation of follicular growth and development in thawed ovarian tissues that were cultured in vitro. RESULTS Our freezing/thawing protocol allows preservation of a high proportion of viable follicles and the preservation of the different follicle developmental stages (p>0.05 versus fresh control). 70.5 ± 5.2 % of follicles retained an intact morphology after cryopreservation (p=0.04). Stroma cells but not follicles exhibited a slight increase of DNA fragmentation after thawing (p<0.05). Microvessel endothelium within thawed tissues appeared to be preserved. Granulosa cells showed signs of proliferation in follicles cultured for 12 days. Secretion of 17β-oestradiol significantly increased during in vitro culture. CONCLUSIONS This protocol leads to good preservation of ovarian integrity and functionality post-thawing and thus appears as a suitable technique of ovarian tissue cryopreservation in clinical settings. Further research could be extended to optimize conditions of in vitro culture.
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Affiliation(s)
- Sandra Sanfilippo
- Laboratoire de Biologie de la Reproduction, Université Clermont 1, UFR Médecine, E.A. 975, 28 Place Henri Dunant, 63001, Clermont-Ferrand Cedex 1, France.
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Troude P, Ancelet S, Guibert J, Pouly JL, Bouyer J, de La Rochebrochard E. Joint modeling of success and treatment discontinuation in in vitro fertilization programs: a retrospective cohort study. BMC Pregnancy Childbirth 2012; 12:77. [PMID: 22862824 PMCID: PMC3514282 DOI: 10.1186/1471-2393-12-77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 07/27/2012] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND As discontinuation in in vitro fertilization (IVF) programs has been associated with a poor prognosis, one hypothesis is that some couple-specific predictive factors in IVF may be shared with opposite effect by both success (i.e. live birth) and treatment discontinuation processes. Our objective was to perform a joint analysis of these two processes to examine the hypothesis of a link between the two processes. METHODS Analyses were conducted on a retrospective cohort of 3,002 women who began IVF between 1998 and 2002 in two French IVF centers: a Parisian center and a center in a medium-sized city in central France. A shared random effects model based on a joint modelization of IVF treatment success and discontinuation was used to study the link between the two processes. RESULTS Success and discontinuation processes were significantly linked in the medium-sized city center, whereas they were not linked in the Parisian center. The center influenced risk of treatment discontinuation but not chance of success. The well-known inverse-J relation between the woman's age and chance of success was observed, as expected. Risk of discontinuation globally increased as the woman's age increased. CONCLUSIONS The link between success and discontinuation processes could depend on the fertility center. In particular, the woman's decision to pursue or to discontinue IVF in a particular center could depend on the presence of other IVF centers in the surrounding area.
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de Bennetot M, Rabischong B, Aublet-Cuvelier B, Belard F, Fernandez H, Bouyer J, Canis M, Pouly JL. Fertility after tubal ectopic pregnancy: results of a population-based study. Fertil Steril 2012; 98:1271-6.e1-3. [PMID: 22818285 DOI: 10.1016/j.fertnstert.2012.06.041] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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: 04/11/2012] [Revised: 06/12/2012] [Accepted: 06/14/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility. DESIGN Observational population based-study. SETTING Regional sistry. PATIENT(S) One thousand sixty-four women registered from 1992 to 2008. INTERVENTION(S) Laparoscopic (radical or conservative), or medical treatment. MAIN OUTCOME MEASURE(S) Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence. RESULT(S) The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy. CONCLUSION(S) Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention.
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Affiliation(s)
- Marianne de Bennetot
- Department of Obstetrics and Gynecology, Pôle de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
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Botchorishvili R, Rabischong B, Larraín D, Khoo CK, Gaia G, Jardon K, Pouly JL, Jaffeux P, Aublet-Cuvelier B, Canis M, Mage G. Educational value of an intensive and structured interval practice laparoscopic training course for residents in obstetrics and gynecology: a four-year prospective, multi-institutional recruitment study. J Surg Educ 2012; 69:173-179. [PMID: 22365862 DOI: 10.1016/j.jsurg.2011.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/25/2011] [Accepted: 08/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the educational value of an ongoing interval practice laparoscopy training program among obstetrics and gynecology residents. DESIGN Prospective cohort, multi-institutional recruitment study. We conducted structured laparoscopic training sessions for residents, using both inanimate and porcine models. The 6-day course was separated into two 3-day long modules conducted 2 months apart. A prospective evaluation of standardized tasks was performed using validated scales. Resident's performance was compared using the Student t test and Wilcoxon signed-rank test when appropriate. SETTING International Center of Endoscopic Surgery (CICE), Clermont-Ferrand, France. PARTICIPANTS 191 PGY2 or PGY3 residents from different institutions. RESULTS Significant improvement in time and technical scores for both laparoscopic suturing and porcine nephrectomy was noted (p < 0.0001). After 2 months, we found no improvement in suturing time (p = 0.59) or technical scores (p = 0.62), and significant technical deterioration was observed for the right hand (p = 0.02). Porcine nephrectomy improvement remained significant after 2 months (p < 0.0001). CONCLUSIONS Despite significant short-term educational value of interval practice in laparoscopic performance, some acquired skills seem to deteriorate faster than anticipated.
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Affiliation(s)
- Revaz Botchorishvili
- Service de Gynecologie-Obstetrique et Medecine de la Reproduction, CHU Estaing, Clermont-Ferrand, France.
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Soullier N, Bouyer J, Pouly JL, Guibert J, de La Rochebrochard E. Effect of the woman's age on discontinuation of IVF treatment. Reprod Biomed Online 2011; 22:496-500. [PMID: 21397562 DOI: 10.1016/j.rbmo.2011.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 01/20/2011] [Accepted: 01/25/2011] [Indexed: 11/28/2022]
Abstract
Treatment discontinuations are an important issue in IVF programmes. In the French context, financial constraint does not intervene in discontinuation until older ages. This study examined treatment discontinuation in IVF programmes, according to the woman's age and when there is no financial burden for couples. Medical records were collected for 3037 women who began their IVF programme between 1998 and 2002 in two French IVF units. Up to four attempts were taken into consideration. Cumulative success (delivery) rates were calculated, as well as discontinuation rates. Multiple imputation was applied to estimate a theoretical cumulative success rate as if no woman discontinued treatment before the end of the IVF programme without delivering. Cumulative discontinuation rates at the end of the IVF programme increased with the woman's age (41% for age <35, 56% for age 35-39, 80% for age ⩾40). The benefit in terms of delivery rates of pursuing treatment would be smaller for older women (∼10% for age <35, 7% for age 35-39, 4% for age ⩾40). Even when treatment is reimbursed, the discontinuation rate is high for older women, suggesting that the strong decrease in success rate with age induces older women to discontinue. Treatment discontinuations are an important issue in IVF programmes. In the French context, financial constraint does not intervene in discontinuation until older ages. We aimed to examine treatment discontinuation in IVF programmes, according to the woman's age and when there is no financial burden for couples. Medical records were collected for 3037 women who began their IVF programme between 1998 and 2002 in two French IVF units. Up to four attempts were taken into consideration. Cumulative success (delivery) rates were calculated, as well as discontinuation rates. Multiple imputation was applied to estimate a theoretical cumulative success rate as if no woman discontinued treatment before the end of the IVF programme without delivering. Cumulative discontinuation rates at the end of the IVF programme increased with the woman's age (41% for age <35, 56% for age 35-39, 80% for age ⩾40). The benefit in terms of delivery rates of pursuing treatment would be smaller for older women (∼10% for age <35, 7% for age 35-39, 4% for age ⩾40). Even when treatment is reimbursed, the discontinuation rate is high for older women, suggesting that the strong decrease in success rate with age induces older women to discontinue.
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Affiliation(s)
- Noémie Soullier
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, F-94276 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France; INED, F-75020 Paris, France
| | - Jean Bouyer
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, F-94276 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France; INED, F-75020 Paris, France
| | - Jean-Luc Pouly
- Unité de FIV, CHU de Clermont-Ferrand, F-63003 Clermont-Ferrand, France
| | - Juliette Guibert
- Unité de Médecine de la Reproduction, Service de Gynécologie-Obstétrique II, Hôpital Cochin, F-75014 Paris, France; Laboratoire de Procréation Médicalement Assistée, Institut Mutualiste de Montsouris, F-75014 Paris, France
| | - Elise de La Rochebrochard
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, F-94276 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France; INED, F-75020 Paris, France
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Larraín D, Marengo F, Bourdel N, Jaffeux P, Aublet-Cuvelier B, Pouly JL, Mage G, Rabischong B. Proximal ectopic pregnancy: a descriptive general population–based study and results of different management options in 86 cases. Fertil Steril 2011; 95:867-71. [DOI: 10.1016/j.fertnstert.2010.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 09/02/2010] [Accepted: 10/13/2010] [Indexed: 01/23/2023]
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Chevalier N, Letur H, Lelannou D, Ohl J, Cornet D, Chalas-Boissonnas C, Frydman R, Catteau-Jonard S, Greck-Chassain T, Papaxanthos-Roche A, Dulucq MC, Couet ML, Cédrin-Durnerin I, Pouly JL, Fénichel P. Materno-fetal cardiovascular complications in Turner syndrome after oocyte donation: insufficient prepregnancy screening and pregnancy follow-up are associated with poor outcome. J Clin Endocrinol Metab 2011; 96:E260-7. [PMID: 21147890 DOI: 10.1210/jc.2010-0925] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [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: 02/12/2023]
Abstract
CONTEXT Recombinant human GH treatment and oocyte donation (OD) have improved the quality of life in women with Turner syndrome (TS). However, life expectancy is reduced, mainly due to cardiovascular complications. Pregnancy may itself increase that risk and be associated with hazardous materno-fetal outcome. OBJECTIVE The objective of this study was to evaluate the materno-fetal outcome of ongoing pregnancies beyond 20 wk of gestation obtained by OD in TS. DESIGN This was a multicenter retrospective study including all assisted reproductive technology centers affiliated with the French Study Group for Oocyte Donation. RESULTS Among 93 patients, only 37.6% were prescreened with echocardiography or thoracic magnetic resonance imaging. Maternal outcome was dominated by 37.8% of pregnancy-associated hypertensive disorders including preeclampsia in 54.8% and severe eclampsia in four patients. Prematurity occurred in 38.3% and was correlated with pregnancy-associated hypertensive disorder (P = 0.01). The frequency of in utero growth retardation was 27.5%. One fetal demise was linked to eclampsia. Two patients died from aortic rupture after cesarean section in a context of aortic root dilatation. Only 40% of pregnancies were associated with an absolutely normal materno-fetal outcome. CONCLUSIONS OD pregnancies in TS who have not been managed following recent specific recommendations were at high risk for maternal death by aortic dissection and for preeclampsia and its complications (fetal distress and in utero growth retardation). These recommendations include previous echocardiography, thoracic magnetic resonance imaging, and overnight blood pressure monitoring associated with a tight follow-up during pregnancy. Until future assessment of these recent recommendations, pregnancies obtained in TS after OD must be still considered as very high-risk pregnancies.
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Affiliation(s)
- Nicolas Chevalier
- Department of Endocrinology and Reproductive Medicine, Centre Hospitalier Universitaire de Nice and Institut National de la Santé et de la Recherche Médicale Unité 895/C3M, 06202 Nice, France
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Rabischong B, Tran X, Sleiman AA, Larraín D, Jaffeux P, Aublet-Cuvelier B, Pouly JL, Fernandez H. Predictive factors of failure in management of ectopic pregnancy with single-dose methotrexate: a general population-based analysis from the Auvergne Register, France. Fertil Steril 2011; 95:401-4, 404.e1. [DOI: 10.1016/j.fertnstert.2010.08.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/27/2010] [Accepted: 08/13/2010] [Indexed: 11/15/2022]
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Kondo W, Bourdel N, Cotte B, Tran X, Botchorishvili R, Jardon K, Rabischong B, Pouly JL, Mage G, Canis M. Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis? BJOG 2010; 117:1027-30. [PMID: 20465557 DOI: 10.1111/j.1471-0528.2010.02580.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this retrospective study of 314 patients undergoing surgery for ovarian dermoid cysts, conducted over a 20-year period, we evaluated the impact of the routine use of laparoscopic surgery without recourse to laparotomy to retrieve the specimen, using an endoscopic retrieval bag placed under the cyst to prevent intraperitoneal spillage of cyst contents, and subsequent postoperative granulomatous peritonitis. Accidental cyst rupture was more frequent when a total laparoscopic approach was used (26/174 or 15% versus 39/140 or 28%; P = 0.005), but there were no cases of intraperitoneal spillage when an endoscopic bag was used. Two cases of granulomatous peritonitis developed out of 26 women with intraperitoneal spillage of cyst contents (8%). We conclude that the risk of granulomatous peritonitis can be minimised by undertaking laparoscopic removal of dermoid cysts with the routine intraoperative use of an endoscopic retrieval bag to prevent intraperitoneal spillage of cyst contents.
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Affiliation(s)
- W Kondo
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Clermont-Ferrand, Polyclinique de l'Hôtel Dieu, Clermont-Ferrand, France.
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Matsuzaki S, Canis M, Darcha C, Pouly JL, Mage G. HOXA-10 expression in the mid-secretory endometrium of infertile patients with either endometriosis, uterine fibromas or unexplained infertility. Hum Reprod 2009; 24:3180-7. [PMID: 19736237 DOI: 10.1093/humrep/dep306] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate HOXA-10 expression in endometrium from infertile patients with different forms of endometriosis; with uterine fibromas, or with unexplained infertility and from normal fertile women. METHODS Expression levels of HOXA-10 mRNA and protein in endometrium were measured during the mid-secretory phase. This study utilized laser capture microdissection, real-time RT-PCR and immunohistochemistry. RESULTS HOXA-10 mRNA and protein expression levels in endometrial stromal cells were significantly lower in infertile patients with different types of endometriosis (deep infiltrating endometriosis, ovarian endometriosis and superficial peritoneal endometriosis), with uterine myoma, and unexplained infertility patients as compared with healthy fertile controls. HOXA-10 mRNA expression levels of microdissected glandular epithelial cells were significantly lower than those of microdissected stromal cells, without significant differences among the different groups. No protein expression was detected in glandular epithelial cells. The percentage of patients with altered protein expression of HOXA-10 in stromal cells were significantly higher in patients with only superficial peritoneal endometriosis (100%, 20/20, P < 0.05) compared with the other infertile groups (deep infiltrating endometriosis: 72.7%, 16/22; ovarian endometriosis: 70.0%, 14/20; uterine myoma: 68.8%, 11/16; unexplained infertility: 55.6%, 5/9). CONCLUSION The present findings suggested that altered expression of HOXA-10 in endometrial stromal cells during the window of implantation may be one of the potential molecular mechanisms of infertility in infertile patients, particularly in patients with only superficial peritoneal endometriosis. One of the underlying causes of infertility in patients with only superficial endometriosis may be altered expression of HOXA-10 in endometrial stromal cells.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Polyclinique-Hôtel-Dieu, Gynécologie Obstétrique et Médecine de la Reproduction, Boulevard Léon Malfreyt, 63058 Clermont-Ferrand, France.
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Matsuzaki S, Houlle C, Botchorishvili R, Pouly JL, Mage G, Canis M. Excision of the posterior vaginal fornix is necessary to ensure complete resection of rectovaginal endometriotic nodules of more than 2 cm in size. Fertil Steril 2009; 91:1314-5. [DOI: 10.1016/j.fertnstert.2008.01.101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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Matsuzaki S, Houlle C, Darcha C, Pouly JL, Mage G, Canis M. Analysis of risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis. Hum Reprod 2009; 24:1402-6. [PMID: 19246468 DOI: 10.1093/humrep/dep043] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to identify risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for endometriosis. METHODS A total of 121 patients who had histologically confirmed ovarian endometriosis and 56 control patients who had other histologically confirmed benign cysts were included for the present analysis. The blocks of removed tissue were sectioned at 120 microm intervals and a total of five sections were analyzed for each ovarian cyst. Eight variables (age, pre-operative medical treatment, previous surgery for ovarian endometriosis, single or multiple cysts, size of the largest cyst, side of cyst, co-existence of deep endometriosis, revised American Society for Reproductive Medicine classification) were evaluated using a generalized linear modeling analysis to identify major factors associated with the removal of normal ovarian tissue. RESULTS Normal ovarian tissue adjacent to the cyst wall was detected in 71 patients (58.7%) with endometriosis, whereas normal ovarian tissue was removed from only three patients (5.4%) with other benign cysts. A significant factor that was independently associated with the removal of normal ovarian tissue with ovarian endometriosis was pre-operative medical treatment. CONCLUSIONS The present retrospective, controlled study suggests that pre-operative medical treatment might be a risk factor for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Polyclinique-Hôtel-Dieu, Gynécologie Obstétrique et Médecine de la Reproduction, Boulevard Léon Malfreyt, 63058 Clermont-Ferrand, France.
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Velemir L, Gallot D, Jardon K, Mage G, Pouly JL. Uterine rupture at 26 weeks after metroplasty for uterine enlargement in diethylstilbestrol-exposed uterus: A case report. Eur J Obstet Gynecol Reprod Biol 2008; 138:243-4. [PMID: 17478028 DOI: 10.1016/j.ejogrb.2007.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 03/07/2007] [Accepted: 03/23/2007] [Indexed: 11/30/2022]
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Bourdel N, Matsuzaki S, Bazin JE, Darcha C, Pouly JL, Mage G, Canis M. Postoperative peritoneal dissemination of ovarian cancer cells is not promoted by carbon-dioxide pneumoperitoneum at low intraperitoneal pressure in a syngenic mouse laparoscopic model with controlled respiratory support: a pilot study. J Minim Invasive Gynecol 2008; 15:321-6. [PMID: 18439505 DOI: 10.1016/j.jmig.2008.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 02/04/2008] [Accepted: 02/08/2008] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To investigate postoperative peritoneal dissemination of ovarian cancer cells in a syngenic mouse model with and without controlled respiratory support (CRS). DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING Academic facility. SUBJECTS Sixty-four female C57BJ6 mice. INTERVENTIONS Mice were randomly divided into 4 surgical groups: anesthesia alone group; 2 carbon-dioxide pneumoperitoneum groups, 1 with low (2 mm Hg) and 1 with high (8 mm Hg) intraperitoneal pressure (IPP); and finally the laparotomy group. Each of the 4 groups was then subdivided into one group with CRS and the other without. Mouse ovarian cancer cells were injected intraperitoneally just before surgery. MEASUREMENTS AND MAIN RESULTS A laparotomy was performed to evaluate postoperative peritoneal dissemination of ovarian cancer cells on postoperative day 14. A computerized analysis system was then used to evaluate peritoneal dissemination. In the groups with CRS, the peritoneal dissemination score was significantly higher in the laparotomy and high IPP groups compared with anesthesia alone (p <.0001 vs laparotomy, p <.002 vs high IPP) and low IPP (p <.0002 vs laparotomy, p <.004 vs high IPP) groups. No significant difference was detected between the low IPP and anesthesia alone groups. CONCLUSION Postoperative peritoneal dissemination of ovarian cancer cells is not promoted by a carbon-dioxide pneumoperitoneum with a low IPP in a mouse model with CRS when assessed on postoperative day 14.
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Affiliation(s)
- Nicolas Bourdel
- Université d'Auvergne-Clermont I, Centre d'Endoscopie et des Nouvelles Techniques Interventionnelles, Clermont-Ferrand, France
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Matsuzaki S, Canis M, Darcha C, Déchelotte PJ, Pouly JL, Mage G. Effects of a protein kinase C inhibitor on the initial development of ectopic implants in a syngeneic mouse model of endometriosis. Fertil Steril 2008; 89:206-11. [PMID: 17481625 DOI: 10.1016/j.fertnstert.2007.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Revised: 02/16/2007] [Accepted: 02/21/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effect of protein kinase C inhibition on surgically induced endometriosis in mice. DESIGN Prospective, randomized study. SETTING Academic facility. ANIMALS Sixty adult female C57BJ6 mice. INTERVENTION(S) On day -7, oral gavage of a vehicle alone or of a protein kinase C inhibitor (100 mg/kg/day, once a day) was started and continued for 1 week in donor groups A and B, respectively. On day 0, uterine fragments from donor group A were implanted into recipient mice. Recipient mice were divided randomly into two groups: group 1 (vehicle) and group 2 (protein kinase C inhibitor). Uterine fragments from donor group B were implanted into recipient mice, and they were divided randomly into two groups: group 3 (vehicle) and group 4 (protein kinase C inhibitor). Oral gavage of a protein kinase C inhibitor (100 mg/kg/day, once a day) or vehicle was continued for 1 week. MAIN OUTCOME MEASURE(S) Presence and number of ectopic implants. RESULT(S) The number of mice that developed ectopic implants was significantly lower in groups 3 (40%) and 4 (30%) than in group 1 (100%). The number of ectopic implants was significantly lower in groups 2, 3, and 4 than in group 1. CONCLUSION(S) Protein kinase C inhibitor use partially prevented the development of ectopic implants in a mouse model of endometriosis.
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Affiliation(s)
- Sachiko Matsuzaki
- Université d'Auvergne-Clermont I, Centre d'Endoscopie et des Nouvelles Techniques Interventionnelles, Clermont-Ferrand, France.
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Soullier N, Bouyer J, Pouly JL, Guibert J, de La Rochebrochard E. Estimating the success of an in vitro fertilization programme using multiple imputation. Hum Reprod 2007; 23:187-92. [PMID: 17977864 DOI: 10.1093/humrep/dem352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The outcome of in vitro fertilization (IVF) has been widely investigated over the last 30 years, but evaluation was mostly based on pregnancy rate per oocyte retrieval. Our objective was to estimate the cumulative live birth rate after four IVF aspirations, using multiple imputation that takes into account treatment interruptions. METHODS We analysed data from 3037 couples beginning IVF treatment between 1998 and 2002 in two French IVF units. Multiple imputations were used at each aspiration to impute the IVF outcome (delivery or not) for couples who interrupted treatment. The global success rate after four aspirations was then computed. RESULTS At the first aspiration, 21% of couples obtained a live birth and 24% discontinued treatment. The multiple imputation method provided an estimated cumulative live birth rate at each aspiration as if no couple discontinued treatment: 35% at the second aspiration and 41% at the third. The cumulative success rate after four aspirations was estimated at 46% (95% CI: 44-48%). CONCLUSIONS Multiple imputation is a promising method for estimating the cumulative success rate of IVF. It could provide new insight on IVF evaluation and should be tested in further studies.
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Affiliation(s)
- N Soullier
- INSERM, U822, 82 rue du Général Leclerc, F-94276 Le Kremlin-Bicêtre Cedex, France.
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Canis M, Jardon K, Niro J, Rabischong B, Bourdel N, Botchorishvili R, Pouly JL, Mage G. [Endoscopic management of gynecological malignancies: an update. 2007]. Bull Acad Natl Med 2007; 191:1357-1366. [PMID: 18447057] [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: 05/26/2023]
Abstract
All the different surgical procedures used to treat gynecologic cancers have already been performed with the endoscopic approach. However, the prospective randomized trials required to confirm the oncologic efficacy of this approach are still lacking in gynecology, whereas such studies are available for abdominal surgery. Animal studies suggest that the risk of tumor dissemination in the non traumatized peritoneum may be higher after pneumoperitoneum than after laparotomy, and they also show the importance of the surgeon's experience and technique. All the parameters of pneumoperitoneum can influence the risk of postoperative dissemination. By controlling these parameters we may, in future, be able to create a peritoneal environment suitable for oncologic indications and thereby prevent or minimize the risk of peritoneal dissemination and postoperative tumor growth. In endometrial cancer, the laparoscopic approach should be reserved for clinical stage I disease, if the volume of the uterus and local conditions are appropriate for vaginal extraction. In cervical cancer, the laparoscopic approach should be reserved for patients with favorable prognostic factors (stage IB, less than 2 cm in diameter). Laparoscopy is the gold standard for surgical diagnosis of adnexal masses, but puncture should be avoided whenever possible. Surgical treatment of invasive ovarian cancer should use laparotomy, whatever the stage. In contrast, restaging of early ovarian cancer initially managed as a benign mass is a good indication for the laparoscopic approach. Laparoscopic management of tumors with low malignant potential should include complete staging of the peritoneum. An excellent knowledge of the principles of endoscopy and of oncologic surgery is required. Training in endoscopic oncological techniques will be a major challenge in the field of gynecologic surgery in coming years.
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Affiliation(s)
- Michel Canis
- Gynécologie obstétrique et médecine de la reproduction, Université d'Auvergne Clermont 1, Polyclinique de l'Hôtel Dieu, CHU de Clermont-Ferrand.
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Matsuzaki S, Canis M, Bazin JE, Darcha C, Pouly JL, Mage G. Effects of supplemental perioperative oxygen on post-operative abdominal wound adhesions in a mouse laparotomy model with controlled respiratory support. Hum Reprod 2007; 22:2702-6. [PMID: 17720702 DOI: 10.1093/humrep/dem114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Post-operative adhesion formation is a major clinical problem. Tissue oxygenation is one of the most important determinants in adhesion formation. The objective of this study was to investigate whether supplemental perioperative oxygen could reduce post-operative adhesion formation through increasing the peritoneal tissue oxygen tension (PitO(2)) in a mouse model. METHODS Adult C57BJ6 mice were randomly assigned to two groups: Group 1 (n = 20), Fraction of Inspired Oxygen (FiO(2)): 0.21; Group 2 (n = 20), FiO(2): 0.80. On day 0, over the course of the 90 min procedure including the 60 min of laparotomy, PitO(2) was continuously monitored. On day 7, a second laparotomy was performed to assess abdominal wound adhesions. Real-time RT-PCR was performed to measure expression levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) mRNA in peritoneal tissues. RESULTS The PitO(2) levels in Group 2 were significantly higher compared to Group 1 (P < 0.001) and controls (P < 0.003). There was no significant difference in the incidence of abdominal wound adhesions; however, the severity of adhesions was significantly reduced in Group 2 compared to Group 1 (P < 0.03). A significantly higher tPA/PAI-1 mRNA ratio was detected in Group 2 and the controls compared to Group 1 (P < 0.02 and P < 0.002, respectively). CONCLUSIONS Supplemental perioperative oxygen may help to reduce post-operative adhesion formation.
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Affiliation(s)
- Sachiko Matsuzaki
- Université d'Auvergne - Clermont I, Faculté de Médecine, Centre d'Endoscopie et des Nouvelles Techniques Interventionnelles (CENTI), Clermont-Ferrand, France.
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Seror V, Gelfucci F, Gerbaud L, Pouly JL, Fernandez H, Job-Spira N, Bouyer J, Coste J. Care pathways for ectopic pregnancy: a population-based cost-effectiveness analysis. Fertil Steril 2007; 87:737-48. [PMID: 17222832 DOI: 10.1016/j.fertnstert.2006.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 02/27/2006] [Revised: 10/31/2006] [Accepted: 11/02/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To define care pathways in terms of frequency, costs, and outcomes and to assess their cost-effectiveness. DESIGN Population-based cost-effectiveness study. SETTING Auvergne EP registry (France). PATIENT(S) Women (n = 1,664) registered between 1994 and 2003. INTERVENTION(S) Standard diagnosis and treatment of EP. MAIN OUTCOME MEASURE(S) Costs before, during, and after hospitalization were assessed from data concerning medical costs of examinations and treatments. One-year fertility was used for effectiveness assessment. We assessed cost-effectiveness for the healthcare system. RESULT(S) Diagnostic ultrasound (47% of scans were nondiagnostic) was essential for the use of methotrexate as a first-line treatment for subacute EP. Hospital and ambulatory care costs were similar for all surgical-care pathways (diagnostic or nondiagnostic ultrasound scan followed by conservative or radical laparoscopy). Hospital and ambulatory-care costs associated with methotrexate treatment were less than half those for surgical-care pathways. In subacute cases, conservative treatments, and methotrexate in particular, were associated with better fertility at similar or lower cost to salpingectomy for EP for reproductive failure. CONCLUSION(S) Conservative treatments are cost-effective with respect to salpingectomy, when subsequent fertility is at stake. Efforts should be made to increase the frequency of diagnostic ultrasound scans, making it possible to increase methotrexate use and cost-effectiveness.
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Affiliation(s)
- Valérie Seror
- INSERM Unité 379, Institut Paoli-Calmettes, Marseille, France
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Bourdel N, Matsuzaki S, Bazin JE, Pouly JL, Mage G, Canis M. Peritoneal tissue-oxygen tension during a carbon dioxide pneumoperitoneum in a mouse laparoscopic model with controlled respiratory support. Hum Reprod 2007; 22:1149-55. [PMID: 17208946 DOI: 10.1093/humrep/del482] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous animal studies suggested that the peritoneal environment during a carbon dioxide (CO(2)) pneumoperitoneum is hypoxic and that this may contribute to the formation of intra-abdominal adhesions or the growth of malignant cells. There is no study, however, that investigates the relationship between anaesthesia, ventilation and the laparoscopic peritoneal environment to the development of hypoxia. The objective of this study is to monitor the peritoneal tissue-oxygen tension (PitO(2)) under various conditions including anaesthesia alone, during a CO(2) pneumoperitoneum at both low and high intraperitoneal pressure (IPP), and laparotomy, in animal models with controlled respiratory support (CRS). METHODS C57BL6 mice were divided into eight groups (n = 5) consisting of anaesthesia alone or with CO(2) pneumoperitoneum at low (2 mmHg) or high (8 mmHg) IPP or undergoing laparotomy. Groups were further subdivided into those with or without CRS with endotracheal intubation and mechanical ventilation. Over the course of the 1 h procedure, PitO(2) was continuously monitored. RESULTS Protocol 1. The PitO(2) levels (104.2 +/- 7.8 mmHg, mean +/- SEM) in non-injured peritoneum during a CO(2) pneumoperitoneum at a low IPP were elevated approximately 2-fold over the levels during laparotomy (49.8 +/- 15.0 mmHg) in ventilated mice. Protocol 2. After insufflation with CO(2), the PitO(2) was immediately elevated and maintained at a higher level. Following laparotomy, it decreased immediately. This elevation was not seen with air insufflation. CONCLUSION In mice, a significant elevation in PitO(2) occurs during a CO(2) pneumoperitoneum at low IPP with CRS.
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Affiliation(s)
- Nicolas Bourdel
- Université d'Auvergne - Clermont I, Centre d'Endoscopie et des Nouvelles Techniques Interventionnelles (CENIT), Faculté de Médecine, Clermont-Ferrand, France
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Salvatores M, Pellegrini P, Botchorishvili R, Canis M, Pouly JL, Mage G, Wattiez A. [Laparoscopic promontal fixation: assessment of 100 cases]. Minerva Ginecol 2006; 58:405-10. [PMID: 17006427] [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: 05/12/2023]
Abstract
AIM Aim of the study is to evaluate long term results of 100 patients treated laparoscopically to repair genital prolapse and urinary incontinence. METHODS A retrospective review analysis of 100 women, who underwent laparoscopic genital prolapse repair at Primary Referral University Hospital in Clermont-Ferrand. Patients characteristics, preoperatory exams, intraoperative, postoperative and outpatient clinic data were collected and analyzed. RESULTS The mean operative time was 172 minutes. One laparotomy conversion was required, due to a technical problem. The mean hospitalization stay was 4.7 days. Two patients required a reintervention during their hospitalization stay, due to a complication. All the patients were reviewed during the 6 months later the intervention. The follow-up is between 6 months and 3 years. The average degree of cystocele and hysterocele was ameliorated from stage 3 to stage 0, the average stage of rectocele was ameliorated from stage 2 to stage 0, finally the average stage of vault prolapse was ameliorated from stage 1 to stage 0. The incidence of genuine stress incontinence was 47% in the preoperative time and only 4% at the long follow-up. We had a total 4% rate of mesh vaginal erosion. CONCLUSIONS The laparoscopic sacrocolpopexy is an effective and safe technique to repair the major pelvic prolapses.
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Affiliation(s)
- M Salvatores
- Polyclinique de l'Hotel Dieu, University of Clermont-Ferrand, Clermont-Ferrand, France.
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Matsuzaki S, Canis M, Pouly JL, Rabischong B, Botchorishvili R, Mage G. Relationship between delay of surgical diagnosis and severity of disease in patients with symptomatic deep infiltrating endometriosis. Fertil Steril 2006; 86:1314-6; discussion 1317. [PMID: 16978622 DOI: 10.1016/j.fertnstert.2006.03.048] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 03/25/2006] [Accepted: 03/25/2006] [Indexed: 10/24/2022]
Abstract
We investigated relationships between delay of surgical diagnosis and severity of disease in 95 patients with symptomatic deep infiltrating endometriosis. The delay before surgical diagnosis of deep infiltrating endometriosis was significantly longer for patients with advanced stage IV (revised American Society for Reproductive Medicine [ASRM] score >70) disease than for those with stage I, II, III, or IV (revised ASRM score <or=70) disease.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Polyclinique de l'Hôtel-Dieu, Gynécologie Obstétrique et Médecine de la Reproduction, Clermont-Ferrand, France.
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Matsuzaki S, Canis M, Pouly JL, Botchorishvili R, Déchelotte PJ, Mage G. Differential expression of genes in eutopic and ectopic endometrium from patients with ovarian endometriosis. Fertil Steril 2006; 86:548-53. [PMID: 16815388 DOI: 10.1016/j.fertnstert.2006.02.093] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [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: 09/26/2005] [Revised: 02/06/2006] [Accepted: 02/06/2006] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate whether genes that had been found to be differentially expressed in deep-infiltrating endometriosis and matched eutopic endometrium in our previous complementary DNA microarray study also are differentially expressed in ovarian endometriosis and matched eutopic endometrium. DESIGN Prospective study. SETTING University hospital in France. PATIENT(S) Patients with ovarian endometriosis. INTERVENTION(S) During surgery, paired samples of tissue representing ovarian endometriosis and eutopic endometrium were obtained from 12 patients. MAIN OUTCOME MEASURE(S) Expression levels of messenger RNA for heat shock protein 90 alpha (HSP90A), chicken ovalbumin upstream promoter transcription factor 2 (COUP-TF2), prostaglandin E(2) receptor subtype EP3 (PGE(2)EP3), tyrosine kinase receptor B (TrKB), and 17beta-hydroxysteroid dehydrogenase type 2 (17betaHSD2; epithelial cells) and of platelet-derived growth factor receptor alpha (PDGFRA), protein kinase C beta 1 (PKCbeta1), Janus kinase 1 (JAK1), mitogen-activated protein kinase kinase (MKK7), Sprouty2, mu-opioid receptor (MOR), and 5HTT (stromal cells) from ovarian endometriosis and matched eutopic endometrium were determined by using laser capture microdissection and real-time reverse-transcription polymerase chain reaction (RT-PCR) techniques. RESULT(S) Expression of PDGFRA, PKCbeta1, JAK1, HSP90A, COUP-TF2, MOR, and 17betaHSD2 was significantly higher in ovarian endometriosis than in eutopic endometrium, whereas that of Sprouty2 and PGE(2)EP3 was significantly lower. There was no significant difference in mitochondrial RNA expression of MKK 7, TrKB, and 5HTT. CONCLUSION(S) Ovarian endometriosis might share several common molecules with deep-infiltrating endometriosis that act to sustain endometriotic lesions, whereas molecules involved in local endocrine control might be different between these two types of endometriosis.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Polyclinique-Hôtel-Dieu, Gynécologie Obstétrique et Médecine de la Reproduction, France.
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Matsuzaki S, Canis M, Darcha C, Déchelotte PJ, Pouly JL, Mage G. Expression of WT1 is down-regulated in eutopic endometrium obtained during the midsecretory phase from patients with endometriosis. Fertil Steril 2006; 86:554-8. [PMID: 16879825 DOI: 10.1016/j.fertnstert.2006.02.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 07/08/2005] [Revised: 02/07/2006] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate whether WT1 protein expression is altered in eutopic endometrium of endometriosis patients. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Patients with endometriosis and fertile women with macroscopically normal pelvic cavities. INTERVENTION(S) During surgery, endometrial tissues were obtained from 59 patients with deep infiltrating endometriosis, ovarian endometriosis, or only superficial peritoneal endometriosis. Control endometrial tissue samples were obtained from 40 fertile women who underwent laparoscopic tubal ligation or reversal of tubal sterilization. MAIN OUTCOME MEASURE(S) The percentage of nuclear surface positively immunostained for WT1 (PI) and WT1-positive microvessel density. RESULT(S) The PI was significantly lower in endometrial stromal cells from patients with deep infiltrating endometriosis than in stroma from control subjects during the midsecretory phase, whereas there was no significant difference between the two populations during the proliferative, early secretory, and late secretory phases. The PI was also significantly lower during the midsecretory phase in endometrial stromal cells from patients with ovarian endometriosis and superficial peritoneal endometriosis compared with control subjects. CONCLUSION(S) During the midsecretory phase, PI in endometrial stromal cells is down-regulated in patients with deep infiltrating endometriosis, ovarian endometriosis, and superficial peritoneal endometriosis compared with endometrium from healthy control subjects.
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Affiliation(s)
- Sachiko Matsuzaki
- CHU Clermont-Ferrand, Polyclinique-Hôtel-Dieu, Gynécologie Obstétrique et Médecine de la Reproduction, France.
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Matsuzaki S, Canis M, Pouly JL, Déchelotte PJ, Mage G. Analysis of aromatase and 17beta-hydroxysteroid dehydrogenase type 2 messenger ribonucleic acid expression in deep endometriosis and eutopic endometrium using laser capture microdissection. Fertil Steril 2006; 85:308-13. [PMID: 16595205 DOI: 10.1016/j.fertnstert.2005.08.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [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: 05/04/2005] [Revised: 08/03/2005] [Accepted: 08/03/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate mRNA expression of aromatase and 17beta-hydroxysteroid dehydrogenase type 2 (17betaHSD2) in epithelial and stromal cells from eutopic and ectopic endometrium of patients with deep endometriosis. DESIGN Prospective study. SETTING University hospital. PATIENT(S) Patients with deep endometriosis and fertile women with macroscopically normal pelvic cavities. INTERVENTION(S) During surgery, 30 endometrial and 16 endometriotic samples were obtained from 30 patients with deep endometriosis. Control endometrial samples were obtained from 24 fertile women with macroscopically normal pelvic cavities who underwent laparoscopic tubal ligation or reversal of tubal sterilization. Epithelial cells and stromal cells from endometrial or endometriotic tissues were microdissected using laser capture microdissection. MAIN OUTCOME MEASURE(S) Expression levels of aromatase and 17betaHSD2 mRNA in microdissected epithelial and stromal cells were determined using quantitative real-time reverse transcriptase polymerase chain reaction. RESULT(S) Aromatase mRNA expression was significantly higher in epithelial cells than in stromal cells in both eutopic and ectopic endometrium obtained from endometriosis patients. In the ectopic endometrium of 8 patients (8/16, 50%), 17betaHSD2 expression was not detected in either epithelial or stromal cells. In eutopic endometrium from endometriosis patients, 17betaHSD2 expression in epithelial cells was significantly increased during the early, middle, and late secretory phases compared with the late proliferative phase, whereas no significant cyclical difference was detected in control endometrium. CONCLUSION(S) Local estrogen concentration may be much higher in epithelial cells than in stromal cells in deep endometriotic tissue.
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Affiliation(s)
- Sachiko Matsuzaki
- Department of Gynecology, Polyclinique de l'Hôtel-Dieu, CHU, Clermont-Ferrand, France.
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Huirne JA, Hugues JN, Pirard C, Fischl F, Sage JC, Pouly JL, Obruca A, Braat DM, van Loenen ACD, Lambalk CB. Cetrorelix in an oral contraceptive-pretreated stimulation cycle compared with buserelin in IVF/ICSI patients treated with r-hFSH: a randomized, multicentre, phase IIIb study. Hum Reprod 2006; 21:1408-15. [PMID: 16537563 DOI: 10.1093/humrep/del030] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [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 The aim of this study was to assess the non-inferiority of an oral contraceptive (OC)-pretreated cetrorelix regimen and a buserelin regimen in IVF/ICSI patients treated with r-hFSH in terms of total number of oocytes retrieved. METHODS Multicentre, randomized study. One hundred and eighty two patients were randomized to receive cetrorelix with OC pretreatment (n = 91) or to receive buserelin (n = 91). The cetrorelix group started with daily OCs on cycle day 5 and continued for 21-28 days. Cetrorelix (0.25 mg) was given daily from stimulation day 6 up to and including the day of r-hCG administration. The buserelin group started with buserelin (500 microg/day) for at least 10 days until down-regulation was achieved, after which the dose was reduced to daily 200 microg up to and including the day of r-hCG administration. r-hFSH was started in both groups on a Friday, in the cetrorelix group 5 days after the last OC pill intake. Both regimens were followed by a standard IVF or ICSI procedure. The primary efficacy endpoint was the number of oocytes retrieved per patient. RESULTS Number of oocytes, cancellation rates, r-hFSH requirements, number of oocyte retrievals during the weekend or public holiday and number of pregnancies were similar in both groups. Both treatment regimens were well tolerated. CONCLUSIONS Cetrorelix pretreated with OCs resulted in similar number of oocytes retrieved compared with a long buserelin protocol. Both regimens were well tolerated and allowed scheduling of the oocyte retrieval, with only small number of retrievals falling on a weekend or public holiday.
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Affiliation(s)
- J A Huirne
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
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Brugnon F, Van Assche E, Verheyen G, Sion B, Boucher D, Pouly JL, Janny L, Devroey P, Liebaers I, Van Steirteghem A. Study of two markers of apoptosis and meiotic segregation in ejaculated sperm of chromosomal translocation carrier patients. Hum Reprod 2005; 21:685-93. [PMID: 16339168 DOI: 10.1093/humrep/dei401] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To try to explain the infertility of chromosomal translocation carrier patients, we compared the expression of two markers of apoptosis in the sperm of patients and of fertile donors, and we studied the meiotic segregation in the ejaculated sperm of these translocation carriers. METHODS Twenty semen samples of translocation carriers, [reciprocal (n=14) and Robertsonian translocations (n=6)], were compared with the semen samples of donors (n=20). Different tests were applied: annexin V binding assay; terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling (TUNEL); and fluorescence in situ hybridization (FISH). RESULTS The annexin V binding assay in sperm of patients with chromosomal translocation (n=17) showed a significantly increased proportion of sperm with externalized phosphatidylserine (PS) than in the control group (n=20, P<or=0.05). The rates of DNA fragmentation investigated by TUNEL reaction were higher in samples of translocation carriers (n=14) than in donors (n=20, P<0.0001). The measures by FISH technique showed that the proportions of balanced or normal gametes were predominant in the reciprocal translocation group (alternate: n=7; from 33.0 to 58.8%; adjacent I: n=7; from 4.6 to 43.8%) and in the Robertsonian translocation group (normal: n=5; from 76.0 to 88.5%). CONCLUSIONS Our data show a predominant proportion of balanced gametes in sperm of chromosomal translocation carrier patients. Moreover, PS externalization and DNA fragmentation rates are significantly higher in ejaculated sperm of these patients than in donor sperm. These tests could be used to predict the outcome of ICSI for these patients.
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Affiliation(s)
- F Brugnon
- Biologie de la Reproduction, CECOS, Département de gynécologie obstétrique et reproduction humaine and Research Centre Reproductive and Genetics, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090, Belgium.
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