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Morcel K, Merviel P, Bouée S, Le Guillou M, Carlier M, James P, Drapier H, Beauvillard D. What is the impact of endometriosis and the AFS stage on cumulative pregnancy rates in IVF programs? Reprod Health 2024; 21:13. [PMID: 38287446 PMCID: PMC10823753 DOI: 10.1186/s12978-024-01747-8] [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: 09/07/2023] [Accepted: 01/23/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Endometriosis is commonly observed in infertile women and can be staged with regard to severity [e.g. according to the American Fertility Society (AFS) classification]. This condition can cause infertility through impaired oocyte quality, fertilization disorders, tubal lesions, adhesions, deep infiltration, and adenomyosis. Although women with endometriosis often turn to in vitro fertilization (IVF) programs, the literature data on IVF outcomes are sometimes contradictory (i.e. the same as in other etiologies of infertility, or worse). The objective of the present study was to assess and compare pregnancy rates in women with and without endometriosis and according to the endometriosis stage. METHODS We retrospectively studied clinical and ongoing pregnancy rates in IVF and the cumulative pregnancy rates after frozen/thawed embryo transfers, in women without endometriosis (group A) or with endometriosis (group B). We further compared groups in which endometriosis was staged according to the revised AFS classification: stage 1/2 (group C), stage 3/4 (group D, without endometrioma), and endometrioma alone (group E). RESULTS We documented 430 cycles in group A and 460 in group B (including 56 in group C, 88 in group D and 316 in group E). After fresh or frozen/thawed embryo transfers, the differences in ongoing pregnancy rates between groups A and B were not significant. However the cumulative rates per couple were significantly lower (p < 0.05) in group D. CONCLUSIONS We recommend IVF for women with endometriosis because the pregnancy rates are similar to those observed for women with other types of infertility. This approach is in line with the international guidelines issued by assisted reproductive technology societies. These results again raise the question of whether surgical resection of deep infiltrating endometriosis (stage 3/4) should be recommended before admission to an IVF program. Trial registration This study was approved by an institutional review board (CPP Ouest VI, Brest, France): reference: B2020CE.43.
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Affiliation(s)
- Karine Morcel
- Reproductive Medicine Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
| | - Philippe Merviel
- Reproductive Medicine Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France.
| | - Sarah Bouée
- Reproductive Medicine Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
| | - Mathilde Le Guillou
- Reproductive Medicine Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
| | - Marine Carlier
- Reproductive Medicine Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
| | - Pandora James
- Reproductive Medicine Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
| | - Hortense Drapier
- Reproductive Laboratory Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
| | - Damien Beauvillard
- Reproductive Laboratory Department, ART Center, Brest University Medical Center, 2 Avenue Foch, 29200, Brest, France
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Morcel K, Merviel P, Pertuisel D, James P, Bouée S, Le Guillou M, Chabaud JJ, Roche S, Drapier H, Perrin A, Beauvillard D. Live Birth Rates in Women Under 38 Years Old with AMH Level < 1.2 ng/ml in the First In Vitro Fertilization + / - Intracytoplasmic Sperm Injection: Retrospective Study and Arguments for Care. Reprod Sci 2023; 30:1133-1142. [PMID: 36175614 DOI: 10.1007/s43032-022-01091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy; however, acceptable pregnancy rates for young women with low AMH levels were observed in IVF + / - ICSI. The objectives of this retrospective study were to evaluate the clinical pregnancy and live birth rates in the first IVF + / - ICSI cycle in women under 38 years old with AMH level < 1.2 ng/ml and to determine the arguments for care. We classified the women into three groups: group A: AMH < 0.4 ng/ml (n: 86); group B: AMH: 0.4 to 0.8 ng/ml (n: 90); and group C: AMH > 0.8 to < 1.2 ng/ml (n: 92). We recorded data on the patients' characteristics, stimulation cycles, embryo cultures, and ongoing pregnancies. No difference was observed between the three groups for the number of embryos transferred, the clinical pregnancy, and the live birth rates (LBR) per embryo transfer (LBR/transfer: 24.1% in group A, 25.9% in group B, and 28.1% in group C). The young age of the women reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF + / - ICSI.
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Affiliation(s)
- Karine Morcel
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Philippe Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.
| | - Diane Pertuisel
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Pandora James
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Sarah Bouée
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Mathilde Le Guillou
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Jean-Jacques Chabaud
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Sylvie Roche
- Department of Gynecology, Obstetrics and Reproductive Medicine, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Hortense Drapier
- Department of Reproductive Biology, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Aurore Perrin
- Department of Reproductive Biology, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Damien Beauvillard
- Department of Reproductive Biology, ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
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Goualou M, Noumegni S, de Moreuil C, Le Guillou M, De Coninck G, Hoffmann C, Robin S, Morcel K, Le Moigne E, Tremouilhac C, Merviel P, Le Mao R, Leroyer C, Bouée S, Couturaud F, Tromeur C. Venous Thromboembolism Associated with Assisted Reproductive Technology: A Systematic Review and Meta-analysis. Thromb Haemost 2023; 123:283-294. [PMID: 36588288 DOI: 10.1055/s-0042-1760255] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hormonal exposure leads to an increased risk of venous thromboembolism (VTE) but the risk of VTE associated with assisted reproductive technology (ART) is not clearly determined. METHODS We searched in PubMed, EMBASE, Web of Science, and the Cochrane Library databases and identified all relevant articles published up to February 1, 2021. The primary objective was to determine the frequency of VTE associated with ART. Secondary objectives were to determine (1) the risk of VTE associated with ART as compared to pregnancy without ART; (2) the risk of VTE associated with ovarian hyperstimulation syndrome (OHSS); and (3) to determine potential risk factors of VTE related to ART. RESULTS Fourteen studies were included. The overall frequency of VTE associated with ART was 0.23% (95% confidence interval [CI]: 0.07-0.46). Women undergoing ART had a two- to threefold increased risk of VTE as compared to spontaneous pregnancy (relative risk [RR]: 2.66; 95% CI: 1.60-4.43). The overall frequency of VTE specifically related to OHSS was <0.001%. The risk of VTE after ART complicated by OHSS, as compared to ART without OHSS, was higher but not statistically significant (RR: 14.83; 95% CI: 0.86-255.62). Risk factors of VTE associated with ART were in vitro fertilization procedure (RR, odds ratio [OR], and hazard ratio varying from 1.77, 95% CI: 1.41-2.23 to 4.99, 95% CI: 1.24-20.05), hyperhomocysteinemia (OR: 15.2; 95% CI: 2.0-115.0), polycystic ovarian syndrome (PCOS) (RR: 4.8; 95% CI: 1.7-13.4), successful ART leading to pregnancy (OR: 13.94; 95% CI: 1.41-137.45). CONCLUSION Further large prospective studies on risk factors of VTE in women undergoing ART are needed in order to optimize thromboprophylaxis in this context.
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Affiliation(s)
- Marianne Goualou
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
| | - Steve Noumegni
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
| | - Claire de Moreuil
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
| | | | - Gabrielle De Coninck
- INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
| | - Clément Hoffmann
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,F-CRIN INNOVTE, Saint-Etienne, France
| | - Sara Robin
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,F-CRIN INNOVTE, Saint-Etienne, France
| | | | - Emmanuelle Le Moigne
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,F-CRIN INNOVTE, Saint-Etienne, France
| | - Christophe Tremouilhac
- INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,Gynecology Department, CHU Brest, Brest, France
| | - Philippe Merviel
- INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,Gynecology Department, CHU Brest, Brest, France
| | - Raphael Le Mao
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France
| | - Christophe Leroyer
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,F-CRIN INNOVTE, Saint-Etienne, France
| | - Sarah Bouée
- INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,Gynecology Department, CHU Brest, Brest, France
| | - Francis Couturaud
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,F-CRIN INNOVTE, Saint-Etienne, France.,Centre d'investigation clinique INSERM 1412, University Brest, Brest, France
| | - Cécile Tromeur
- Internal and Vascular Medicine and Pulmonology Department, CHU Brest, Brest, France.,INSERM U1304 Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), University Brest, Brest, France.,F-CRIN INNOVTE, Saint-Etienne, France
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Merviel P, James P, Bouée S, Le Guillou M, Rince C, Nachtergaele C, Kerlan V. Impact of myo-inositol treatment in women with polycystic ovary syndrome in assisted reproductive technologies. Reprod Health 2021; 18:13. [PMID: 33468143 PMCID: PMC7816413 DOI: 10.1186/s12978-021-01073-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 09/16/2020] [Accepted: 01/05/2021] [Indexed: 02/02/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is marked in 30 to 40% by insulin resistance and hyperandrogenism. Myo-inositol (MI) increases insulin sensitivity, decreases hyperandrogenism and improves the menstrual cycle. Its effect during assisted reproductive technologies (ART) has been studied by many authors. We conducted a review of the literature on the impact of MI administration in PCOS women in assisted reproductive technologies. Myo-inositol is effective in normalizing ovarian function, improving oocyte and embryo quality in PCOS, however further evaluations by large multicentre randomized controlled trials are needed to assess the clinical pregnancy and live birth rates in ART.
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Affiliation(s)
- Philippe Merviel
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.
| | - Pandora James
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Sarah Bouée
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Mathilde Le Guillou
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Camille Rince
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Charlotte Nachtergaele
- Endocrinology and Metabolism Department, Brest University Hospital, Boulevard Tanguy Prigent, 29200, Brest, France
| | - Véronique Kerlan
- Endocrinology and Metabolism Department, Brest University Hospital, Boulevard Tanguy Prigent, 29200, Brest, France
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Prié L, Gaston R, Ferrière JM, Richaud P, Bui BN, Guillou ML. [Conservative treatment of infiltrating cancer of the bladder: neoadjuvant chemotherapy and radiotherapy]. Cancer Radiother 1998; 2 Suppl 1:62s-66s. [PMID: 9749081] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Retrospective evaluation of tolerance and efficacity of a combination of chemotherapy and radiotherapy in non metastatic invasive cancer of the bladder. MATERIALS AND METHODS From 1984 to 1995, 36 patients presenting with invasive urothelial carcinoma of the bladder were treated conservatively with primary chemotherapy: cisplatin-methotrexate-vinblastine (24 patients), methotrexate-vinblastine-doxorubicin-cisplatin (11 patients) or carboplatin (one patient). Fourty-six Gy were then delivered by external radiation therapy to the pelvis, with a complement of 10 to 20 Gy to the bladder. Seventeen patients received a concomitant chemotherapy with cisplatin. RESULTS The intolerance to chemotherapy was hematologic and digestive. One patient died from bone marrow depletion. External irradiation was well tolerated, except for one patient whose treatment was stopped at 48 Gy. Fifteen tumours (44%) were in complete remission (CR) after chemotherapy and 23 (64%) at the end of treatment. With a median follow up of 64.6 months, 13 out of 23 patients in CR had a relapse (ten local relapses, three metastatic); five salvage cystectomies were done. The median survival and 26 months and the probability of survival at 5 years was 43%. All but two patients surviving 5 years had a functional bladder. CONCLUSION Neoadjuvant chemotherapy leads to CR in 44% of patients and CR is observed in 64% of the patients after radiation therapy. However, the survival rate at 5 years is insufficient, even if the rate of bladder conservation is high.
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Affiliation(s)
- L Prié
- Service de radiothérapie, Institut Bergonié, centre régional de lutte contre le cancer, Bordeaux, France
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Affiliation(s)
- J L Pariente
- Department of Urology, Pellegrin Hospital, University of Medicine, Bordeaux, France
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Guillou ML, Mensah A, Mathieu F, Petit M, Jardin A, Chatelain C, Küss R. [Current therapeutic orientations for malignant teratomas of the testis with a choriocarcinomatous element. 14 cases (author's transl)]. J Urol Nephrol (Paris) 1976; 82:821-36. [PMID: 1034024] [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: 12/25/2022]
Abstract
In teratomas with a choriocarcinomatous element, the association with surgery of sequential chemotherapy lasting at least two years would appear to represent an improvement. Definitive conclusions may only be drawn from the study of large series.
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Guillou ML, Perron J, Küss R. [Retroperitoneal hematoma caused by rupture of an aneurysm of the renal artery trunk. Survival]. J Urol Nephrol (Paris) 1975; 81:785-91. [PMID: 1219130] [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: 12/26/2022]
Abstract
A dramatic accident, the rupture of an aneurysm of the renal arterial trunk is exceptionally accompanied by survival. This case enables one to look at different problems, especially diagnostic and therapeutic.
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Guillou ML, Merland JJ, Lepage T, Giraud B, Bories J, Küss R. [Control of incoercible vesical hematuria by selective vesical embolization. 7 cases of radium induced cystitis and of recurrent tumors]. Nouv Presse Med 1975:1703-8. [PMID: 1161457] [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: 12/25/2022]
Abstract
A means of stopping dramatic vesical hemorrhage due to a hemorrhage cystitis secondary to radiation therapy or a tumor: the selective vesical arterial embolisation.
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Merland JJ, Guillou ML, Lepage T, Bories J, Kuss R. [Hyperselective arteriography and therapeutic embolization in genito-urinary pathology in males (author's transl)]. Ann Radiol (Paris) 1974; 17:611-27. [PMID: 4478055] [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: 01/10/2023]
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