Does Endometriosis Impact the Composition of Follicular Fluid in IL6 and AMH? A Case-Control Study

OBJECTIVE

The aim of this study was to compare follicular liquid levels of IL6 and AMH in women with and without endometriosis and to evaluate their potential impact on ICSI outcomes.

MATERIALS AND METHODS

It is a prospective case-control study conducted on 25 women with proven endometriosis and 50 patients diagnosed with other causes of infertility. All these patients were candidates for ICSI cycles. Their follicular fluid was collected at the time of oocyte retrieval and used to evaluate IL-6 and AMH titers by electro-chemiluminescent immunoassay (Cobas e411-Roche).

RESULTS

The IL-6 levels in follicular fluid were higher in the endometriosis group than in the control group (152.3 vs. 19.9 pg/mL; p = 0.02). The median level for AMH was 2.2 ± 1.88 ng/mL with no statistical difference between the two groups (2.2 vs. 2.7 ng/mL, p = 0.41). No significant correlation between the follicular IL6 and AMH levels was observed.

CONCLUSIONS

The oocyte quality seems to be preserved in patients with endometriosis with the adequate response to ovarian stimulation. High levels of follicular IL6 are in accordance with the inflammatory phenomenon of the disease; however, this increase has no impact on ICSI outcomes.

P-236 Impact of Hyaluronan-enriched embryo transfer medium on the ICSI cycles outcomes

Study question

Does the use of hyaluronan-enriched embryo transfer medium improve the ICSI cycles outcomes?

Summary answer

The pregnancy rate was significantly higher when a hyaluronan-enriched embryo transfer medium was used compared to standard medium.

What is known already

Hyaluronan (HA) is a naturally existing macromolecule in the uterine fluid that seems to increase embryo adhesion.

In fact, the human embryo and uterine endometrium express a receptor for HA in the implantation window, and it is conceivable that HA is involved in the initial phases of blastocyst attachment to the endometrium. Multiple studies demonstrated that the use of HA-enriched transfer medium in women receiving either cleavage-stage embryos or blastocyst improved the outcome of IVF cycle such as the implantation rate and life birth rate compared to the standard transfer medium. However, the effectiveness of this ET medium is controversial.

Study design, size, duration

A descriptive, prospective and randomized study was enrolled in the ART center at Aziza Othmana Hospital in Tunis recruiting patients between January 2021 and June 2021. One hundred and thirty three ICSI cycles with fresh embryo transfer (FET) were included. The embryo transfer medium was either a hyaluronan-enriched one (EmbryoGlue®, Vitrolife) or a standard one (G-2®, Vitrolife).

Participants/materials, setting, methods

ICSI cycles with FET were divided into two groups according to the ET medium. The latter’s choice was made according to the transfer’s day. Two groups were constituted: Group1 including embryo transfers with EmbryoGlue(N = 67) and Group2 including those with G2(N = 66). The pregnancy, the implantation, the miscarriage and the live birth rates were compared between the two groups. The statistical analysis was performed by Chi-square and U tests using SPSS and p < 0.05 was considered as significant.

Main results and the role of chance

Among the 133 transfer cycles included, 67 were performed with EmbryoGlue medium and 66 with G2 medium. The mean female’s age was 35.14 ±4.628 years. Both groups were comparable according to the epidemiologic characteristics (age, ovarian reserve, infertility etiology) and according to the number of embryos transferred. The pregnancy rate was significantly higher when using HA-enriched transfer medium compared with standard medium (31% vs 23%, p = 0.04). However, no statistical differences between Group 1 and Group 2 were found concerning the implantation rate (18.65% vs 15.65 %, p = 0.634), the miscarriage rate (28.57% vs 40%; p = 0.804) and the life birth rate (22.38 % vs 13.64 %, p = 0.189).

Limitations, reasons for caution

The results did not consider the embryo stage transferred (cleavage stage or in blastocyst stage). All transfer cycles were included without taking into account of the transfer cycle rank and the medical history of patients.

Wider implications of the findings

The hyaluronan-enriched embryo transfer medium seems to improve the pregnancy rate and should be used especially for patients with a miscarriage history.

Trial registration number

Not Applicable

Evaluation of ovarian reserve before and after chemotherapy

BACKGROUND

Progress in oncology has improved patient survival. However, cancer chemotherapy can be gonadotoxic and affect their fertility. Recourse to fertility preservation before starting these treatments is therefore necessary in order to allow a better life quality after survival. The aim of this work was to study the impact of chemotherapy on ovarian reserve by AMH measurement.

METHODS

This is a descriptive and longitudinal study from 2015 to 2018 carried out at Aziza Othmana hospital ART center in Tunis on patient aged less than 41 years who were candidates for fertility preservation. Patients included had AMH measurement prior to cancer treatment. We called them back to follow up the AMH level after chemotherapy. The AMH assay was performed by electrochemilumiescence technique. At the end, only 66 patients met the inclusion criteria.

RESULTS

The most frequent pathologies were Hodgkin's lymphoma and breast cancer. The mean age of patients was 26.7 ± 6.8. The most used chemotherapy protocols were BEACOPP, ABVD or the combination of both in lymphoma and FEC + TXT for breast cancer treatment. A significant difference between AMH before and after chemotherapy was found for BEACOPP and FEC + TXT protocols (p < 10 3). The patient's age was correlated with the AMH decrease after chemotherapy (r = 0.577, p < 10 3).

CONCLUSION

Our results showed that the high risk gonadotoxicity protocols were BEACOPP for lymphoma treatment and FEC + TXT for breast cancer treatment. However, studies with a larger sample and more time extended monitoring are necessary for a better gonadotoxicity understanding of the cancer treatments available today.

Laparoscopic Adnexectomy for Ovarian Torsion during Late Pregnancy: Case Report of a Non-Conservative Treatment and Literature Analysis

Diagnosis of adnexial torsion is difficult during pregancy (1). The time of decision and laparoscopy is that of the risk of necrosis of the adnexa and, therefore, of the ovarian prognosis. The loss of an ovary can compromise the following fertility. Even if concerns related to laparoscopy in pregnant patients include a limited surgical field, with a risk of uterine injury and negative fetal effects of CO₂ insufflation. Evidence base suggests that minimally invasive surgery can be safe and better than laparotomy for management of adnexal masses during late pregnancy with good postoperative and obstetric outcomes. If for most authors laparoscopy appears to become the best approach for ovarian torsion during pregnancy (2), nonetheless, the ideal surgical laparoscopic approach of adnexa in late pregnancy remains controversial. Since there is no technical gold standard to overcome surgical difficulties which could make laparoscopic procedures as real challenge in patients in second and third trimester (3); at least, in case of radical and non-conservative treatment, the risk for a first trimester of pregnancy is to remove the corpus luteum (1).

Robotic Surgery in Gynecology

Minimally invasive surgery (MIS) can be considered as the greatest surgical innovation over the past 30 years. It revolutionized surgical practice with well-proven advantages over traditional open surgery: reduced surgical trauma and incision-related complications, such as surgical-site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the two-dimensional (2D) monitor reduction in-depth perception, camera instability, limited range of motion, and steep learning curves. The surgeon has a low force feedback, which allows simple gestures, respect for tissues, and more effective treatment of complications. Since the 1980s, several computer sciences and robotics projects have been set up to overcome the difficulties encountered with conventional laparoscopy, to augment the surgeon’s skills, achieve accuracy and high precision during complex surgery, and facilitate widespread of MIS. Surgical instruments are guided by haptic interfaces that replicate and filter hand movements. Robotically assisted technology offers advantages that include improved three-dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision.

Verrucous Carcinoma of the Vulva: A Case Report and Review of the Literature

Verrucous carcinoma of the vulva is a rare lesion (1). Affecting essentially postmenopausal women, this lesion is a distinct and particular entity in vulval carcinoma classification and its scalability is uncertain and unpredictable. Here, we present a case concerning a 48-year-old patient, without follow-up after a condyloma acuminate of the vulva (large left lip). The origin of this case will be discussed in this article. The treatment decided was only surgical. A review of literature shows the rarity of this lesion of the female genital tract.

Ovarian Drilling in PCOS: Is it Really Useful?

Polycystic ovary syndrome (PCOS) is a frequent disorder, affecting approximately 5-10% of infertile women. It can represent more than 80% of cases of infertility due to anovulation. The main goal of treatment is the induction of mono-ovulatory cycles. A pragmatic management of infertility in PCOS will allow most patients to conceive. Weight loss and clomiphene citrate (CC) are the first-line components of patients treatment before gonadotrophins are used. However, during gonadotrophin administration, there is a high risk of ovarian hyper-stimulation and multiple pregnancies. So, surgery with laparoscopic ovarian drilling is often used before gonadotrophins in order to obtain normal ovulatory cycles.

Endometriosis and Vesico-Sphincteral Disorders

Objectives

The aim of this mini review is to determine the relationship between endometriosis and urinary tract symptoms and to investigate the consequences of surgical treatment of mild to severe endometriosis, especially deep lesions, on the vesico-sphincteral function (lower urinary tract function).

Materials and methods

We performed a literature review by searching the MEDLINE database for articles published between 2000 and 2014, limiting the searches to the words: urinary tract, vesico-sphincteral, dysfunction, endometriosis, symptoms, and surgery.

Results

The incidence of vesico-sphincteral symptoms in endometriosis varies from 3.4 up to 15.4%. The frequency of such symptoms seems to be under estimated because of a lack of specific questionnaire including urinary symptoms. Urodynamic evaluation could help to detect unsuspected abnormalities. It seems that endometriosis surgery (particularly deep infiltrating lesions) is a purveyor of de novo urinary dysfunction, with an incidence varying from 6.8 up to 17.5%. Nerve sparing processes such as neuro-navigators or neuro-stimulators seem to be promising techniques to avoid postoperative urinary tract dysfunction.

Conclusion

A precise anamnesis and the use of specific validated questionnaires (IPSS and BFLUTS) improve the screening of vesico-sphincteral symptoms in case of endometriosis. No recommendation can be found in the literature about the place of urodynamic evaluation. Most publications lack of proof and therefore do not allow making recommendations about optimal treatment of endometriotic lesions to avoid urinary tract disorders.

Placental site trophoblastic tumor: a case report and review of the literature

Placental site trophoblastic tumor is rare. They represent a rare form of gestational trophoblastic disease. They occur mainly in women who have a history of miscarriage, termination of pregnancy, or even a normal or pathological ongoing pregnancy. The clinical course is unpredictable. This malignancy has different characteristics from other gestational trophoblastic tumors. Following a clinical case that we encountered and treated, we conducted a literary research and review, focusing primarily on prognostic factors and treatment.

Two case reports of a malignant germ cell tumor of ovary and a granulosa cell tumor: interest of tumoral immunochemistry in the identification and management

Objective: In this article, we present two case reports. The first case was a malignant germ cell tumor of the right ovary in a 23-year old woman and the second case was a bilateral undifferentiated granulosa cell tumor in a 71-year old woman. The aim of these reports is to illustrate the interest of the immunohistochemical analysis to define the correct diagnosis, to better classify these ovarian tumors and improve their management.

Methods: In this study, we report two cases. The first case concerns a 23-year old woman (A) with a mixed germ cell tumor of the right ovary [dysgerminoma (75%), yolk sac tumor (20%), and a mature teratoma (5%)], and the second case concerns a 71-year old woman (B) with a bilateral non-differentiated and necrotic granulosa cell tumor of both ovaries. The staging system was used according to both the classifications: International Federation of Gynaecology and Obstetrics 1987 for ovarian cancer and TNM code 2009.

Results: The immunostaining establishes the malignancy and the immunochemistry contributes to confirm effectively the right diagnosis (Tables 2 and 3).

Conclusion: An immunohistochemical analysis is mandatory for the choice of chemotherapy to obtain a better response of the disease and improve the survival prognosis. The efficiency of the chemotherapy authorizes a conservative surgery including a unilateral salpingo-oophorectomy preserving fertility (A). Concerning the non-dysgerminoma tumor (B), and after a surgical staging and debulking, chemotherapy was recommended. The type of tumor and its histological feature conditioned the choice of treatment. The benefit of the immunohistological analysis in this case allowed the right adjuvant treatment.

Endometriosis and infertility: how and when to treat?

Endometriosis is defined as the presence of endometrial-like tissue (glands or stroma) outside the uterus, which induces a chronic inflammatory reaction. Although endometriosis impairs fertility, it does not usually completely prevent conception. The question of evidence based-medicine guidelines in endometriosis-associated infertility is weak in many situations. Therefore, we will highlight in this issue where the challenges are.

Chromosomal evaluation in a group of Tunisian patients with non-obstructive azoospermia and severe oligozoospermia attending a Tunisian cytogenetic department

Male infertility is the cause in half of all childless partnerships. Numerous factors contribute to male infertility, including chromosomal aberrations and gene defects. Few data exist regarding the association of these chromosomal aberrations with male infertility in Arab and North African populations. We therefore aimed to evaluate the frequency of chromosomal aberrations in a sample of 476 infertile men with non-obstructive azoospermia (n=328) or severe oligozoospermia (n=148) referred for routine cytogenetic analysis to the department of cytogenetics of the Pasteur Institute of Tunis. The overall incidence of chromosomal abnormalities was about 10.9%. Out of the 52 patients with abnormal cytogenetic findings, sex chromosome abnormalities were observed in 42 (80.7%) including Klinefelter syndrome in 37 (71%). Structural chromosome abnormalities involving autosomes (19.2%) and sex chromosomes were detected in 11 infertile men. Abnormal findings were more prevalent in the azoospermia group (14.02%) than in the severe oligozoospermia group (4.05%). The high frequency of chromosomal alterations in our series highlights the need for efficient genetic testing in infertile men, as results may help to determine the prognosis, as well as the choice of an assisted reproduction technique. Moreover, a genetic investigation could minimize the risk of transmitting genetic abnormalities to future generations.

[Diagnostic hysteroscopy before the first in vitro fertilization. For whom?]

BACKGROUND

For some teams, hysteroscopy, should be performed before each IVF attempt to maximize the chances of implantation because of the high cost, the investment in time and the psychological impact of each IVF cycle, but answer to the question of the systematic practice of hysteroscopy prior to IVF is far from settled.

AIM

Assess the benefits of conducting a routine hysteroscopy before the first IVF / ICSI and to identify subgroups in whom this examination provides a real benefit.

METHODS

This is a comparative retrospective study about 334 patients, included in an IVF program with micro-injection, in the center of ART of Aziza Othmana hospital of Tunis, for a period of one year. The results of ICSI in patients with a first attempt at IVF / ICSI were compared according to the realization (HSC +) or not (HSC-) of a diagnostic hysteroscopy prior to the first IVF attempt. results : The implantation rate in our series was 21.62%. We got a pregnancy in 128 cases, that is a pregnancy rate per transfer of 38.32%. The rate of live births was 29.34%, including 94.89% deliveries to terms with living fetus. We found no significant difference between groups "HSC +" and "HSC -" in terms of pregnancy rates of biological or clinical pregnancy rate or in terms of live births. But, in patients aged 40 and over, we found improved results of IVF in a meaningful way in the group "+ HSC".

CONCLUSION

Our study finds no benefit in terms of outcomes of IVF/ ICSI to the completion of hysteroscopy in a systematic way, despite a high incidence of abnormalities detected by intra-cavity examination. The benefit of routine hysteroscopy is significant only in women 40 and older.

[Cost of medical treatment with methotrexate for ectopic pregnancy. Study comparing medical treatment versus laparoscopy. Experience of Aziza Othmana Hospital]

BACKGROUND

The ectopic pregnancy can be treated surgically (conservative or radical) or medically. Currently, the choice between medical and surgical treatment is a critical issue. One of the parameters of this choice is the total cost of management.

AIM

To compare the cost of the management of ectopic pregnancy by medical treatment (methotrexate, MTX) and coeliochirurgicaux.

METHODS

This is a prospective, comparative, nonrandomized,unicentric study, on 39 patients who have ectopic pregnancies treated with MTX versus 16 patients treated by laparoscopic surgery with conservative treatment. This study was collected at the service of Obstetrics and Gynecology Reproductive Medicine Aziza Othmana Hospital (Tunis) for a period of two years.

RESULTS

The average cost of hospital stay per patient was 549.38 dt for the MTX group against 268.39 dt for laparoscopic surgery group (p <0.001). There was no statistically significant difference between the two groups. In terms of overall absenteeism, there is no statistically significant difference (16.43 vs 17.5 days).

CONCLUSION

The initial treatment with MTX costs more cost than the conservative laparoscopic treatment and this is mainly due to the long period of hospitalization.

[Quality of life during menstruation in women with an inherited bleeding disorder: report of 31 cases]

BACKGROUND

Menstruations, by their abundance and their duration, can be a source of impaired quality of life. Women with inherited bleeding disorders appear to be, specially at risk.

AIM

Assess the impact of menstrual blood loss on the quality of life for women with inherited bleeding disorders.

METHODS

31 women with various inherited bleeding disorders were interviewed. They completed a quality of life questionnaire.

RESULTS

Von Willebrand disease was the most frequent inherited bleeding disorder in our population (38.7%). 54.8% of patients had a menstrual period more than 6 days 61.3% of them consider their menstrual flow to be normal. The general condition apart of the menstrual period was considered medium to poor in 35.5% of patients. The average score assessing the impact of menstruation on daily life was of 5.00 ± 3.47. Only 19.35% of patients felt that dysmenorrhea significantly affect their quality of life. Impaired quality of life was seen in 64.5% of patients according to score Aand in 41.9% of them according to score B. During menstruation 22.6% of the patients didn't do to work or to school because of the menstrual flow. On the other hand, 48.4% of patients were hospitalized at least once for a heavy menstrual flow.

CONCLUSION

The quality of life during menstruation, in women with an inherited bleeding disorder, according to the different scores appear altered. Although because of the small size of our study population, we could not prove correlation between the importance of menstrual blood loss and the impairment of quality of life.

[Basal fsh level is only predictive of the quantitative aspect of the ovarian response]

BACKGROUND

Determination FSH and LH at day 3 of the menstrual cycle predicts the response to stimulation.

AIM

To evaluate the value of FSH and LH measurements compared with women's age in predicting qualitative and quantitative ovarian response to gonadotrophin stimulation.

METHODS

305 patients underwent at least one intra cytoplasmic sperm injection (ICSI) cycle. The levels of FSH and LH at day 3 were determined in an earlier cycle. A good quantitative ovarian response was defined as ³3 oocytes retrieved and 3 embryos obtained. A good qualitative ovarian response was defined as a percentage of mature oocytes ³75% and immature ones²15% of the total number of oocytes retrieved with at least one top quality embryo obtained.

RESULTS

Receiver operating characteristic (ROC) curves were generated for FSH, LH and female age. FSH is better than female age in predicting the number of oocytes retrieved (respectively ROCAUC=0.77, p=10-3 versus ROCAUC=0.73, p=10-3) and the number of embryos obtained (ROCAUC=0.69, p=10-3 versus ROCAUC=0.66, p=10-3). LH is non predictive. None of the three tested parameters was predictive of the fertilization and pregnancy rates. An FSH cutoff was calculated and a value of 7.8mUI/ml is associated with a sensitivity of 73% and a specificity of 70% for the prediction of ovarian response to controlled stimulation.

CONCLUSION

Basal FSH level predicts good quantitative rather than qualitative response. LH is non predictive. FSH and LH do not predict pregnancy rate. Patients having high FSH levels should not be excluded from IVF/ICSI treatment.

[Delivery in twin pregnancies. The experience of the obstetrics department of Aziza Othmana's Hospital, about 117 cases]

BACKGROUND

The conduct and delivery of twin pregnancies are interspersed with as well as maternal fetal and neonatal complications. The obstetrician is faced with the birth of 2 children often fragile and a uterus often exposed to dynamic dystocia.

AIM

To study the maternal and newborn morbidity and mortality in twins, in order to clear the optimal route of delivery in such circumstances.

METHODS

A retrospective study over a period of 3 years (1 January 2005 to December 31, 2007), about 117 twin pregnancies. Inclusion criteria were a term exceeding 28 weeks and fetuses alive. We analyzed maternal complications during and after delivery and neonatal complications.

RESULTS

Maternal complications were significantly more frequent in case of caesarean section. The frequency of perinatal complications (Apgar score, respiratory distress, immediate neonatal resuscitation and neonatal intensive care unit transfer) in the first twin was not influenced by the route of delivery as opposed to the second twin which Apgar score's alters when vaginally. The newborns of low birth weight (<1,500 Kg) and those whose term was less than 32 weeks were more at risk of an Apgar score <7 (at 1 and 5 minutes), respiratory complications, need for immediate resuscitation and transfer to intensive care and that statistically significant both for the 1st and the 2nd twins.

CONCLUSION

The twins pregnancies' morbidity appears to be more related to prematurity and intra uterine growth retardation) more than to the mode of delivery and hence the interest to detect and prevent its anomalies. It seems that vaginal delivery has a deleterious effect at least for the second twin but cesarean section doesn't seem to be the solution. Better learning techniques and obstetric maneuvers would reduce morbidity.

[Particularities of pregnancy and labor in 40-year-old women. Report of 300 cases]

BACKGROUND

Pregnancy beyond age 40 is considered as a high risk pregnancy associated with high rates of maternal and fetal complications.

AIM

To analyze particularities of pregnancy and labor and to examine obstetrical and neonatal outcomes among women age 40 years and older.

METHODS

There was a retrospective study including two groups of 300 patients, the first including the 40-year- old and over women (case group), and the second including 20-to 39 -year-old mothers (control group).

RESULTS

The mean age for the case group was 41 years. Ten (10.6%) of the women in the ca se group were primiparous as compared with twenty-seven (27.5%) in the control one (p=0.001).The antenatal surveillance was better in the control group. The morphologic sonograhy was performed in 73% of cases of 40-year -old-women versus 90% in the control group (p<0.001). Maternal age 40 and over was associated with an increased risk for gestational diabetes (6.4% versus 1.7%, p<0.001). The premature rupture of membranes was frequent in the case group (25.7% versus 11.7% p<0.001), and the amniotic fluid meconuim (16.3% versus 6.7%, p<0.001). The risk for cesarean section was higher in older women (25.7% versus 14% avec p <0.001). Neonatal outcomes (Apgar score, birth weight, perinatal mortality) were similar to those in the younger age group.

CONCLUSION

The analysis of our results and the review of the literature have proven that advanced-maternal-age-pregnancy is associated with increased complications. So some recommendations' are necessary to ameliorate the management of this pregnancy.

The sirenomelia sequence: a case history

We report a case of sirenomelia sequence observed in an incident of preterm labor during the 29th gestational week. According to some authors, this syndrome should be classified separately from caudal regression syndrome and is likely to be the result of an abnormality taking place during the fourth gestational week, causing developmental abnormalities in the lower extremities, pelvis, genitalia, urinary tract and digestive organs. Despite recent progress in pathology, the etiopathogenesis of sirenomelia is still debated.

Endometrial adenocarcinoma in a 27-year-old woman

BACKGROUND

Endometrial adenocarcinoma usually occurs after menopause, but in 2%-14% of cases, it occurs in young patients (less than 40 years of age) who are eager to preserve their fertility. Its treatment includes hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, and, in some cases, radiation therapy.

AIM

To describe a case of endometrial adenocarcinoma occurring in a young woman and to undertake a literature review of risk factors and therapeutic options proposed for young women wishing to preserve their fertility.

CASE

We report a case of endometrial cancer in a 27-year-old woman treated for resistant menorrhagia and cared for in our department as well as in the Salah Azaiez Institute.

CONCLUSION

Endometrial adenocarcinoma rarely occurs in young women. In such cases, other therapeutic options can be proposed: progesterone therapy and LH-RH (Luteinzing-Hormone-Releasing-Hormone) agonists therapy in order to preserve fertility in younger patients.

[A retrospective study of 339 ICSI cycles: assesment of the two first years of activity of the Assisted Reproductive Technology Center of Aziza Othmana Hospital]

BACKGROUND

Intracytoplasmic sperm injection (ICSI) is a micromanipulation-assisted fertilization, whereby one spermatozoon is injected into the oocyte cytoplasm. Initially, ICSI was the treatment of choice for male factor infertility. However, because of the high fertilization and pregnancy rates achieved with this technique, the scope of the procedure has been widened to include couples with other causes of infertility.

AIM

The aim of this study was to study the progression of the activity of the assisted reproductive technology's center of Aziza Othmana's Hospital and the ICSI results during the first two years.

METHODS

Our study included 269 infertile couples who underwent 339 ICSI cycles between 1st May 2001 and 30 April 2003. Cycles with no oocytes obtained at the follicular aspiration and women aged over 40 years were excluded from this study.

RESULTS

The number of ICSI cycles progressed in our center: 150 ICSI cycles in the 1st year, 189 ICSI cycles in the 2nd year. The mean number of picked-up oocytes was 8,8 +/- 5,6. The fertilization rate was 62%. The mean number of transferred embryos was 3,1 +/- 1,5. The pregnancy rate per transfer was 32,4%. The miscarriage rate was 28,4%. The take home baby rate was 67,9%.

CONCLUSION

The number of couples undergoing ICSI cycles in our center is increasing. The fertilization rates and pregnancy rates in our center are similar to those published in the literature.

[Are there any predictive factors for successful intracytoplasmic sperm injection. Statical analysis of 339 cycles]

BACKGROUND

Intracytoplasmic sperm injection (ICSI) outcome is tightly depinding of male and female factors. The assesment of several clinical and laboratory parameters may predict results of ICSI.

AIM

This study aimed at investigation wich parameter(s) may predict successful intracytoplamic sperm injection for infertility.

METHODS

We restrospectively analysed patients who had intracytoplasmic sperm injection for male or female factor infertility. The clinical and laboratory factors that influenced the fertilization, pregnancy and implantation rates were also analysed. Three hundred and thirty nine cycles in 269 couples were analysed. Women's age, etiology of infertility, duration of infertility, number of retrived oocyts, sperm parametres and number of transferred embryos were evaluated.

RESULTS

Optimal pregnancy rates were observed in women aged 25-35 years, with gradual decline with advanced age (p=0.049). The pregnancy/transfer rate was statistically depending of, the numbre of retrieved oocytes (p<0.001) and the numbre of transferred embryos (p<0.001). However, transferring more than three embryos was no significatively superior to two or three. Etiology of infertility had no influence in fertilization and pregnancy, but may predict the implantation rate (p=0.042). The duration of infertility was of no value in predecting the fertilization, implantation or pregnancy rates, and neither seam's to be the sperm parameters.

CONCLUSION

The only statitically significant variables of ICSI outcome were women partner's age, numbre of retrived oocytes and numbre of transferred embryos.

[Intrauterine insemination with conjoint semen. How to increase the success rate?]

BACKGROUND

Intrauterine insemination is usually proposed as the first line therapy for infertility related to cervical hostility, male factor, unexplained infertility or mild endometriosis. The overall succes rate of IUI is about 10-20% clinial pregnancy per cycle. The Aim of this study is to evaluate factors that increase the succes rate of IUI.

METHODS

we restrospectively analysed 206 cycles of IUI with partner's semen in 138 infertile couples. The clinical and laboratory factors that may influence the pregnancy rates were analysed: women's age, etiology of infertility, duration of infertility, ovarian stimulation, day of hCG and sperm parametres.

RESULTS

The per-cycle clinical pregnancy rate was of 14.56%. Optimal pregnancy rates were observed in less than 38 years old women (18.29% vs 9.52%, p<0.05). The succes rate was statistically depending of the number of IUI cycles until three (p<0.05), the day of hCG (p<0.05) and the sperm count after conventionally prepared semen (p<0.05). Sperm parameters was of no value in predecting the pregnancy rates, and neither seam's to be the total dose of administrated Gonadotrophin or the etiology of infertility, but it seams that, when a cervical factor or PCO were involved, the succes rate is higher. Besides, getting three or more than three follicles may increase the succes rate but expose to a warrying risk of multiple pregnancy.

CONCLUSION

According to this study, the only statitically significant factors that are associated with successful IUI were, women partner's age (<38 ans), number of IUI cycles (during the first three IUI cycles), day of hCG (>J13) and sperm count after conventional semen preparation (>1.106/mL).

[Prolonged pregnancy: apropos of a series of 102 cases]

It was a retrospective and continuous prospective study about 102 post-term pregnancy recensed on a 14 months period. The aim of this study is to evaluate our management of post term pregnancy and the peto-maternal morbidity and mortality.

RESULTS

Frequency of post-term pregnancy in our study is 5.92%, in rate of session sector is not higher it is of 18.62. There is no maternal mortality. Neonatal mortality is a about 19/1000, the rate of neonatal morbidity is 2.9%.

[Drainage by echo-guided nephrostomy in hydronephrosis secondary to a pyelo-ureteral junction in a single kidney syndrome in a pregnant woman. Apropos of a case]

We report an exceptional case of pyeloureteral malformation which occurred on a single kidney. The malformation was discovered at 32 week of gestation when ultrasonography showed hydronephrosis. Initial treatment consisted in echoguided drainage. The patient gave birth to a live infant via normal vaginal delivery and then underwent resection of the pyeloureteral malformation with anastomotic reconstruction of the upper urinary tract.