[Hemorrhage associated with delivery. Diagnosis, treatment principles].
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Adult↗
Biomedical subjects
B Hédon
Publications and source records attributed to B Hédon.
Successful in vitro fertilization-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and pelvic irradiation.
OBJECTIVE: To present a case of IVF-surrogate pregnancy in a patient with ovarian transposition who had undergone chemotherapy and total pelvic irradiation. DESIGN: Case report. SETTING: Teaching hospital. PATIENT(S): A 29-year-old woman who had undergone Wertheim's hysterectomy for a bulky carcinoma of the uterine cervix. INTERVENTION(S): Ovarian transposition before chemotherapy and total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to the surrogate mother. MAIN OUTCOME MEASURE(S): Results of the IVF cycle. RESULT(S): A twin pregnancy at the first cycle and two live newborns. CONCLUSION(S): This is the first reported case of ovulation induction and oocyte retrieval performed on a transposed ovary.
Adult↗
[Coasting: a response to excessive ovarian stimulation].
The ovarian hyperstimulation treatment increases results of in vitro fertilization. However, the risk of ovarian hyperstimulation syndrome must be carefully evaluated for each patient. An excessive response increases complication and cancellation rates. Coasting could be applied when an excessive response occurred. This method requires stopping gonadotropin administration while GnRH agonist is continued. When the estradiol rate decreases, the hCG administration is allowed. In the literature, results shows adequate pregnancy rates, between 26 and 64%. It seems oocyte quality was not spoiled. However, coasting does not eliminate definitively the risk of ovarian hyperstimulation syndrome. Coasting method could be a safe and efficient method to treat an excessive ovarian response during in vitro fertilization protocol. Pregnancy rates seem to be preserved.
Chorionic Gonadotropin↗
[How to assess ovarian reserve in 1999?].
Fertility and results of infertility therapies are submitted to amajor drop in relation with the age of the female patient and her so-called ovarian reserve. Although there is no clear definition of what is exactly the ovarian reserve, the consequence of its decline is a greater difficulty to produce ovocytes with a capacity of becoming living embryos after fertilization. Several tests have been developed to assess the ovarian reserve in order to evaluate the prognosis of spontaneous fertility, the results of infertility therapy and assisted procreation techniques, and to make necessary technical adaptations. Basal determinations of FSH, estradiol and inhibin B at day 3 of the cycle an all reflect the ovarian potential, but only FSH reflects a decline infecundability reliable enough to be used as a screening test. Challenge tests such as the clomiphene citrate, the exogenous FSH or the GnRH challenge tests have the purpose to reveal an exaggerated liberation of FSH or an insufficient secretion of estradiol after stimulation. None of these tests have demonstrated a better sensibility together with a higher specificity and they should be considered as evaluating tools in specific cases only. In conclusion, assessing the ovarian reserve has become a clinical necessity in the following situations: ovulation defect, unexplained infertility, before undergoing ovarian stimulation for assisted procreation, in particular in women above the age of 35. This assessment can be made by determining the basal FSH level on day 3 of a cycle and should be renewed every year.
Biomarkers↗
Does previous salpingectomy improve implantation and pregnancy rates in patients with severe tubal factor infertility who are undergoing in vitro fertilization? A pilot prospective randomized study.
OBJECTIVE: To evaluate the implantation rate and pregnancy rate (PR) in patients with severe tubal factor infertility who were undergoing IVF. Patients who had undergone salpingectomy were compared with those who had not. DESIGN: A prospective randomized study. SETTING: A department of obstetrics and gynecology at a university hospital. PATIENT(S): Thirty patients who previously had undergone salpingectomy and 30 patients who had not undergone salpingectomy before IVF treatment. INTERVENTION(S): Laparoscopy with or without salpingectomy followed by IVF with the use of combined GnRH agonist and hMG therapy in a long stimulation protocol. MAIN OUTCOME MEASURE(S): Embryo implantation rate and ongoing PR per transfer. The cumulative PRs were compared for the two groups of patients. RESULT(S): After the first IVF attempt, the implantation rate was 10.4% in the group with salpingectomy and 4.6% in the group without salpingectomy. For all IVF attempts, the respective embryo implantation rates in the two groups were 13.4% and 8.6%. The ongoing PR per transfer was 34.2% in the group with salpingectomy compared with 18.7% in the group without salpingectomy. After four IVF attempts, the probability of becoming pregnant was greater in the group of patients with salpingectomy (75%) than in the group without salpingectomy (63%). CONCLUSION(S): Previous salpingectomy in patients with severe tubal factor infertility who are undergoing IVF seems to increase the embryo implantation rate and the PR per cycle of IVF. This monocentric study must be followed by other similar studies to allow for a metaanalysis and confirm this clear trend with definitive evidence.
Adult↗
Cellular specificity of fibroblastic proMMP-3 downregulation by normal or cancer trophoblastic cells.
It has been shown previously that endometrial fibroblast prometalloproteinase-3 (proMMP-3) secretion is inhibited by normal cytotrophoblasts as a result of paracrine interactions. To investigate the specificity of this downregulation, two different types of co-culture were used. First, peritoneal and synovial fibroblasts obtained from human tissue biopsies were co-cultured with normal cytotrophoblasts. By contrast to what has been observed with endometrial fibroblasts, their proMMP-3 secretion increased though their morphology was slightly modified. Secondly, the regulation of endometrial proMMP-3 secretion was tested in co-cultures with two choriocarcinoma cell lines (JAr and JEG-3 cell lines). With tumoral cytotrophoblastic cells, endometrial fibroblasts became decidua-like cells and JAr and JEG-3 cell lines grew in syncytium. However, co-culture of endometrial fibroblasts with JAr and JEG-3 choriocarcinoma cells did not decrease proMMP-3 secretion. The present results show that endometrial proMMP-3 downregulation is tissue specific and does not depend on cell differentiation. A cytotrophoblast cell membrane factor which might not be expressed in tumoral cells could probably play a role in paracrine relations between epithelial cells and surrounding stroma.
Choriocarcinoma↗
Evaluation of endometrial inflammation by quantification of macrophages, T lymphocytes, and interleukin-1 and -6 in human endometrium.
PURPOSE: Our purpose was to determine the impact of endometrial inflammation on fertility. METHODS: The study population included 49 women: 5 women bearing an intrauterine device, 33 sterile patients, and 11 fertile women. Endometrial biopsies were performed between day 17 and day 21 of the cycle. Immunostaining was performed with an ABC kit. Monoclonal antibodies were CD68 for macrophages, CD3 for T lymphocytes, and B-E8 for interleukin (IL)-6; IL-1 alpha and IL-1 beta were stained with polyclonal antibodies. A double immunofluorescence staining was performed to identify endometrial cells. Macrophage and lymphocyte rates were defined as the percentage of stained cells by field. Double staining was compared among macrophages, T lymphocytes, and anti-IL antibodies in each group. RESULTS: The macrophage rate was high for women bearing an intrauterine device, intermediate for sterile patients, and low for fertile women (P = 0.03). There was a lack of double staining between activated T lymphocytes and anti-IL-6 antibody in tubal sterility and endometriosis. Endometrial macrophages were stained with anti-IL antibodies for all groups. CONCLUSIONS: Endometrial macrophages seem to be an interesting parameter for evaluating endometrial inflammation. In tubal infertility and endometriosis, the lack of expression of IL-6 in T lymphocytes could participate in impaired embryo implantation.
Adult↗
[Repeat spontaneous abortions].
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Abortion, Habitual↗
[Sexuality and religions].
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Christianity↗
Respective evaluation of the prevalence of haemostasis abnormalities in unexplained primary early recurrent miscarriages. The Nimes Obstetricians and Haematologists (NOHA) Study.
The prevalence of haemostasis abnormalities was evaluated in 500 consecutive women with unexplained primary recurrent miscarriages. Two matched reference groups with no antecedent of miscarriage were studied: 100 healthy mothers and 50 childless women. In the prospective part of the study, we found 9.4% of the patients (95% C.I.: 6.8-12%) with an isolated factor XII deficiency, 7.4% of the patients (5.0-9.8%) with primary antiphopholipid antibodies, 47% of the patients (42.6-51.4%) with an insufficient response to the venous occlusion test and an isolated hypofibrinolysis was found in 42.6% (38.2-47%) of the patients (reference groups: respectively 0/150, 3/150, 2/150, p < 10(-3)). Willebrand disease, fibrinogen, deficiency, antithrombin, protein C or protein S deficiencies were not more frequent in recurrent aborters than in members of the reference groups. In the retrospective part of the study, cases of plasma resistance to activated protein C were not abnormally frequent. Patients had higher Willebrand factor antigen (vWF), tissue-type plasminogen activator antigen (t-PA), plasminogen activator inhibitor activity (PAI) and D-dimers (D-Di) than the reference women. Values of vWF, t-PA, PAI and D-Di were altogether correlated but were not related to C-reactive protein concentrations. Among patients, those with an antiphospholipid syndrome and those with an insufficient response to the venous occlusion test had higher vWF, t-PA, PAI and D-Di values than the patients with none of the haemostasis-related abnormalities. Thus, factor XII deficiency and hypofibrinolysis (mainly high PAI) are the most frequent haemostasis-related abnormalities found in unexplained primary recurrent aborters. In patients with antiphospholipid antibodies or hypofibrinolysis, there is a non-inflammatory ongoing chronic elevation of markers of endothelial stimulation associated with coagulation activation. This should allow to define subgroups of patients for future therapeutic trials.
Abortion, Habitual↗
[Delivery of the overweight woman. Analysis of 115 patients].
OBJECTIVE: Our purpose was to assess the effect of weight gain during pregnancy on labor and delivery. Abnormal pregnancies were excluded from the study to avoid interaction with the management of labor. POPULATION AND METHODS: A retrospective monocentric case-control study was carried out. We analysed 115 pregnancies delivered in our institution between June 1994 and November 1994. The course of labor was studied in 2 groups of patients: a group of overweight patients and a control group. RESULTS: In the overweight patients, the frequency of induction of labor (25%) and of obstetrical analgesia (82%) was significantly higher than in the control group (respectively 7% and 64%), as well as the average duration of labour and the average duration of the rupture of the membranes. The rate of cesarean section was higher in the overweight patient group (16.7%) than in the control group (3.7%). The difference was not significant because of the small number of patients. CONCLUSION: These results show a more frequent requirement of induction of labour, analgesia, and cesarean section in overweight patients. This led us to propose a multidisciplinary management of overweight patients to minimize these different obstetrical risks during labor.
Adolescent↗
Identification of prometalloproteinase-3 as a major protein secreted by human endometrial fibroblasts and inhibited by coculture with trophoblast cells.
To assess endometrial fibroblast-cytotrophoblast interactions, we used a coculture system allowing analysis of the potential cell morphology modifications and protein secretion variations possibly involved in endometrial invasion arrest. Stromal cells and cytotrophoblasts were isolated from endometrial biopsies and first-trimester placental villi, respectively. In our culture conditions, a 57-kDa protein that was secreted by cultured fibroblasts but was absent in the 4-day coculture medium was found to be identical to prometalloproteinase-3 (proMMP-3) through determination of amino acid sequences of NH2-terminal and internal peptides. Northern blotting analysis of endometrial fibroblast total RNA showed a 38.6% metalloproteinase-3 (MMP-3) mRNA inhibition by 4-day 10(-6) M R5020 treatment. Inhibition of proMMP-3 secretion was weak when cytotrophoblasts were cultured for 4 days in a polycarbonate membrane insert over cultured fibroblasts without possible cell contact in spite of high levels of progesterone produced by cytotrophoblasts. Furthermore, cytotrophoblasts cultured on a monolayer of endometrial fibroblasts became syncytia, and most of the fibroblasts were decidualized. The closeness of the two cell types allowed paracrine relationships that might facilitate the progesterone action. Since MMP-3 is known to activate collagenases, inhibition of its secretion by cell contact might be a mechanism of invasion arrest for trophoblast cell migration.
Amino Acid Sequence↗
[Prognostic value of high FSH concentrations].
Ovarian age is a major determinant of success in assisted reproductive technologies. The number and quality of oocytes retrieved directly depend upon the ovarian reserve. The evaluation of FSH concentration during the first days of the menstrual cycle provides a simple and accurate means of assessing ovarian reserve. Plasma FSH value is correlated with cancellation rate, peak estradiol, number of oocytes retrieved and of the resulting embryos, pregnancy rate, outcome of cryopreservation. However, a poor response to the stimulation treatment is unpredictable in a subgroup of women whose FSH concentration remain within the normal range. Ovarian aging begins several years before any clinical or endocrinological modification. Recurrent FSH determinations may help in predicting a poor response, as a large intercycle FSH variability is correlated with ovarian failure. The value of ovarian reserve tests is presently not fully established.
Age Factors↗
[The use of growth hormone (hGH) in ovulation induction in women].
Number of in vitro experiments have shown increasing evidence for local ovarian actions of GH by demonstrating: the presence of receptors for GH in human granulosa cells; the ability of GH to enhance estradiol (E2) production by human granulosa cells withdrawn in late follicular phase; the increasing effect of GH on progesterone (P) biosynthesis by human luteal cells. Moreover, GH being the main regulator of IGF-I plasma levels, its indirect effect by means of hepatic and/or ovarian IGF-I production remains possible. Few patients have been included in randomized studies using hGH with gonadotropins for induction of ovulation and their selection criteria were heterogeneous so that no definitive conclusion can be drawn about the beneficial effect of GH in facilitating ovulation. The reduction both in duration of stimulation and in the requirement for menopausal gonadotropins found in some studies have been challenged by others. The recombinant human growth hormone (hGH) is able to modify the game of intraovarian regulators and may affects ovocyte and embryo. Such a potential impact cannot be occulted, justifying to develop larger in vivo animal experimentation before new further clinical studies.
Clinical Trials as Topic↗
Therapeutic strategies in tubal infertility with distal pathology.
Since 1980, various treatments have been proposed for patients suffering from distal tubal infertility. Difficult choices between surgical (microsurgery/laparoscopy) treatments and in-vitro fertilization (IVF) still confront many workers. In this study, we evaluated the cumulative results of both therapeutic methods for this group of patients. From 1979 to 1990, 266 patients with distal tubal infertility were operated in our programme (group M: microsurgery, n = 211; group L: laparoscopy, n = 55). In group M, pathological findings were hydrosalpinges (n = 135) and incomplete distal tubal occlusion, (n = 76) and in group L hydrosalpinges (n = 31) and incomplete distal tubal occlusion (n = 24). After differing time intervals, IVF was proposed for these patients when no pregnancy occurred. The results were as follows: in group M, 35.5% intra-uterine pregnancy (IUP) and 6.6% ectopic pregnancy (EP) after fimbrioplasties versus 28.1% IUP and 11.9% EP after salpingostomy; in group L, 16.6% IUP and 4.2% EP after fimbrioplasty versus 12.9% IUP and 6.5% EP after salpingostomy. Following IVF, 55.7% of patients in group M and 14.5% in group L became pregnant. The cumulative results including both treatment techniques (surgery and IVF) show an average of 70% and 65% pregnancy rates in groups M and L respectively. The best results after surgery and throughout IVF were obtained during the first year. It is concluded that a short delay after surgery, averaging 6 months to 1 year, before involving patients in IVF, is very important.
Adult↗
[Intra-conjugal immunotherapy and the pathology of reproduction. Experiences at the Center for the Treatment of Sterility, Montpellier-Nîmes].
81 patients who had consulted for infertility, of whom 26 had recurrent spontaneous abortions (RSA), 28 unexplained infertility (UI), and 27 with difficulties for implantation following in vitro fertilization (IVF) were tested by a cross-match for the presence of the partner's lymphocyte antibodies. When the result was negative, leucocyte transfusions were carried out (200 million of the partner's lymphocytes in 3 successive injections at intervals of one month). Positive antipaternal cytotoxic antibodies were found in 81% of cases. There was, however, no benefit in groups of unexplained infertility or implantation difficulties. In the RSA group there was a 50% recurrence of spontaneous abortions.
Abortion, Habitual↗
[Menopause. Diagnosis, consequences and principles of treatment].
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Atrophy↗