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Primary dysmenorrhea affects 60% of adolescent girls between 14 and 19 years of age and higher rates of depression and absenteeism are found in these young women. Having developed a sense of coherence (SOC) protects against depression... more
Primary dysmenorrhea affects 60% of adolescent girls between 14 and 19 years of age and higher rates of depression and absenteeism are found in these young women. Having developed a sense of coherence (SOC) protects against depression associated with and improves the experience of primary dysmenorrhea. The aim of the study was to describe the association between primary dysmenorrhea and SOC. Méthods : A multicentric and cross-sectional study was performed on 247 high school girls from Finistère (France). sixty point seven per cent of high school girls suffer from primary dysmenorrhea: average VAS greater than or equal to 4 out of 10 with an improvement in pain by analgesics if severe pain (greater than 7 out of 10) to eliminate secondary dysmenorrhea (3.6% suspected). Thirty five point six per cent do not present dysmenorrhea (VAS between 0 and 3). This study shows that having a high SOC reduces menstrual pain (p = 0.014). The main treatments used are not those recommended by Clinic...
Objective Unexplained infertility is defined by the absence of identifiable causes of infertility. The results of randomized studies and meta-analysis regarding the treatment of unexplained infertility are discordant due to methodological... more
Objective Unexplained infertility is defined by the absence of identifiable causes of infertility. The results of randomized studies and meta-analysis regarding the treatment of unexplained infertility are discordant due to methodological problems. Design The aim of this study is to compare the clinical pregnancy rate per cycle (CPR/c) in IUI and IVF/ICSI in cases of unexplained infertility, according to the woman’s age group and to identify the factors which predict success. Interventions We performed a retrospective study in two ART centers, comparing overall clinical pregnancy, ongoing pregnancy and live birth rates in IVF/ICSI and IUI. We also compared pregnancy and birth rates according to different female age groups. Results 855 IVF/ICSI and 804 IUI cycles were compared. We found a significant difference ( p < 0.001) in the pregnancy and live birth rates per cycle between IUI and IVF/ICSI, overall and in the different female age groups, except in women aged 40 and over. The greatest chances of pregnancy with IUI are found in women with secondary unexplained infertility, during the first two cycles and with a bi-follicular response to stimulation. In IVF/ICSI, pregnancy rates are higher in women with secondary unexplained infertility, in the first two cycles, in IVF and in women receiving a transfer of two embryos regardless of the embryonic stage. Conclusion We recommend IVF/ICSI treatment rather than IUI for unexplained infertility (OR CPR/c 4.20 with 95% CI [3.72–4.68]). This is in accordance with NICE, which advises the use of IVF after 2 years.
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Research Interests: Medicine and Endometritis
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La qualite des ovocytes (atresie, immaturite), leur fecondabilite, le taux de fecondations anormales (parthenogenese, triploidie) et le developpement embryonnaire (vitesse de division et morphologie) sont identiques chez les mauvaises... more
La qualite des ovocytes (atresie, immaturite), leur fecondabilite, le taux de fecondations anormales (parthenogenese, triploidie) et le developpement embryonnaire (vitesse de division et morphologie) sont identiques chez les mauvaises repondeuses et les normo-repondeuses. Seul le petit nombre d'embryons disponibles (0,9 / patiente vs 4,4) penalise ces patientes.
Research Interests: Biology and Gynecology
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Onset of malignancy during pregnancy is distressing for the future parents and raises thorny problems for the oncologist and obstetric gynecologist. Many diagnostic and therapeutic approaches cannot be used. Some first-line reference... more
Onset of malignancy during pregnancy is distressing for the future parents and raises thorny problems for the oncologist and obstetric gynecologist. Many diagnostic and therapeutic approaches cannot be used. Some first-line reference treatments are known to cause fetal loss or severe birth defects, yet any delay in treatment may unacceptably worsen the maternal prognosis. In the absence of large randomized trials and cohort studies, it is difficult to know how best to manage these patients. An estimated one in ten thousand pregnancies are associated with malignancies, especially gynecologic tumors (cervix, breast, ovary), lymphomas, melanomas, brain tumors and leukemia. The obstetrician, in close collaboration with the oncologist, has a major role in choosing the most appropriate diagnostic and therapeutic strategy, and must keep the couple fully informed. Importantly, improvements in cancer cure rates and the development of conservative treatments mean that many of these young wome...
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Le but de cet article est de comparer les indications, complications, echecs, la morbidite, voire la mortalite (risque potentiel de cancer apres resection endometriale) entre l'endometrectomie par hysteroscopie, la thermo-ablation par... more
Le but de cet article est de comparer les indications, complications, echecs, la morbidite, voire la mortalite (risque potentiel de cancer apres resection endometriale) entre l'endometrectomie par hysteroscopie, la thermo-ablation par ballon intra-uterin et l'hysterectomie abdominale, vaginale ou percoelioscopique. La difficulte du diagnostic d'adenomyose et le taux d'echec de l'endometrectomie dans ce cas doivent etre clairement exposes avant de choisir entre un traitement chirurgical radical (hysterectomie) ou conservateur (endometrectomie).
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La survenue d'un cancer du sein au cours de la grossesse est une eventualite rare. L'âge moyen des femmes est de 34 ans. Les memes types histologiques (essentiellement canalaires) sont retrouves, mais il existe plus de formes... more
La survenue d'un cancer du sein au cours de la grossesse est une eventualite rare. L'âge moyen des femmes est de 34 ans. Les memes types histologiques (essentiellement canalaires) sont retrouves, mais il existe plus de formes inflammatoires et/ou metastatiques ganglionnaires et generales. Les recepteurs hormonaux sont habituellement negatifs. Le diagnostic clinique est souvent difficile et retarde. L'analyse de la mammographie est perturbee par la congestion mammaire. De ce fait, un prelevement histologique est souvent necessaire afin d'orienter le diagnostic. Le traitement doit repondre aux memes exigences therapeutiques qu'en dehors de la grossesse, en respectant autant que possible le fœtus. La mastectomie associee au curage axillaire, autrefois largement preconisee, est desormais remplacee le plus souvent par la tumorectomie elargie avec lymphadenectomie axillaire, a condition de ne pas retarder la radiotherapie complementaire de plus de 3 mois et qu'elle...
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Research Interests: Medicine and Gynecology
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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... more
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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In 2016 ovarian stimulation faces two main challenges: hot to obtain goog quality oocytes while non endangering the patients treated, but also limited by maternal age and poor ovarian responders (POR). The first IVF birth, Louise Brown,... more
In 2016 ovarian stimulation faces two main challenges: hot to obtain goog quality oocytes while non endangering the patients treated, but also limited by maternal age and poor ovarian responders (POR). The first IVF birth, Louise Brown, was obtained from a natural cycle. With the introduction, in the 1980s of gonadotropin releasing hormone agonists (GnRHa) and in the 2000s of GnRH antagonists (GnRHant), stimulation became plurifollicular (and source of consequences). Today, only about 50% of the transferred blastocysts after IVF lead to a pregnancy. The purpose of this review is to describe the current challenges and limits of ovarian stimulation.
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PATIENT-RELATED FACTORS: Multiparous patients with a past history of severe pre-eclampsia are a high risk population which should be identified early in pregnancy. Selection on this criterion alone is however insufficient for large scale... more
PATIENT-RELATED FACTORS: Multiparous patients with a past history of severe pre-eclampsia are a high risk population which should be identified early in pregnancy. Selection on this criterion alone is however insufficient for large scale screening and prevention because most of the susceptible women are nulliparous. Search for a particular familial or personal history of vascular disorders can be helpful. The usefulness of blood pressure measurements during the second trimester has not been proven. There is a significant association between pre-eclampsia and a large number of biological markers. No one assay can however fulfill the requirements for effective early screening because sensitivity is too low or the rate of false positives is too high, or because the examination is too invasive or costly. Doppler exploration of the uterine arteries at 20 to 24 weeks gestation offers satisfactory sensitivity and specificity but the positive predictive value is low. Persistence of a bilate...
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Satellite symposium of the 10th International Congress of Human Genetics 2001 Vienna, Austria, May 15–19, 2001 within the frame of the European Union project COPERNICUS-2
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L'hemorragie de la delivrance est definie par l'existence de pertes sanguines superieures a 500 ml pour un accouchement par les voies naturelles et superieures a 1 000 ml pour une cesarienne. Il s'agit d'une pathologie... more
L'hemorragie de la delivrance est definie par l'existence de pertes sanguines superieures a 500 ml pour un accouchement par les voies naturelles et superieures a 1 000 ml pour une cesarienne. Il s'agit d'une pathologie grave (2 a 10 % des accouchements) pouvant conduire a un deces maternel. La prise en charge est encore trop souvent retardee, mal adaptee et incomplete. Le facteur temps est en effet capital, tout comme le caractere pluridisciplinaire de la prise en charge (sage-femme, obstetricien, chirurgien, anesthesiste et reanimateur). Les actions preventives, au cours de la grossesse et durant le travail, visant a diminuer la frequence des macrosomies foetales, des infections, de la prise de poids maternel, des dystocies, des declenchements abusifs, des extractions instrumentales trop souvent systematiques, permettent de diminuer leur frequence.
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IntroductionRecurrent miscarriage (RM), defined by three or more consecutive losses during the first trimester of pregnancy, affects 1%–2% of fertile couples. Standard investigations fail to reveal any apparent cause in ~50% of couples.... more
IntroductionRecurrent miscarriage (RM), defined by three or more consecutive losses during the first trimester of pregnancy, affects 1%–2% of fertile couples. Standard investigations fail to reveal any apparent cause in ~50% of couples. However, on the basis of animal models and clinical studies, several hypotheses have been put forward concerning underlying mechanisms of RM: altered ovarian reserve, progesterone defect, thrombotic and/or endothelial dysfunction and immunological disturbances. Nonetheless, no study has yet reached conclusive beneficial clinical evidence for a potential treatment in unexplained RM. Hydroxychloroquine (HCQ) is a molecule with extensive safety data during pregnancy. The pharmacological properties of HCQ (eg, antithrombotic, vascular protective, immunomodulatory, improved glucose tolerance, lipidlowering and anti-infectious) could be effective against some mechanisms of unexplained RM. Furthermore, eventhough clinical benefit of HCQ is suggested in prev...
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The negative impact of endocrine-disrupting pesticides on human fertility is now a key issue in reproductive health. There are much fewer literature data about the impact of pesticide exposure on women than on men and very few studies of... more
The negative impact of endocrine-disrupting pesticides on human fertility is now a key issue in reproductive health. There are much fewer literature data about the impact of pesticide exposure on women than on men and very few studies of women participating in an in vitro fertilization (IVF) programme. In the present review, we found that (1) various pesticides with an endocrine-disrupting action are associated with poor oocyte maturation and competency, embryonic defects and poor IVF outcomes, and (2) some pesticide compounds are linked to specific causes of female infertility, such as premature ovarian insufficiency, polycystic ovarian syndrome, and endometriosis. IVF participants living in agricultural regions should be informed about the fertility decline, low ongoing pregnancy rates, and elevated risk of miscarriage associated with exposure to high doses of pesticides.
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To compare the probability of postoperative pregnancy in infertile women with ovarian endometrioma larger than 3 cm in diameter, managed by either ablation using plasma energy or cystectomy. A multicentric case-control study (Canadian... more
To compare the probability of postoperative pregnancy in infertile women with ovarian endometrioma larger than 3 cm in diameter, managed by either ablation using plasma energy or cystectomy. A multicentric case-control study (Canadian Task Force classification II-2). Six surgical departments, affiliated with 4 university hospitals and 2 private facilities. One hundred four infertile patients with ovarian endometrioma larger than 3 cm. Endometrioma ablation using plasma energy was performed in 64 patients (61.5%) and cystectomy in 40 patients (38.5%). Patients were enrolled in the CIRENDO prospective cohort database (NCT02294825) from June 2009 to June 2014 and managed in 6 different facilities. The minimum length of follow-up was 1 year. Postoperative probabilities of pregnancy in patietns and control subjects were estimated using the Kaplan-Meier method with 95% confidence intervals (CIs) and compared using the log-rank test. The Cox model was used to assess independent predictive factors for pregnancy. Patients managed by plasma energy were significantly older than patients managed by cystectomy, had significantly higher overall revised American Fertility Society (rAFS) score, and had higher rate of Douglas pouch obliteration, deep endometriosis, and colorectal localizations. After a mean follow-up of 35.3 ± 17.5 months (range, 12-60), fertility outcomes were comparable between the groups. The probability of pregnancy at 24 and 36 months after surgery in plasma energy and cystectomy groups was, respectively, 61.3% (95% CI, 48.2%-74.4%) versus 69.3% (95% CI, 54.5%-83%) and 84.4% (95% CI, 72%-93.4%) versus 78.3% (95% CI, 63.8%-90%). The Cox&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s model revealed that the type of surgical procedure on ovarian endometrioma had no statistically significant impact on the probability of pregnancy, after adjustment for women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s age, bilateral cysts larger than 3 cm, colorectal endometriosis, and rAFS stage of endometriosis. Postoperative pregnancy rates were comparable after management of ovarian endometrioma by either ablation using plasma energy or cystectomy despite an overall higher rate of unfavorable fertility predictive factors in women managed by ablation.
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Background Two meta-analyses have shown that pregnancy and birth rates are significantly higher after blastocyst transfer than after cleaved embryo transfer. Other studies have revealed that a serum progesterone level > 1.5 ng/ml on... more
Background Two meta-analyses have shown that pregnancy and birth rates are significantly higher after blastocyst transfer than after cleaved embryo transfer. Other studies have revealed that a serum progesterone level > 1.5 ng/ml on the trigger day is responsible for premature luteinization and is associated with a low pregnancy rate. The objectives of this retrospective study were to determine whether blastocyst transfer gave higher pregnancy rates than cleaved embryo transfer at day 3 in both the general and selected IVF/ICSI populations, and whether the serum progesterone level influenced the pregnancy rate. Method We studied IVF/ICSI cycles with GnRH antagonist - FSH/hMG protocols in a general population (n = 1210) and a selected “top cycle” population (n = 677), after blastocyst transfer on day 5 or cleaved embryo transfer on day 3. The selected couples had to meet the following criteria: female age 14 mm) index (PFI). Results In the general population, the clinical pregnan...
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Oocyte quality is a key limiting factor in female fertility which is primarily reflected in morphological features. Centrally located cytoplasm granulation (CLCG) is one type of cytoplasmic dimorphism exhibited by oocytes that could be... more
Oocyte quality is a key limiting factor in female fertility which is primarily reflected in morphological features. Centrally located cytoplasm granulation (CLCG) is one type of cytoplasmic dimorphism exhibited by oocytes that could be linked to pesticide exposure with a significant risk of decreased ICSI outcomes. This retrospective study included 633 women who were part of an intracytoplasmic spermatozoa injection (ICSI) program between 2009 and 2011. The participants lived in the Picardy region of France and had been exposed to pesticides. The participants were divided in two groups based on prevalence of oocytes with CLCG (LCLCG [n = 83]: low prevalence of oocytes with CLCG under 25%. HCLCG [n = 68]: high prevalence of CLCG over 75%). The embryological and clinical outcomes were analysed for both groups and were calculated using the difference between the two values. Results for couples with HCLCG compared to LCLCG showed a decrease in embryo cleavage, ongoing pregnancy, and liv...
The intrauterine insemination with husband's sperm is an assisted reproductive technologie, as proposed in the case of cervical infertility, moderate male infertility, dysovulation, mild or moderate endometriosis or unexplained... more
The intrauterine insemination with husband's sperm is an assisted reproductive technologie, as proposed in the case of cervical infertility, moderate male infertility, dysovulation, mild or moderate endometriosis or unexplained infertility. In the last three indications the ovarian stimulation is necessary. The couple demographic criteria (age of both partners, lifestyle, duration of infertility) and the results of the infertility evaluation (ovarian reserve, uterus, spermogram-spermocytogram) increase the chances of pregnancy by intrauterine insemination with husband's sperm and reduce the risk of multiple pregnancies. Pregnancy rates observed ranged from 8 to 20% per cycle according to indications.
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Objective To investigate the effect of anticoagulant treatment on pregnancy outcomes in patients with previous recurrent miscarriages (RM) who carry a methylenetetrahydrofolate reductase ( MTHFR) gene mutation. Methods In this... more
Objective To investigate the effect of anticoagulant treatment on pregnancy outcomes in patients with previous recurrent miscarriages (RM) who carry a methylenetetrahydrofolate reductase ( MTHFR) gene mutation. Methods In this longitudinal retrospective study, patients with RM were treated during pregnancy with either: (i) 100 mg/day aspirin and 5 mg/day folic acid (group 1); or the same protocol plus 0.4 mg/day enoxaparin (group 2). An age-matched group of triparous women without RM or thrombophilia was used as the control group (group 3). Results This study enrolled 246 women with RM (123 per treatment group) and age-matched controls ( n = 117). The delivery rate was significantly lower in group 1 than group 2 (46.3% versus 79.7%, respectively). The miscarriage rate was significantly lower in group 2 compared with group 1 (20.3% versus 51.2%, respectively). In the control group 3, the delivery rate was 86.3% and the miscarriage rate was 12.8%. Conclusion Treatment with low-dose as...