Dominique Cornet

Materno-Fetal Cardiovascular Complications in Turner Syndrome after Oocyte Donation: Insufficient Prepregnancy Screening and Pregnancy Follow-Up Are Associated with Poor Outcome

CONTEXT Recombinant human GH treatment and oocyte donation (OD) have improved the quality of life in women with Turner syndrome (TS). However, life expectancy is reduced, mainly due to cardiovascular complications. Pregnancy may itself increase that risk and be associated with hazardous materno-fetal outcome. OBJECTIVE The objective of this study was to evaluate the materno-fetal outcome of ongoing pregnancies beyond 20 wk of gestation obtained by OD in TS. DESIGN This was a multicenter retrospective study including all assisted reproductive technology centers affiliated with the French Study Group for Oocyte Donation. RESULTS Among 93 patients, only 37.6% were prescreened with echocardiography or thoracic magnetic resonance imaging. Maternal outcome was dominated by 37.8% of pregnancy-associated hypertensive disorders including preeclampsia in 54.8% and severe eclampsia in four patients. Prematurity occurred in 38.3% and was correlated with pregnancy-associated hypertensive disorder (P = 0.01). The frequency of in utero growth retardation was 27.5%. One fetal demise was linked to eclampsia. Two patients died from aortic rupture after cesarean section in a context of aortic root dilatation. Only 40% of pregnancies were associated with an absolutely normal materno-fetal outcome. CONCLUSIONS OD pregnancies in TS who have not been managed following recent specific recommendations were at high risk for maternal death by aortic dissection and for preeclampsia and its complications (fetal distress and in utero growth retardation). These recommendations include previous echocardiography, thoracic magnetic resonance imaging, and overnight blood pressure monitoring associated with a tight follow-up during pregnancy. Until future assessment of these recent recommendations, pregnancies obtained in TS after OD must be still considered as very high-risk pregnancies.

Determinants of pregnancy rate in the donor oocyte model: a multivariate analysis of 450 frozen-thawed embryo transfers

BACKGROUND Conflicting results have been published about the determinants of pregnancy after oocyte donation (OD). We used the OD model to determine predictive factors of pregnancy in the recipient after frozen-thawed embryo transfer (FTET) in a specific series where all the embryos were cryopreserved without any prior selection for fresh transfer. METHODS We report a retrospective study in a university tertiary care center. Multivariate analysis and logistic regression were used to identify predictive factors of pregnancy in a series of 450 OD FTET cycles in 198 infertile women between January 1992 and December 2006. RESULTS The mean (+/-SD) recipient age was 35.7 (+/-4.5). Impaired ovarian function was the main indication for OD. The mean +/- SD (range) number of embryos transferred was 1.65 +/- 0.5 (1-3). Overall clinical pregnancy, implantation and delivery rates were 30, 18 and 23%, respectively. After univariate analysis, pregnancy rates were significantly higher in recipients under 35 years, in women with a body mass index (BMI) <30 kg/m(2), in women with an endometrial thickness of > or =8 mm, in amenorrheic women and in women not receiving pituitary down-regulation before endometrial preparation. Using multivariate analysis, the BMI, endometrial thickness and the use of pituitary down-regulation were independent predictors of pregnancy, regardless of age. CONCLUSIONS This study supports that endometrial thickness of <8 mm, obesity and the use of GnRH analogue pituitary down-regulation before endometrial priming negatively impact pregnancy rates, independently of the recipients age.

A multiparametric analysis of endometrial estrogen and progesterone receptors after the postovulatory administration of mifepristone.

A double-blind randomized study was performed in two groups of eight normally cycling patients: group I received 10 mg/d of RU486 for 4 days from the date of ovulation and group II received a placebo. On day +5, cytosol and endometrial estrogen receptors (ERs), and progesterone receptors (PRs) were analyzed by radioligand binding assay as well as by enzyme immunochemistry. Histologic studies showed that all the endometria of group I were abnormal (luteal insufficiency and/or E/P imbalance). The nuclear PR levels were significantly higher in group I (843 +/- 422 fmol/mg) deoxyribonucleic (DNA) compared with 482 +/- 232 fmol/mg DNA in group II. Immunohistochemical study showed that ER and PR staining was higher for both glands and stroma in group I (52% and 72% for the respective receptors), compared with the receptor-immunostained surface observed in group II, which was reduced to 40% for ER and to 4% for PR. This study demonstrates that RU486 administered in the immediate postovulatory period blocks normal tissue evolution in the follicular phase as well as the processing of PR.

Hormonal secretions in singleton pregnancies arising from the implantation of fresh or frozen embryos after oocyte donation in women with ovarian failure

Objective To determine whether levels of human chorionic gonadotropin (hCG), 17 β -estradiol (E 2 ), and progesterone (P) are different in the peri-implantation phase of fresh versus frozen embryos. Design Hormonal secretions were measured on days 9 and 11 after implantation and at 4, 5, and 6 weeks gestation. Patients Thirty-one pregnancies were achieved in 65 patients with ovarian failure. Seventeen singleton pregnancies developed after implantation of 4 frozen and 13 fresh embryos. Results Human chorionic gonadotropin and E 2 , contrary to P, were higher in cases of fresh embryos from the 9th day after transfer to the 5th week at which time they become statistically significant (respectively, for hCG and E 2 , 5,800.3 ± 332.3 versus 2,027.3 ± 916.3 [mean ± SD] mIU/mL for hCG and 562.3 ± 215 versus 291 ± 152 pg/mL for E 2 ). Conclusions This difference might be explained by either the higher number of fresh embryo replaced or by the fact that the number of blastomeres and also their metabolic activity could be reduced after freezing and thawing.

Obstetric evolution of pregnancies obtained from donated oocytes.

Of 44 pregnancies obtained at the Tenon Maternity Hospital by in vitro fertilization (IVF) using donated oocytes, 25 have already been completed by spontaneous delivery or cesarean section: 22 (88%) single; 2 (8%) twins, and 1 (4%) triple. The most frequently seen complications of pregnancy were hypertension (16%) and preterm labor in the last 3 months (12%). However, as compared to a control group of 275 pregnancies resulting from classical IVF, the only difference was a very high percentage of cesarean sections (72%). No fetal deaths or neonatal malformations were reported.

Les donneuses d’ovocytes : quels critères de sélection ?

La situation du don d’ovocytes en France est preoccupante, en partie du fait de la penurie de donneuses. Les centres d’aide medicale a la procreation qui le proposent doivent a la fois travailler en autosuffisance, gerer la penurie de don et assurer des resultats acceptables en termes de naissances. Cette penurie de donneuses conduit a rendre difficile leur selection, pourtant indispensable pour des taux de grossesses acceptables. Les criteres d’eligibilite proposes ici tiennent compte a la fois des limites proposees par la loi francaise, des donnees de la litterature et des contraintes de la penurie.

Ultrasonographic Prediction of Ovarian Hyperstimulatton (OHS) After IVF

The incidence of ovarian hyperstimulation syndrome (OHS) ranges from 3% to 6% for the moderate forms and from 0.3% to 4% the severe.1 If it is easy to predict this complication in cases of Polycystic Ovarian Disease (PCO);2 in all the other cases of stimulation, the reports concerning the correlations between the multiple variables (age, weight, type of stimulation, number of ampules of human Menopausal Gonadotropin (hMG) used) with OHS are conflicting. Daily monitoring of 17 B estradiol (E2) and sequential pelvic ultrasonography proved to be beneficial, but they may obviate OHS only after six to eight days of stimulation and a variable number of ampules used. As the pathophysiology of this syndrome is unknown, it is of interest to indicate some predictive factors to avoid cancelling cycles or being faced with severe complications. In 1987, Blankstein et al.,3 attempted to predict OHS by ultrasonographic determination of the number and the size of preovulatory ovarian follicles. Navot et al., in 1988,4 using a stepwise logistic regression performed on 22 variables, identified a “high-risk group” for this syndrome: “young and lean patients, who after relatively few ampules of hMG, develop high estradiol levels and multiple small follicles”.

Traitement des dystrophies ovariennes polykystiques au cours de fecondation in vitro. considerations physiopathogeniques

More than 60% of patients with polycystic ovary disease (PCO) cannot conceive after repeated ovulation inductions with Clomifene citrate although there is ovulation or more frequently follicle luteinization. Because of hyperstimulation, therapy with hMG has been superseded by low doses of purified FSH with variable results according to authors. It has been even claimed that there was no benefit to replace hMG with FSH. However, on the basis of the PCO physico-pathology, namely LH hypersecretion and androgen hyperproduction, it would be rational to associate the desensitization of the pituitary with LH-RH agonist and the ovary stimulation with variable doses of hMG or purified FSH. In the series where such therapy associating LH-RH agonists with purified FSH was applied, the results concerning suppression of LH and androgen secretion, and the occurrence of pregnancy were interesting. However, the risk of hyperstimulation still occurred. Thus, the first part concerns the critical review of these results while, in the second part, our experience in in vitro fecundation will be reported.