Patrick Thonneau

Contraceptive efficacy of intrauterine devices.

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

Risk factors for intrauterine device failure: a review

After reviewing the literature on intrauterine devices (IUDs) published over the last 30 years, we selected and analyzed recent and most relevant (with appropriate methodology design) articles dealing with the risk factors for IUD failure. There is sufficient evidence to conclude that the TCu380 and levonorgestrel-releasing (LNG) IUD are the most effective, with a cumulative pregnancy rate of less than 2% at 12 years for the TCu380 and around 1% for the LNG IUD at 7 years. In addition, advancing age increases IUD effectiveness, and displacement of the IUD decreases effectiveness. The IUDs with the highest copper concentrations are clearly less prone to failure than those with lower copper concentrations.

Ectopic pregnancy in African developing countries

Objective. We have reviewed the scientific literature on ectopic pregnancy (EP) in African countries published over the past 20u2003years and available from several databases (MEDLINE, EMBASE, POPLINE, and Cochrane Fertility Regulation Group), with the aim of painting a complete picture of the situation (incidence, risk factors, diagnosis, treatment, and complications).

Ectopic pregnancy in Conakry, Guinea

OBJECTIVEnTo assess the incidence of ectopic pregnancy (EP) in hospitals in Conakry, the capital of Guinea, West Africa. Data on EP incidence in developing countries are rare and often out of date, particularly in Africa.nnnMETHODSnA retrospective study was carried out, examining all cases of EP registered in the medical files of two referral maternity units at the Donka and Ignace Deen university hospitals between 1995 and 1999.nnnFINDINGSnThe EP incidence at the two maternity units increased from 0.41% to 1.5% of annual deliveries over this period. Haemoperitoneum was observed in most women, with tubal rupture in 93%; only 6 women received conservative treatment.nnnCONCLUSIONnThe results suggest that the hospital-based incidence of EP per delivery has increased over the last decade in this West African capital, and that health professionals and public health officials in developing countries, especially those in Africa, should consider EP as a major obstetric problem for maternal morbidity.

Abortion and maternal mortality in Africa.

To the Editor: The World Health Organization (WHO) estimates that 5 million unsafe abortions are performed annually in Africa, resulting in the deaths of an estimated 34,000 women.1 In Africa, abor...

Reduced maternal mortality in Tunisia and voluntary commitment to gender-related concerns

To estimate the number and causes of maternal deaths in Tunisia from 1999 to 2007, and compare the results with the last report (1993–1994).

Cumulative parenthood rates in 1735 couples: impact of male factor infertility

BACKGROUNDnMost studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples by taking mainly the female factor into account. However, infertility is a couples concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children.nnnMETHODSnWe carried out a follow-up study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre and after discontinuation from 2000 through 2008. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant.nnnRESULTSnWe were able to contact 65% of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60-67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24-39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45-50) in the 1735 couples.nnnCONCLUSIONSnMore than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the womans age, and these findings should encourage couples to attempt parenthood earlier.

Treatment discontinuation in couples consulting for male infertility after failing to conceive.

OBJECTIVEnTo evaluate rates and reasons for treatment discontinuation in couples with male factor infertility and who failed to conceive.nnnDESIGNnRetrospective study.nnnSETTINGnMale Sterility Center, University Hospital.nnnPATIENT(S)nA total of 407 couples consulting for male factor infertility and who discontinued treatment without conceiving.nnnINTERVENTION(S)nNone.nnnMAIN OUTCOME MEASURE(S)nTreatment, reasons for dropout, and reproductive outcomes after discontinuation.nnnRESULT(S)nOf the 407 patients, 218 (54%) had had fertility treatment (medical or surgical), and 189 (46%) underwent assisted reproductive techniques (ART) (intrauterine insemination [IUI], inxa0vitro fertilization [IVF], or intracytoplasmic sperm injection [ICSI]). The main reasons for dropout were painfulness of treatment (15% for patients with non-ART treatment vs. 32% for patients who had undergone ART), its ineffectiveness (12% vs. 26%), and separation of the couple (18% vs. 7%). Of the 407 patients, 27% consulted in another fertility center, 8% succeeded in having a child by ART with male partner sperm, 1% by ART with donor sperm, and 11% through adoption.nnnCONCLUSION(S)nAbout half of the couples consulting for male factor infertility discontinued fertility treatment, and of those who discontinued only a fifth finally succeeded in having a child. Although support is available to couples during fertility care, ART is a physical and psychological burden.

Altered secretion of Sertoli cells hormones in 2-year-old prepubertal cryptorchid boys: a cross-sectional study

In cryptorchid boys, failures in germ cell development have been clearly established. Some studies reported some abnormalities in Sertoli cells morphology but the results regarding their endocrine secretion remain controversial. To compare testicular hormone levels in young boys with and without cryptorchidism, we performed a cross‐sectional hospital‐based study. From surgery appointment records, we identified a case group of boys with unilateral or bilateral cryptorchidism and a control group undergoing dental care, minor osteoarticular or dermal surgery. Blood samples were withdrawn during the surgical procedure to perform testosterone, inhibin B and anti‐müllerian hormone (AMH) immunoassays. We included 27 cryptorchid boys and 27 controls aged of 26.6 vs. 24.2 months, respectively (p = 0.172) far from the post‐natal mini‐puberty and the corresponding hormonal surges. Age‐adjusted AMH and inhibin B levels were significantly lower in cryptorchid than in control boys (AMH: 87 ng/mL vs. 135 ng/mL; p = 0.009, inhibin B: 97 pg/mL vs. 133 pg/mL; p = 0.019, respectively). Moreover, AMH and inhibin B levels were significantly lower in the bilateral cryptorchid subgroup, being 50% lower than in the controls (p = 0.011 and 0.019, respectively) and while both hormones levels were independent in controls, they became strongly correlated in bilateral cryptorchid boys (R² = 0.75, p = 0.001). In addition, testosterone levels were still detectable in some boys, with significantly lower levels in cryptorchid group than in controls. Overall, 2‐year‐old cryptorchid patients presented a simultaneous and significant drop in AMH and inhibin B levels, suggesting a functional defect of Sertoli cells. This deficiency appeared more pronounced in bilateral cryptorchidism and thus, regarding the pivotal role of Sertoli cells in germ cell development, it may explain the compromised fertility found later in men born with such a malformation.

Introduction of an obstetric health information system: results of a pilot study in North Cameroon.

BACKGROUNDnInternational safe motherhood programs have placed increasing emphasis on assessing progress in reducing maternal mortality in developing countries. We assess the feasibility and relevance of an obstetric health information system introduced in Maroua urban district in North Cameroon.nnnMETHODSnDuring the study period, an obstetric observation register was introduced for obstetric data collection, complemented by anthropological case studies on maternal deaths.nnnRESULTSnAt the end of the study period, implementation and data collection processes were correctly done, and the overall rate of completion of obstetric registers was 95% (ranging from 82.5% to 98.5% between maternity units). Eight hundred and twenty-six deliveries (n=826) were recorded and evenly distributed over the nine weeks of the study period. Eight women (1%) were transferred from non-surgical to surgical health facilities. Thirteen C-sections (n=13; 1.6%; CI: 0.8-2.7%) mainly in the provincial hospital of Maroua (11/13), and four maternal deaths were recorded, giving a maternal mortality rate of 4/826 (484 for 100,000; CI: 132-1240 for 100,000 deliveries). Nevertheless, anthropological enquiry recorded five maternal deaths during the same study period. Analysis of the geographical origin of these women showed that four of the five came from very remote areas. Rapid analysis and dissemination of results have initiated changes in obstetric practices (introduction of the partograph, modifications in the attitudes of health personnel), and also to the creation of a network between maternity units (those with and without surgical facilities) and provincial health headquarters.nnnCONCLUSIONnThe introduction and use of a basic obstetric health information system combined with anthropological survey can provide a relatively accurate assessment of the maternal health situation. Such knowledge would be an excellent basis for implementing obstetric networking and relevant tools for active management of the obstetric pyramid at a regional level in developing countries.