Biomedical subjects

A Bachelot

Publications and source records attributed to A Bachelot.

13 recordsLinked to original sources

PubMed1993

Establishing a national in vitro fertilization registry: methodological problems and analysis of success rates.

A national registry for in vitro fertilization (IVF) was established in France in January 1986 and has been in operation since that date. During 1987, data on 14,763 attempts were collected from 72 teams, representing 80 per cent of all French IVF activity. In this registry, a form is completed for every oocyte recovery attempt, containing information about the infertility diagnosis, the attempt itself and its result. This paper presents results for the years 1986 and 1987 and studies the relationship between pregnancy occurrence and some couple or cycle characteristics. Methodological aspects are discussed, concerning the possible sources of bias, and the analysis of results. Results obtained in this registry are compared with those from other similar registries.

Adult↗

PubMed1993

Oral contraceptive use and risk of benign breast disease in a French case-control study of young women.

We report the results of a French hospital-based case-control study designed to analyse the relation between the use of oral contraceptives (OC) and the risk of benign breast disease (BBD). The cases were 286 women, each less than 46 years old, with BBD histologically verified between 1982 and 1985. Controls were 382 patients, matched to cases on year of birth and month of interview, and who were hospitalized for a non-malignant disease other than BBD. Odds ratios were estimated by multivariate regression, taking into account level of education, place of residence, family history of breast cancer, age at menarche, number of children, age at first full-term pregnancy and Quetelet index. The risk of BBD was found to decrease significantly with a longer use of OC before the first full-term pregnancy (FFTP), but there was no association between the risk of BBD and the duration of OC use after FFTP. OC use before FFTP reduced the risk of non-proliferative disease, but did not significantly affect the risk of proliferative disease. These results did not depend on the amount of oestrogen (0.05 mg or more vs < 0.05 mg) contained in OC.

Adult↗

PubMed1993

[Evaluation of FIVNAT 1992].

FIVNAT registry collected information on 21,960 individual assisted reproductive technology (ART) cycles in 1992. The present analysis concerns 15,557 cycles arrived on time to be incorporated, 97.9% being in vitro fertilization (IVF) cycles. The transfer rate was 80.9% and the clinical pregnancy rate was 19.2% per oocyte recovery cycle and 23.7% per transfer. The mean oocyte number slightly increased compared to 1991 (8.5 +/- 5.6 vs 8.2 +/- 5.6, p < 0.001) whereas the mean number of embryos obtained was not modified and the mean number of transferred oocytes slightly decreased. The mean fertilization rate slightly increased (53.0% +/- 30.2% vs 48.3% +/- 32.7%, p < 0.001). Infertility of tubal origin represented 59.1% of infertilities, and cycles realised with donor semen were associated to the highest pregnancy rate. GnRH analogues were widely used (87.5%), but those using a short blocking period tended to decrease, replaced by protocols without GnRH analogues. Stimulation regimen using a long blockage phase were associated to a higher pregnancy rate than the others (19.8% per recovery). The proportion of transfers involving 4 or more embryos decreased in 1991 to 22.9%. The analysis of 7,960 pregnancy forms resulting of recoveries realised from 1987 to 1991 showed a preterm birth rate of 9.2% for singleton, but a still high rate for twins and multiple pregnancies. For singleton pregnancies, in utero mortality concerned 6.9/1000 of the children, and the neonatal mortality rate (< 7 days) was 6.7/1000. The overall malformation rate was 2.8%.

Adult↗

PubMed1993

[Ectopic pregnancy risk factors after assisted reproductive technology].

Ectopic pregnancies are more frequent among pregnancies resulting from assisted reproductive technology (ART) than in natural conceptions (6% to 7% vs 1%). Fivnat registry has allowed us to analyse 349 ectopics among 6049 clinical pregnancies collected from 1986 to 1990. Ectopic rate decreased with increasing women's age, and since 1986. The risk was also decreased in infertilities of non tubal origin, except for those of unknown origin in which it was at the same level than for tubal infertility. The risk was increased by 65% in stimulation regimens involving clomiphene citrate (CC). The observed decrease from 1986 to 1990 was strongly related to the decrease in use of CC.

Adult↗

PubMed1993

[Multiple pregnancy risk factors in medically assisted reproduction].

FIVNAT registry collected 4,323 clinical pregnancies from 1987 to 1991, and allowed us to analyse the risk factors for multiple pregnancies. The multiple pregnancy rate is around 28%, 23% for twin pregnancies and 5% for triplet pregnancies. The number of transferred embryos is not the only factor to be significantly related with the risk of multiple pregnancy: male infertilities, cleavage rate over 50%, and women's age (at young ages multiple pregnancy rate are higher) are also significant. A multivariate logistic model was applied to analyse the relative part of these different factors. We also estimated the success rate and the multiple pregnancy rate which should have been obtained if the number of transferred embryos has been limited, in order to reduce the multiple pregnancy rate to 3%.

Adult↗

PubMed1993

[In vitro fertilization in women over the age of 40].

IVF practice is increasing for women aged over fourty, in France. Analysis shows that when women's age increases, stimulation protocols with GnRH analogues using a short blocking period or "classical" protocols (without GnRH) are more and more used. However, the highest pregnancy rates are still obtained for protocols using GnRH analogues with a long blocking period. The proportion of the stimulation regimen using pure FSH is also increasing, but pregnancy rates do not show any difference between these protocols and those using hMG.

Adult↗

PubMed1992

Conditions for choosing between drug-induced and surgical abortions.

In France, pregnant women with amenorrhoea of no more than 49 days intending to terminate pregnancy can choose between a surgical abortion via vacuum aspiration under local or general anesthesia and a drug method combining Mifepristone orally administered (RU 486 degrees), with a prostaglandin analogue. This prospective survey was conducted to study the conditions under which women choose their abortion method, and to evaluate the acceptability of each method after the abortion. The data gathered from 488 women were analyzed according to their initial decision, and then according to the method actually used. The majority (62%) chose RU 486. The women's choice was found to be linked to sociodemographic characteristics such as age, education, occupation, geographic origin, and certain attitudes towards pregnancy, as well as to the individual criteria of each method. The women who chose the drug protocol had most often already made their decision before going to the family planning center (68%), having been advised by their doctor (20%). They were slightly less satisfied with the abortion experience than they had expected: 12.4% were unsatisfied in the RU group and 3.6% in the aspiration group. They needed more rest and quiet afterwards (50%) than the other women. They were distinguished by their desire to verify the expulsion (63%). The length of pregnancy is therefore not the only criterion to be considered when recommending one or other of these methods: the women concerned have different requirements and should have several possibilities to choose from.

Abortion, Induced↗

PubMed1990

In-vitro fertilization: influence of women's age on pregnancy rates.

An analysis of the influence of women's age on the results of in-vitro fertilization was performed, using 5590 attempts collected during the year 1986. Increasing age was found to be related to decreased success rates from 19.8% per attempt below the age of 25 years, to 9% per attempt at 40 years or more. A cut-off point was found between the ages of 36 and 37 years, using a mathematical model. The decrease was related to a reduction in oocyte production (4.3 +/- 2.8 at 25 years or less and 3.3 +/- 2.1 at 40 years or more, P less than 0.001), and to a reduced implantation rate, whatever the number of transferred embryos. These findings were not due to spouse's age, rank of attempt, infertility diagnosis or oocyte stimulation regimen, since the effect of age remained significant when a logistical model including these confounders was applied. Finally, a woman's age must be considered as a prognostic factor when IVF is proposed to infertile couples.

Adult↗

PubMed1989

Characteristics of reproductive life and risk of breast cancer in a case-control study of young nulliparous women.

Between 1982 and 1985, a case-control study of nulliparous women, aged 25-45, was conducted to analyse the relationships between the risk of breast cancer and causes of nulliparity, including contraceptive methods. Fifty-one cases of breast cancer diagnosed less than 3 months before interview were matched with 95 controls on age at diagnosis, year of interview, and medical center. The causes of nulliparity related to female sterility or subfertility (mechanical or hormonal disorders) were not found to be associated with a significantly higher risk of breast cancer. The causes related to fertilization failure, i.e. no sexual partner, rare sexual intercourse (less than once per month), or partner with abnormal semen, were found to lead to an increased risk. Detailed analysis of contraceptive methods showed that the risk of breast cancer increased (p = 0.02) with a longer duration of use of barrier methods (withdrawal or condom). Conversely, the risk significantly decreased (p = 0.004) with a longer duration of use of non-barrier methods (oral contraceptives, IUD, cap, local spermicides, vaginal douche, safe period, or no method), i.e. methods allowing a direct exposure to human semen.

Adult↗

PubMedDate not supplied

[Experience of ectopic pregnancy].

This survey relates to the experience and the management of women who have received a treatment for an ectopic pregnancy. It is based on 31 clinical interviews, conducted a month after the end of surgical or medical treatment. Among these women, 42% had had previous treatment for sterility. The main results show that 16% had never previously heard of ectopic pregnancy, and 29% do not see any reason why they had had one. For the patients, the diagnosis had not been made early enough: 45% feel that the consequences could have been serious if they had not taken the matter seriously themselves. Women clearly express some strong feeling against the health professionals (74%) who were responsible for their medical care, in spite of the attention they received, which reveals the psychological trauma they suffered. Although 55% of women felt depressed, for some of them the ectopic pregnancy seemed to operate as an exorcism from a previous more serious situation. They place their hope in a future pregnancy under close medical supervision. When it appears necessary, psychological support should be offered to these patients.

Adaptation, Psychological↗

PubMedDate not supplied

[1997 FIVNAT general balance].

In 1997, the French National Register on in vitro fertilization, FIVNAT, has collected information on 3,854 initiated cycles and 36,583 oocyte recoveries, from which 61.2% were conventional IVF cycles and 38.6% were ICSI. For conventional IVF, the percentage of infertilities of tubal origin was 49.7%, whereas 45% of the recoveries involved a male factor. The stimulation regimen involved a GnRH in 95% of the cases mostly with a long blockage period (82.6%) which was associated to the highest pregnancy rate. The mean number of transferred embryos significantly decreased to 2.50 +/- 0.95 per transfer. Only 9.2% of the transfers involved more than 3 embryos, and were associated to a relatively poor pregnancy rate, confirming that they were preferently realised in couples with poor chances of pregnancy. Finally, the pregnancy rate per recovery (20.5%) and per transfer (26.0%) remained at the same level as in 1996.

Adult↗

PubMedDate not supplied

FIVNAT. Influence of attempt rank in in vitro fertilization.

The French national register on in vitro fertilization (IVF) FIVNAT, which has collected most of the oocyte pick-ups realised in France since 1986 has allowed us to build a cohort of 35,714 couples, of which the first recovery took place between 1990 and 1994 and followed up to a pregnancy or to the 31st of december, 1996. The per recovery clinical pregnancy rate decreased from 20.2% on the first attempt to 17.4% on the second, and to less than 13% after the sixth. This evolution existed whatever the women's age class or the infertility diagnosis. The women's age remained the most important factor, since the cumulative pregnancy rate decreased from 60% for women aged less than 35 years to 17% for those aged more than 41 years. Among the indications, male infertility using spouse's semen had the poorest prognosis, especially for women aged more than 41 years (9.6%) whereas male infertility using donor's semen among women aged less than 35 years was associated to the best results (68%). It must be noticed than a high percentage of unpregnant women did not come again for a further recovery (40% to 50%). Then, the crude cumulative birth rate (24.4%) was far below the theoretical cumulative one(54.2%).

Age Factors↗

PubMedDate not supplied

[Ovulation stimulation].

In 1997, 2 new recombinant FSH were available. The analysis of the first 11,000 attempts IVF and ICSI received by FIVNAT for 1997 shows that recombinant FSH was used in about 20% of cases. Pregnancy rates were similar with urinary and recombinant FSH but the number of ampoulles was significantly lower with recombinant FSH.

Female↗