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Biomedical subjects

R Fanchin

Publications and source records attributed to R Fanchin.

At least 55 records · Page 3Linked to original sources
PubMed1998

Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization.

To investigate the possible consequences of uterine contractions (UC) as visualized by ultrasound (US) on in-vitro fertilization (IVF)-embryo transfer outcome, we studied prospectively 209 infertile women undergoing 220 cycles of controlled ovarian stimulation. Inclusion criteria were age < or = 38 years, a morphologically normal uterus, and at least three good quality embryos transferred. Just before embryo transfer, women underwent 5 min digital recordings of the uterus using US image analysis software for UC assessment. Plasma progesterone and oestradiol concentrations were measured. Four groups were defined according to UC frequency: < or = 3.0 (n = 53), 3.1-4.0 (n = 50), 4.1-5.0 (n = 43), and > 5.0 (n = 74) UC/min respectively. Patients, controlled ovarian hyperstimulation and embryology characteristics were comparable in all groups. A stepwise decrease in clinical and ongoing pregnancy rates as well as in implantation rates occurred from the lowest to the highest UC frequency groups (53, 36, 21; 46, 32, 20; 23, 19, 10; and 14, 11, 4%; P < 0.001). Plasma progesterone and UC frequency were negatively correlated (r = -0.34, P < 0.001). Direction of UC did not affect embryo transfer outcome. As this study was controlled strictly for confounding variables and UC were assessed objectively by a computerized system, its results indicate that high frequency UC on the day of embryo transfer hinder IVF-embryo transfer outcome, possibly by expelling embryos out of the uterine cavity. The negative correlation between UC frequency and progesterone concentrations supports the uterine relaxing properties of progesterone.

Chorionic Gonadotropin↗
PubMed1998

The use of a GnRH antagonist (Cetrorelix) in a single dose protocol in IVF-embryo transfer: a dose finding study of 3 versus 2 mg.

New gonadotrophin-releasing hormone (GnRH) antagonists, which allow suppression of luteinizing hormone (LH) surges, have recently become available. We compared in this study the results of a single administration of 3 versus 2 mg Cetrorelix in 65 patients undergoing ovarian stimulation and in-vitro fertilization (IVF). The GnRH antagonist (Cetrorelix) was non-randomly administered at a dose of 3 mg (34 patients) or 2 mg (32 patients) on day 8 of the stimulation cycle. In the case of slow follicular development, the injection was delayed until oestradiol reached 400 pg/ml. No difference was observed in the decrease in LH and in oestradiol secretion between the 3 and the 2 mg groups, but the LH secretion was suppressed for a shorter time in the 2 mg group. No LH surge was observed in the 3 mg group, while one surge (3%) and one significant rise in LH were observed in the 2 mg group. No significant difference was observed in IVF results in the two groups of patients. This study demonstrates that a single injection of 3 or 2 mg successfully prevents LH surges for at least 3 days in all the patients treated. The LH rises in the 2 mg group led us to choose the 3 mg dose as a safer dose in our single administration protocol.

Adult↗
PubMed1998

[In vitro fertilization and sperm intracytoplasmic injection: psychological repercussions for the couple].

The aim of the study was to assess the psychological repercussions of IVF + ICSI on the male partner of infertile couples and on the couples and on the couple itself. The preliminary work has been done on the 23 couples in the waiting list of an ICSI cycle in A. Beclere hospital in Clamart. All couples respond to the same questionnaire. The two members of the couples were present in a semi-structured interview by 2 clinical psychologists. This ICSI scheme requires a complete change about the biological paternity. For infertile men, getting embryos work as a real reparation of their wounded ego, and the guilt goes from the man to the women when embryos are obtained. This study shows that infertile couples involved in IVF + ICSI have not the same concerns that doctors. Genetic abnormality transmission is not mentioned. On the opposite the male patients are strongly concerned by obtention of embryos which restore their fertility power. At this stage, female patients have to prove by carry out a pregnancy that they are as "good" as their partner.

Adult↗
PubMed1997

Consequences of premature progesterone elevation on the outcome of in vitro fertilization: insights into a controversy.

OBJECTIVE: To investigate whether the consequences of premature P elevation on IVF-ET outcome are modulated by the quality of the ovarian response to controlled ovarian hyperstimulation (COH). DESIGN: Retrospective analysis. SETTING: Assisted Reproduction Unit, Clamart, France. PATIENT(S): One thousand twelve women undergoing 1,189 IVF-ET cycles. INTERVENTION(S): Patients underwent COH with a time-released GnRH agonist and hMG. The ovarian response to COH was classified as strong (< or = 50 hMG ampules, peak E2 levels > 2,500 pg/mL, and > or = 10 mature oocytes; n = 340), weak (> 50 hMG ampules, peak E2 levels < or = 1,500 pg/mL, and < or = 5 mature oocytes; n = 285), or intermediate (remaining cases; n = 564). The IVF-ET outcome in each group was analyzed according to whether or not plasma P levels exceeded 0.9 ng/mL. MAIN OUTCOME MEASURE(S): Pregnancy rates (PRs). RESULT(S): Clinical PRs were similar irrespective of low or high P levels in the strong (30% and 34%, respectively) and intermediate (31% and 30%, respectively) groups. However, in the weak group, P levels > 0.9 ng/mL were associated with lower PRs (3.2% and 23%, respectively). CONCLUSION(S): In the presence of an adequate response to COH, P levels > 0.9 ng/mL were not associated with lower PRs, indicating that good embryo quality may compensate for the adverse endometrial effects of P. Conversely, when the response to COH was weak, premature P elevation led to drastically reduced PRs.

Adult↗
PubMed1997

Premature progesterone elevation spares blastulation but not pregnancy rates in in vitro fertilization with coculture.

OBJECTIVE: To clarify whether embryo development to the blastocyst stage may be affected by premature P elevation during controlled ovarian hyperstimulation (COH) for IVF-ET with embryo coculture. DESIGN: Retrospective study. SETTING: Tertiary care infertility center. PATIENT(S): One hundred thirty-one women undergoing 153 IVF-ET cycles with embryo coculture. INTERVENTION(S): Patients underwent COH with GnRH agonist and hMG. Embryos were cocultured up to the blastocyst stage. According to plasma P levels on the day of hCG, two groups were defined: low P (P < or = 0.9 ng/mL; conversion factor to SI unit, 3.180) and high P (P > 0.9 ng/mL). MAIN OUTCOME MEASURE(S): Blastulation (number of blastocysts/number of noncavitating embryos x 100) and pregnancy rates (PRs). RESULT(S): Blastulation rates were similar in the low and high P groups (51% and 48%, respectively). Moreover, patients included in the high P groups achieved significantly lower clinical and ongoing PRs (12% versus 29% and 7% versus 25%, respectively). CONCLUSION(S): The lack of difference in blastulation rates between the groups further supports the hypothesis that premature P elevation does not alter oocyte and embryo quality. Hence, the observed decrease in PRs is likely to reflect impaired endometrial receptivity in the high P group.

Adult↗
PubMed1997

Premature plasma progesterone and androgen elevation are not prevented by adrenal suppression in in vitro fertilization.

OBJECTIVE: To investigate the effects of adrenal suppression with dexamethasone (DEX) on P and androgen profiles during controlled ovarian hyperstimulation (COH) for IVF-ET. DESIGN: Prospective controlled trial. SETTING: In vitro fertilization program, Clamart, France. PATIENT(S): One hundred twenty IVF-ET candidates aged 25 to 39 years undergoing 120 COH cycles. INTERVENTION(S): Group A: 60 women received a time-release GnRH agonist (GnRH-a) on cycle day 2. After pituitary desensitization was confirmed, 1 mg/d DEX was administered daily until hCG. Ovarian stimulation with hMG was started on the 7th day of DEX. Group B: 60 other women received an identical treatment except DEX was omitted. MAIN OUTCOME MEASURE(S): Plasma E2, P, androstenedione (A), and T were measured 18 days after GnRH-a, on the 7th day of DEX in group A, and on the day of hCG. RESULT(S): Peak plasma E2 levels were similar in groups A and B. After GnRH-a, P and androgen levels were low in both groups. In group A, an additional decrease in these hormones was observed after 7 days of DEX. During COH, we observed similar absolute increases of P, A, and T in groups A (+0.52, +1.56, and +0.12 ng/mL, respectively) and B (+0.55, +1.66, and +0.17 ng/mL, respectively). CONCLUSION(S): As expected, DEX lowered additionally P, A, and T levels from values achieved after GnRH-a alone, reflecting the adrenal contribution to the circulating levels of these hormones at baseline. Yet, the net increases in P, A, and T seen in COH were unaltered by DEX treatment, indicating that this phenomenon results solely from an effect of exogenous gonadotropins on the ovary.

Adrenal Glands↗
PubMed1997

Follow-up of a cohort of 422 children aged 6 to 13 years conceived by in vitro fertilization.

OBJECTIVE: To contact the total cohort of children conceived by IVF-ET consecutively in our center between June 1981 and December 1988. DESIGN: Retrospective study. SETTING: Infertility unit of the department of Obstetrics and Gynecology, Antoine Béclère Hospital, Clamart, France. PATIENT(S): Complete information was obtained on 370 children. The percentage lost for follow-up was 9%. INTERVENTION(S): To assess the children's well-being, telephone interviews of the parents and questionnaires sent to the parents and/or pediatrician were used. MAIN OUTCOME MEASURE(S): Surgical procedures, malformation, height and weight, school performance. RESULT(S): The physical growth of these children showed no major pathological features, with only 2.2% of them being below 2 SD for weight and 0.3% for height. The rates of malformation were not significantly different between these children and the general population. School performance was good, with 92.2% presenting encouraging outcome. Fifty-eight percent of the parents of children aged 6 to 10 years old did not inform their children about the IVF nor did 34% of the parents of children aged 11 to 13. Subsequent to the birth of the IVF child, 30 patients (8.9%) had a spontaneous pregnancy. However, five of them (15.1%) were ectopic. CONCLUSION(S): This study reports, for the first time, reassuring data on the long-term assessment of a large group of older IVF-ET children conceived consecutively, with a low percentage of subjects lost for follow-up.

Achievement↗
PubMed1997

Transvaginal administration of progesterone.

OBJECTIVE: To examine the endometrial effects of three different doses of progesterone administered vaginally. METHODS: Forty women 25-41 years old deprived of ovarian function received estradiol (E2) for 28 days. From days 15 to 27, a new mucus-like vaginal gel of progesterone was administered every other day, randomly, dosed at 45 mg (group A, n = 14), 90 mg (group B, n = 13), or 180 mg (group C, n = 13). Plasma gonadotropins, estrone, E2, and progesterone were measured. An endometrial biopsy was performed on day 20 (n = 20) or 24 (n = 20) for endometrial dating and for estrogen and progesterone receptor determinations. RESULTS: Plasma estrogen levels were in the menstrual cycle range. Mean progesterone levels were lower in group A (2.4 +/- 0.2 ng/mL) than in group B (3.6 +/- 0.2 ng/mL) or C (3.4 +/- 0.4 ng/mL) (P < .005). Plasma FSH and LH decreased significantly during progesterone treatment. In all groups, we observed secretory transformation in the glands (day 20) and stroma (day 24) and the distribution of estrogen and progesterone receptors seen in normal menstrual cycles. CONCLUSION: Transvaginal administration of progesterone induced normal secretory transformation of the endometrium despite low plasma levels, suggesting a direct transit into the uterus or "first uterine pass effect."

Administration, Intravaginal↗
PubMed1996

[Intracytoplasmic injection of spermatozoa].

Management of male infertility has been totally changed with the development of intracytoplasmic sperm injection (ICSI). This technique, used for in vitro fertilization, consists in injecting a single spermatozoa into the ovum. Intracytoplasmic sperm injection can be proposed in case of severe male sterility (oligoasthenospermia) or after repeated failure of in vitro fertilization. Satisfactory rates of fecondation and pregnancy have been obtained. Results have also been obtained with sperm taken from the epididymis or testis. The risks involved concern the transmission of poorly understood genetic defects leading to the infertility. The rates of reported malformations and chromosome anomalies are quite low. Intracytoplasmic sperm injection can be useful in managing most cases of male infertility which to date have had to rely on donor sperm. Long-term results have not yet been obtained.

Female↗
PubMed1996

Premature progesterone elevation does not alter oocyte quality in in vitro fertilization.

OBJECTIVE: To clarify whether premature P elevation during controlled ovarian hyperstimulation (COH) for IVF-ET affects adversely oocyte-embryo quality. DESIGN: Controlled clinical study. PATIENTS: We studied 102 fertile donors undergoing 106 oocyte retrievals and 117 recipients undergoing 162 ET. INTERVENTIONS: Donors underwent COH with a time-release GnRH agonist and hMG. All recipients had inactive or absent ovaries and were primed with E2 and P. MAIN OUTCOME MEASURES: Measurement of LH, P and E2; characteristics of COH; cleavage, pregnancy, and implantation rates. RESULTS: According to donors' plasma P levels on the day of hCG, two groups were defined: P < or = 0.9 ng/mL (conversion factor to SI unit, 3.18), group A, and P > 0.9 ng/mL, group B. Similar results of cleavage (65% and 72%), clinical (30% and 29%), and ongoing pregnancy (20% and 18%), and implantation (14% and 15%) rates were observed in both groups, respectively. CONCLUSIONS: The lack of difference in cleavage, pregnancy, and implantation rates between both groups suggests that preovulation increase in P production does not alter oocyte-embryo quality. Hence, the reported adverse effects on IVF outcome of pre-hCG elevation of P is likely to reflect an impaired endometrial receptivity in the high P group.

Adult↗
PubMed1996

Perinatal outcome of twin pregnancies obtained after in vitro fertilization: comparison with twin pregnancies obtained spontaneously or after ovarian stimulation.

OBJECTIVE: To compare the perinatal outcome of IVF-ET twin pregnancies to twin pregnancies conceived spontaneously or after ovarian stimulation without IVF-ET. DESIGN: Retrospective analysis. PATIENTS: Three groups of patients: those who conceived after IVF-ET (n = 72), after ovarian stimulation without IVF-ET (stimulation group, n = 82), or spontaneously (spontaneous group, n = 164). MAIN OUTCOME MEASURES: High blood pressure, premature rupture of membrane, threatened premature labor, prematurity, low birth, small-for-gestational-age, cesarean section, and perinatal mortality. RESULTS: Patients of the IVF-ET group were older and of higher socioeconomic class. We did not find any significant difference in the data analyzed, with the exception of the rate of emergency cesarean sections. In the IVF-ET group the prematurity rate (38.9%), small-for-gestational-age (18%), and perinatal mortality (3.47%) were not statistically different with respect to the stimulation group (45.1%, 23.2%, and 3.05%, respectively) or the spontaneous group (39.6%, 22.7%, and 4.27%, respectively). CONCLUSIONS: Twin pregnancies account for 20% to 25% of all IVF-ET pregnancies. Their risk of adverse perinatal outcome does not seem to be increased when compared with spontaneous pregnancies or to pregnancies obtained after ovarian stimulation but without IVF-ET. However, a reduction in the proportion of multiple pregnancies, including twin gestation, should be a goal for IVF-ET teams.

Adult↗
PubMed1996

Triggering of ovulation by a gonadotropin-releasing hormone (GnRH) agonist in patients pretreated with a GnRH antagonist.

OBJECTIVE: To determine if GnRH-agonist (GnRH-a) could induce a LH surge in patients where a GnRH antagonist was used to prevent premature spontaneous LH surge. DESIGN: Pilot study. PATIENTS: Five patients treated with ovarian stimulation and IUI for idiopathic infertility. MAIN OUTCOME MEASURES: Luteinizing hormone, FSH, and P plasma levels. RESULTS: A LH and FSH surge as well as a P rise were obtained in the five patients studied. CONCLUSION: A GnRH-a successfully can induce an LH surge after GnRH antagonist administration. The effect of the antagonist on the quality of the GnRH-a-induced LH surge as well as the oocyte quality remain to be evaluated.

Female↗
PubMed1996

A protocol using a low dose of gonadotrophin-releasing hormone agonist might be the best protocol for patients with high follicle-stimulating hormone concentrations on day 3.

We studied 98 in-vitro fertilization (IVF) patients with a high basal follicle stimulating hormone (FSH; >6.5 IU/l) concentration on day 3 who were treated with a low dose gonadotrophin-releasing hormone agonist (GnRHa) protocol and who had received in the previous 6 months a long protocol with GnRHa in a depot formula. The evaluation was made using the previous IVF cycle of the same patient as a control. The mean +/- SD age of the patients was 34.1+/-4.2 years. The use of a low dose agonist protocol ended with significantly less ampoules (37.5 versus 46.1), a shorter duration of stimulation (10.7 versus 12.3 days), a higher oestradiol concentration on day 8 (1068 versus 495 pg/ml), a higher number of mature oocytes (5.9 versus 4.4) and a higher number of good quality embryos (3.3 versus 2.3). The cancellation rate was lower (11 versus 24%). A GnRHa low dose protocol may be the protocol of choice for patients with high FSH concentrations on day 3. Larger randomized studies are needed to confirm these data.

Clinical Protocols↗