PROK1, biomarqueur de l’implantation embryonnaire ?

In spite of improvements in assisted reproductive technology (ART) during the last 30 years, the rate of pregnancy remains constrained, as only about 25 % of embryo transfer lead to successful pregnancies, even with an average of two embryos replaced. Embryo selection is currently based on the establishment of morphokinetic scores, a method that obviously exhibits limitations. Therefore, the assessment of embryo development potency by criteria of higher predictive value is mandatory in order to increase the rates of pregnancy. Nowadays, there is increasing evidence that angiogenic factors might contribute to the success of the implantation and to the pregnancy outcome. Among these factors, prokineticin 1 (PROK1) and its receptors (PROKRs) constitute new targets that showed over the last ten years strong biological features directly linked to ovarian physiology, endometrial receptivity, embryo implantation and thus successful pregnancies. In ART, the rates of circulating PROK1 were reported in 2012 as significantly linked to the quality of embryonic cohort, as well as to the rates of pregnancy. Our preliminary data suggest a high potential of this cytokine in the success of implantation and pregnancy, and strongly overtones the emergency to investigate the value of its measurement in conditioned media of oocytes and embryo cultures in ART.     

La prévention de l’infection maternelle à cytomégalovirus est-elle possible ?

Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection in developed countries. Vaccines are currently under development and antiviral treatment or passive immunizations for pregnant women with CMV primary infection are about to be evaluated in randomized trials. However, as it has been shown in few studies, preventing transmission through behavioral changes could be, at the moment, the most effective and inexpensive way to decrease risk of CMV infection during pregnancy. Despite difficulties, such counseling programs deserve to be established.     

Tumeur limite de l’ovaire unilatérale : l’annexectomie est-elle le bon choix ?

To perform an adnexectomy in case of unilateral borderline tumor must consider the risk of recurrence, the preservation of fertility, and to integrate a global comprehensive management of a couple. Adnexectomy can be considering as a legitimate option when the woman desire a pregnancy. The risk of recurrence is low and the global survey high. Identification of woman with a high risk of recurrence is necessary. Adnexectomy can be considering as a legitimate option to preserve fertility in case of unilateral tumor. However, ovarian reserve data are missing after the surgery. Adnexectomy can be considering for the management of infertile woman with unilateral borderline tumor. IVF can be performed in the absence of any poor prognosis factor. Management with ovarian cryopreservation and In vitro Maturation remain unclear.     

Les marqueurs apoptotiques ont-ils leur place comme marqueurs potentiels de l’exploration de l’infertilité masculine ?

Apoptosis is a cell death program involved in different steps of spermatogenesis, first at puberty, at the beginning of spermatogenesis, then in adult testicles by controlling normal spermatogenesis. As a result, apoptosis deregulation can affect spermatogenesis. Many studies have provided evidence that apoptosis deregulation in germinal cells resulted in male infertility. In addition, apoptosis detection in ejaculated spermatozoa arouses a growing interest in research as a reliable marker of spermatozoon quality. The aim of this review is to summarize our knowledge on physiological apoptosis during spermatogenesis, and then analyse the possibility of using apoptotic markers as selective markers of spermatozoon quality to optimize the rate of success of in vitro fertilization.     

Peut-on diagnostiquer l’atrésie de l’?sophage en prénatal ?

Esophageal atresia is a rare malformation affecting 1/2500?C1/3500 live births. Different subtypes exist but the disruption of the continuity of the esophagus is associated most of the time with a tracheo esophageal fistula (90%). Prenatal diagnosis is perceived to be advantageous as diagnosis of associated anomalies can be offered (by ultrasound, RMI, amniocentesis). Parents could be prepared to the birth and treatment of an affected infant and prenatal diagnosis also allows optimal neonatal management. Polyhydramnios and absent or small stomach bubble on routine ultrasound are the most common signs encountered in case of esophageal atresia but they are not specific. Ultrasound or RMI visualization of a blind ending pouch (proximally dilated esophagus) in the fetal neck or upper mediatinum during fetal swallowing can improve the specificity of prenatal diagnosis. However, prenatal diagnosis of EA is still hazardous and less than 50% are suspected during pregnancy. Amniotic fluid digestive enzyme assay could improve prenatal diagnosis.     

La tératozoospermie à l’heure de l’intracytoplasmic morphologically selected sperm injection (IMSI)

Until now, the morphological sperm analysis (spermocytogram) allows to define sperm normality, but the relationship between sperm morphology and fertility is not yet assessed. Although several studies do not report any relationship between abnormal sperm morphology and ICSI results, nevertheless, the success rate of ICSI sems to be dependent on injected sperm morphological aspect. Detailed morphological sperm examination (especially sperm head) at high magnification (from × 6600 to × 12500) (MSOME) in real time allows to select the best spermatozoa before oocyte injection (IMSI). In some cases, implantation and ongoing pregnancy rates were improved with this sperm selection method. Ultramorphologic criteria were established and the most predictive factor of sperm quality is the presence of vacuoles in the sperm head. Those vacuoles appear to be related to DNA damage (fragmentation and/or denaturation) and affect embryo development. To standardize those observations, several authors tried to establish sperm MSOME classifications in order to be used in routine and to replace the conventional spermocytogram in the next future.     

Cryptorchidie : de la physiopathologie à l’infertilité

Cryptorchidism is a defect of testicular descent. Hormonal, genetic and environmental factors might also contribute to the aetiology of cryptorchidism and its increased incidence in recent years in industrialised countries. Cryptorchidism itself might be considered a complex disease. This testicular pathology represents the best-characterized risk factor for reduced fertility and testicular cancer. The purpose of this review is to better understand physiopathology and mechanisms of infertility in men with history of cryptorchidism.     

Azoospermie et tétrasomie 48,XXYY : quelle prise en charge de l’infertilité ?

48,XXYY syndrome is a rare form of sex chromosomal aneuploidy. Usually considered as a variant of Klinefelter syndrome because of shared features (azoospermia, tall stature, hypergonadotropic hypogonadism), it is a separate entity because diagnostic is currently made in prepubertal boy with neuro-psychological disorders. We here report the case of a 48,XXYY patient consulting for adult infertility and the indication to perform testicular sperm extraction is discussed.     

La femme enceinte obèse : le point de vue de l’anesthésiste

The obese parturient is a high risk patient by the combination of obesity and pregnancy physiological changes. Regional anesthesia is recommended to avoid general anaesthesia. Epidural analgesia is a medical indication for vaginal delivery and spinal combined spinal and epidural anaesthesia is recommended for caesarean section. Antibiotic prophylaxis for cesarean section should use dosages correlated with BMI, some even recommending combination therapy. Thromboprophylaxis may be indicated even if vaginal delivery and will be correlated with BMI.