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Resume Objectifs La diminution de la reserve ovarienne (DOR) est une cause courante d’infertilite. Nous avons cherche a definir les genes dont l’expression par les cellules de la corona radiata (CCR) pourrait etre specifiquement deregulee dans ce contexte. Patientes et methodes Dans le cadre de fecondations in vitro, nous avons analyse, a l’aide de microarrays, le profil d’expression differentiel des CCR chez 4 patientes presentant une DOR et chez 4 patientes presentant une reserve ovarienne normale. L’expression des genes d’interet a ensuite ete etudiee sur un panel independant de 40 patientes, par RT-PCR quantitative. Resultats Nous avons mis en evidence 48 transcrits differentiellement exprimes parmi lesquels, CXXC5 et FOXC1 sous-exprimes chez les patientes avec une DOR, et CTGF, FSTL3, PTGS2 et SOCS2 surexprimes dans ce groupe de patientes. Par ailleurs, deux sous-groupes ont ete individualises parmi les patientes presentant une DOR (DOR Gr1 et Gr2). Le groupe DOR Gr2 se caracterisait par une surexpression significative de CITED2, CTGF, GAS-1, IRS2, PTGS2, SOCS2, VCAN et une sous-expression significative de CXXC5, FOXC1, GBP2 et ZMIZ1. Onze de ces genes sont des cibles des oestrogenes et les patientes de ce groupe DOR2 presentaient un taux basal d’estradiol significativement plus eleve que les autres patientes du groupe DOR (p Discussion et conclusion Nous avons identifie 12 genes deregules dans les CCR de patientes presentant une DOR et potentiellement impliques dans ce phenotype. La distinction d’un sous-groupe particulier de DOR evoque la possibilite d’une deregulation des genes de reponse aux oestrogenes.

The recent demonstration that aromatase is expressed at higher levels in endometriosis implants than in normal endometrium has led to pilot studies using inhibitor aromatasis in patients with endometriosis. We conducted a systematic review of the literature and studied the efficacy of aromatase inhibitors on endometriosis. There were seventeen studies (case reports/series) evaluating outcomes of aromatase inhibitors. Studies suggest that aromatase inhibitors alone or co-administered with progestins, oral contraceptives or gonadotrophin releasing hormone (GnRH) agonist could reduce pain and endometriosis. There is only one randomized controlled trial comparing aromatase inhibitor+GnRH agonist and GnRH agonist and one study with eighty patients. Side-effects profiles of aromatase inhibitor regimens are favorable; it does not appear a significant bone loss. Aromatase inhibitors seem to have a promising effect on endometriosis but randomized controlled trials are needed to prove their effects and their safety.

We report a case of a patient who presented an isthmic pregnancy successfully treated with an intramuscular injection of methotrexate. The diagnosis of isthmic pregnancy was made clinically (cervical colour was normal, inferior segment soft and enlarged) and echographically (long cervix, foetal sack situated in the isthmus and the uterine body was empty). An isthmic full term pregnancy is possible but would carry major haemorrhagic risk. There are several therapeutic options if the pregnancy is interrupted: medical treatment of methotrexate, curettage, curettage with embolisation of the uterine arteries and as a last resort, hysterectomy. The success of conservative treatment seems to be related to the criteria known for the cervical pregnancy, which are cardiac activity, the level of HCG, gestational age and cranial-caudal length.

Three surgical approaches have been described for the treatment of women presenting an endometrial cancer. The aim of this study was to appreciate the current criteria that would offer guidelines for this choice. We reviewed the data available in the literature (search Medline). Only laparotomy and laparoscopy permit the carrying out of all the routine surgical staging according to the FIGO's criteria (classification 1988). Only one randomised study compares the results obtained by laparotomy and laparoscopy. Laparoscopy patients had significantly less morbidity. Overall survival did not differ in both groups with a limited follow-up. The other not randomised studies show that laparoscopy is usually proposed to patients having a lower IMC and presenting limited stages. No randomized study had compared laparotomy with the only vaginal surgery. The latter is generally proposed for patients having an associated comorbidity and presenting limited stages. In such cases, no difference in survival is highlighted. Obesity does not represent an absolute contra indication for any way. It makes the surgery generally more complex. A suspicious ovarian lesion, a large uterus are, currently, an indication for laparotomy. Laparoscopy can be accepted only if the uterine volume is lower than 500 g and without deep myometrial infiltration. Laparotomy surgery is the standard. The main indication of vaginal surgery is to permit treatment to high operatory risk patients. Laparoscopy is an option for the early stages. It is not recommended if an ovarian lesion or a deep uterine parietal infiltration are suspected. Whatever the route used, the surgeon must be trained.