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Minimal and mild endometriosis (stages I/II) is frequently identified in subfertile patients, especially in case of unexplained infertility. The impact of those lesions on fecundity is still debatted and they have been considered as paraphysiological by some experts. In addition, they are heterogenous with variable spread, biological activity, induced inflammation and, sometimes, the presence of associated mild adhesions. Stages I/II endometriosis are the most frequent endometriotic lesions encountered in subfertile women. Reduced oocyte quality, anti sperm effects and, possibly, endometrial disorders appear as the most pertinent mechanisms involved. Spontaneous fecundity of women with minimal or mild endometriosis is reduced when compared to fecundity of women whose infertility is unexplained. Intra-uterine insemination with controlled ovarian stimulation improves fecundity. Laparoscopic ablation of endometriotic lesions modestly improves fecundity. This procedure has thus been recommended in view of the very small increased surgical risk. IVF is the most efficient method allowing to obtain pregnancy, with slightly reduced or similar results when compared to the performances of IVF in case of tubal infertility.

Objectives: To study the social dimension of age-related female infertility through an analysis of three key themes: the personal life histories of infertile women over 40 years of age; representations of age and the desire to become pregnant after age 40; opinions of French legislations framing Assisted Reproductive Technologies, age limits, egg donation, and egg freezing for non-medical reasons., Methods: This qualitative sociological study was based on semi-structured interviews with infertile women over age 40 going through fertility treatments. The interviews contained three parts: personal and relationship histories; experiences related to age; opinions related to French legislation., Results: Twenty-three interviews were conducted; each lasting between 90 to 120minutes. Far from having similar life histories, the women interviewed had very different backgrounds leading to their desire for a pregnancy after 40 years of age. From the beginning of their fertility treatments, they perceived a "race against the clock". This feeling of urgency accompanied their experiences and was related to the desire to not be too old for their future child. The women interviewed were mainly in favor of loosening French bioethical laws in order to avoid the need to travel abroad to pursue fertility treatments., Conclusion: The profiles studied attest to a growing gap between biological and biographical temporalities, as well as an inability of women to reduce their desire for a child. Faced with this disparity, egg donation and egg freezing were seen as practical solutions., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objectives: The prevalence of female obesity is increasing. Obesity leads to increased infertility and difficulties in the management of Assisted Reproductive Technology (ART). A specialized nutritional consultation was created in 2008 at University Hospital of Lille, to support infertile obese and overweight patients and to achieve a BMI below 35kg/m(2) before pregnancy. The aim of this retrospective study was to evaluate our practice of nutritional support on weight and pregnancy rate., Methods: Seventy-eight obese or overweight patients, followed in nutrition and ART for at least two years, were compared to a control group of 119 normal weight patients. The nutritional strategy was mainly based on lifestyle changes, to establish healthier food and higher physical activity., Results: The mean initial BMI was 37.5kg/m(2) vs 35.6kg/m(2) after nutritional support (significant weight loss, [P<0.001]). Obese or overweight patients had more frequently metabolic syndrome (P<0.01). The chances of pregnancy, after weight loss, were similar to the control group both in IUI and IVF/ICSI. However, gonadotropin doses were increased in the obese and overweight group (P=0.007). The hypocaloric diet was the most effective nutritional strategy to achieve a weight loss greater than 5% of initial weight (P=0.017). Regular physical activity practice allowed also more frequently to achieve this goal (P=0.074). Even after weight loss, a significant number of gestational diabetes (25% of pregnancies in our population) occurred in the obese or overweight group., Conclusion: This nutritional consultation promotes weight loss in infertile obese or overweight patients. The maternity desire is a strong motivational lever to weight loss, which leads to satisfying pregnancy rate., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objectives: To study feasibility of day care surgery for laparoscopy for adnexial pathology, infertility treatment or exploration and to research influencing factors., Material and Method: Women who beneficiate of laparoscopy for adnexial pathology, infertility treatment or exploration and to research influencing factors were included between 1st January 2010 and 30th June 2012 in this monocentric retrospective study., Results: Four hundred women were included. Day care surgery was possible in 63% of cases. A switch to conventional hospitalization was required for 17% of the women planned for day care surgery. The rate of a second hospitalization in the month following day care procedure was 1% with 0.4% of second surgery for complications. Influencing factors for day care surgery are age, surgeon and time of the surgery. The global satisfaction rate of women was 98%., Conclusion: Day care surgery is feasible for women who beneficiate of laparoscopy for adnexial pathology, infertility treatment or exploration. Second hospitalization or surgery for complications is very rare., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Ovarian endometriomas is a common condition among women of reproductive age and represents a major cost in terms of public health. Despite these implications for public health, it remains difficult to arrive at a consensus on the optimal surgical treatment., Aims: To study the clinical and paraclinical characteristics of this pathology and to compare two major surgical techniques: the intraperitoneal cystectomy and fenestration -coagulation in terms of recurrence and prognosis for future fertility., Methods: A retrospective study of 31 patients who underwent surgical treatment for ovarian endometrioma histologically proved. The study period covers 10 years from January 2000 to December 2009., Results: Laparoscopy was performed in 27 patients. The endometrioma was located to the left side in 64% of cases. The main strategy performed is intraperitoneal cystectomy in 18 patients (58.8%). In second place we find the fenestration-coagulation. The mean duration of postoperative follow-up is 10.3 months. The recurrence of the cyst and the persistence of pain symptoms were significantly less frequent in the group of patients who underwent intraperitoneal cystectomy., Conclusion: The laparoscopic surgery remains the first line approach in terms of ovarian endometrioma.Cystectomy offers performance equal or superior to the fenestration-coagulation technique, and exposes to fewer recurrences. For these reasons, it should be recommended. The fenestration-coagulation is possible in case the cystectomy is difficult or incomplete.

We performed hysterosalpingography (HSG) and transvaginal ultrasound (TVU) in 124 Ivorian women as part of an infertility evaluation. The aim was to investigate the causes of infertility and show the advantages of combining HSG and TVU as part of a comprehensive evaluation of infertility in African woman. TVU and HSG were normal in 35.5% of cases, while in 64.5% of cases, at least one disease was demonstrated. This included uterine pathology in 50.3%, tubal disease in 25.2%, ovarian pathology in 7.5% and peritoneal pathology in 7% of cases. Of all the diseases identified by the association HSG and TVU, 71.3% were found by TVU, while 61.5% were confirmed by HSG. TVU was more efficient in identifying uterine and ovarian pathologies while HSG excelled in tubal pathology. HSG and TUV had identical performances on the peritoneal pathology. The association HSG-ETV should be systematic in the full assessment of female infertility in sub-Saharan Africa.

The development of conservative surgical approaches and interventionnal radiology for conservative treatment in cases of severe post-partum haemorrhage allows nowadays a preservation of the genital tract in most of the cases in developed countries. The consequences of these techniques for the future fertility and pregnancy outcome are not fully evaluated. Very few cases of infertility are reported and the majority of the patients seem to recover regular menstrual menses after application of any of the described conservative approach. Pregnancy outcomes appear unchanged without any consequence concerning foetal growth. However, complications might occur, impairing future fertility or pregnancy outcome: uterine synechia have been described after arterial embolization, ovarian failures occurred after stepwise surgical approach including lombo-ovarian artery ligature, synechia and uterine infection impaired uterine compression sutures. Furthermore, recurrence of post-partum haemorrhage and abnormal placentation rates seem to be higher for future pregnancies., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: In literature, a uterine lesion in found in half of the infertile women., Aim: To compare the results of the hysteroscopy and the hysterosalpingography in the study of the uterine cavity as exploration of feminine infertility., Methods: Retrospective study, over a period of four years from 1 January 2005 to 31 December 2008 however, on 140 cases of infertile patients explored in the gynecology obstetrics department in Mahmoud El Matri hospital., Results: Compared with hysteroscopy, hysterography had an overall sensitivity of 76.56%, a specificity of 77.63%, a PPV of 74.24%, an NPV of 79.72% and a very strong correlation with coefficient of 0.83. Best correlations between the two examinations were found with polyps, fibroids and synechia., Conclusion: Hysterosalpingography remains the first line examination in the exploration of feminine infertility. However, hysteroscopy must be realized as a second examination in case of lesions found at the hysterography or at once in certain cases.

At present, it is estimated that fibroids may be associated with infertility in 5 to 10% and are possibly the sole cause of infertility in 1 to 3%. Their effects on fertility remain debated. The aim of this review of published studies between January 1990 and November 2010 was to clarify the relation between myoma and fertility, and to assess the role of myomectomy in infertile patients. In assisted reproduction technology and spontaneous conception, hysteroscopic sub-mucous myoma resection increased pregnancy rates. Intramural fibroids appear to decrease fertility, but the myomectomy does not improve assisted reproduction technology and spontaneous fertility. More high-quality studies are needed to conclude toward the value of myomectomy for intramural fibroids. Subserosal fibroids do not affect fertility outcomes, and removal does not confer benefit., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are invalidating inflammatory affections, which evolve by relapse interrupted with clinical remission. Crohn's disease commonly affects young women in their reproductive years with a peak of incidence between 20 and 30. Infertility and sexual dysfunction are equivalent to that of the general population while they are increasing in patients with active IBD or after colorectal surgery. IBD are well controlled by medical treatments and the frequency of relapse during the pregnancy is similar to that of the non-pregnant IBD patients. The data concerning the risk of congenital malformations in IBD are contradictory. The risk of preterm delivery and low birth weight is significantly increased and correlated to the disease activity. When a medical treatment insures a quiescent disease before the pregnancy, it is advisable to continue it during the pregnancy because the benefits of controlled disease outweigh the risks of medication. IBD, possible perianal lesions and colorectal surgical interventions influence the mode of delivery, but the indication of caesarean section should primarily be governed by obstetric necessity. Preconceptional counseling seems desirable because of the risks during pregnancy, according to the disease activity, the surgical histories and the therapeutic agents., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objectives: Uterine fibroids is the most common benign pathology during reproductive age. Fibroids are implicated as a possible cause of infertility. The mechanism of infertility may depend on the size and the location of the fibroids and remain unclear. Myomectomy is performed in case of symptomatic patients who want to preserve their reproductive potential or in case of infertile patients. There are few data concerning fertility following abdominal myomectomy in patients over the age of 38., Patients and Methods: Retrospective study of a case series. Assessment of reproductive outcome after abdominal myomectomy among patients older than 38 years., Results: Abdominal myomectomy was performed on 34 patients aged over 38 during. Among these patients, 25 (74%) were contacted and 15 (60%) tried to obtain a pregnancy. Seven patients (46%) needed a new intervention. Five patients (33%) required intra-uterine insemination or in vitro fertilization and embryo transfer postoperatively. Three patients obtained a pregnancy and two (13%) had a delivery. All pregnancies were obtained spontaneously. None infertile or nulliparous woman before surgery became pregnant postoperatively., Conclusion: After 38 years old, nulliparity and infertility before abdominal myomectomy seem to be a factor of poor prognostic to become pregnant after surgery., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: The subsequent fertility of women who had experienced ectopic pregnancy (EP) is the best criteria of the effectiveness of the treatment. In the absence of randomised trials comparing laparotomy, laparoscopy, medical treatment by methotrexate (MTX) and expectative, the only way to compare treatments is to make use of data from observational studies., Methods: The databases consulted were Medline, Cochrane Library, National Guideline Clearinghouse and Health Technology Assessment Database. Keywords used for research: fertility; ectopic pregnancy; expectative; methotrexate; salpingectomy; salpingotomy., Results: Twenty-four papers of randomised control trial (RCT) or observational studies were analysed. No difference between laparotomy and laparoscopy for fertility was found. Tubal suture does not modify the subsequent fertility. The risk of normal pregnancy or ectopic recurrence is similar between salpingotomy or salpingectomy when controlateral tube is normal. Conversely, in case of altered tube, the fertility appears higher after conservative treatment. Between conservative treatments, surgical or medical, no difference appears., Conclusions: Conservative surgical treatment is the gold standard. However, the fertility seems similar with the other treatments. Three ongoing RCT could answer to the three main questions: Which is the best fertility between medical and conservative surgical treatment? Which is the best fertility between radical and conservative surgical treatment? Which is the best fertility between MTX and expectative?, (Copyright 2010. Published by Elsevier Masson SAS.)

Currently, an estimated one out of six in couples has trouble to conceive. Normally a standard infertility evaluation is started, after one year of unsuccessful attempts in obtaining a pregnancy. Nevertheless, it is useful to inform couples before of different factors that can affect the occurrence of pregnancy. An initial evaluation of infertility is always carried out in parallel with the two members of the couple and includes various tests. The invasive nature of some examinations will depend on the findings of other tests. The particular situation of recurrent miscarriages requires special assessment but unfortunately less than half of the cases have identifiable causes. There are three main procedures of assisted reproductive technologies: ovulation monitoring, intrauterine insemination and in vitro fertilization. In vitro fertilization is a practice currently very supervised in Belgium, accessible to the majority of the population and resulting in a pregnancy about three times out of ten. There are some complications even if they remain uncommon (2%). The family doctor has certainly a role to play in order to have optimal care of unfertile couples from the beginning until the end.

The number of infertile couples to be cared for in infertility centres is estimated to be between 1 to 6 %. This figure has been rising over the past years. During the 24th annual meeting of the ESHRE (European society of Human Reproduction) in Barcelona, changes in the population of infertile couples have been analysed. The major trend is an increase in women's age but also in men's age when desiring their first child. This mean rise has reached more than two years for women's age, over the past 10 years. The negative influence of the woman's age on fertility, especially after 35 years, is clearly established. However, new data in men suggest that an age higher than 35 years could be linked to an increased rate of miscarriages. The concept of preconceptionnal care in order to detect comorbidities, especially smoking, overweight and diabetes has been emphasized. Furthermore, the influence of current lifestyles on fertility, a potential role of endocrine disrupters, represent new concerns, which are in line with a policy of preventive care of infertility. Lastly, patients undergoing treatment with gonadotoxic drugs represent a 'new" population in fertility clinics. Techniques of testicular and ovarian preservation, especially frozen oocytes, must be disseminated and improved in order to prevent infertility in those patients.

Obesity is a growing public health problem because of the morbimortality factors linked to it. In obstetrics and gynecology, consequences on fertility and contraception are notable: infertility, low assisted reproductive technologies (ART) results, miscarriages, congenital abnormalities, obstetrical and neonatal complications, low hormonal contraception efficacy. These effects are partially corrected by weight loss which can be achieved by behavioural, medical or surgical treatment. Gynaecologists should always participate in a multidisciplinary management of obesity before hormonal contraception or ART.

Objective: For years, induced abortions (IA) have been deemed responsible for altered fertility. The implication of various mechanisms including tubal infertility, intra-uterine adhesions, spontaneous abortion, ectopic pregnancy, cervical incompetence, shortened gestations, and any psychological trouble leading to anovulation has been raised. Though many authors find no evidence of an increased risk on fertility for women, whose IA is not complicated by infection, it might sometimes be insinuated that infertility is the consequence of previous abortion. Thus, we compared the rate of patients with any prior IA in a population of newly delivered women and in women ongoing IVF., Patients and Methods: A retrospective study was conducted at Sèvres hospital, comparing two populations of women, newly delivered women (n=1738) between January 1st and December 31st 2005, and women ongoing IVF at the same period (n=430). We reported the number of previous medical or surgical induced abortions and compared it in both groups. Another analysis compared these rates, among two subgroups of women with one or more prior pregnancy (secondary infertility (n=148), and secondary gestation (n=1088)., Results: The rate of prior IA was not different in the two populations. In the IVF group, 13% (n=56) had undergone one or more IA, versus 16.7% (n=291) in the newly delivered group (P=0.06). Among women with previous pregnancy, 37.8% (56) women of the IVF group had undergone one or more previous IA, versus 26.7% (291) of the newly delivered women (P=0.007)., Discussion and Conclusion: As expected by literature data on IA and fertility, rates of prior induced abortions were not different in the population of fertile women versus infertile. However, women with one or more previous pregnancy are more likely to have undergone previous IA in the IVF group than in the newly delivered group, possibly due to a bias of age. More data are requested to eliminate linkage between IA and infertility.

Schistosomiasis represents the second most endemic diseases following malaria. It is now endemic in 76 countries of the world, and it is estimated that more than 200 million persons are infected. The objective of this work is to help in the improvement of knowledge about Female Genital Schistosomiasis (FSG) effects on the women reproductive. A transversal prospective survey during six months, on women consulting for infertility in the health reproductive center of Niamey. The women included (109 persons) have been asked and consulted in gynecology, cervical smears urine pathology, urine ragent strips test, vesico-renal and gynecologic trans-abdominal ultrasound, hysterosalpingography (HSG) and cervical biopsy on infected patients. The infestation prevalence at S.haematobium was 38,5%. The infected persons have presented more gyneco-obstétrical symptomatology than the non infested ones. The proportion of exocervicite was 31,0% by clinical examination. The cervical biopsy done on 26 bilharziosis patients confirmed the frequence of highs chronic exocervicites (50%) and leucoplasia (11,5%). Echography and HSG noticed that the bilharzios patients can let develop other annexiel pathologies such as: ovary cyst, peri-tuboovary adhesions and wide ovaries. The symptomatology felt by infested women showed the parasitose consequence on women in endemic area. The treatment in o large schaddle by the national program allows to reduce morbidity caused by that infection in Niger.

There is no simple answer to the problem of fertility after one ectopic pregnancy. Results reported in the literature have been satisfactory with rate of subsequent pregnancy about 60% and the risk of new ectopic pregnancy (EP) around 28%. We have deliberately excluded studies before 1990 except when the methodology was particularly good or the treatment particularly interesting. Strict and exhaustive criteria were lacking in most of these studies due to widely varying aims, the prospective or retrospective nature of the data, the number of patients included, and varying therapeutic decision-making schemes. Many patients were lost to and no mention is given concerning the proportion of patients who desired a subsequent pregnancy. Infertility factors were not considered in most cases. We were looking for fertility results according to treatment used. Among the 50 studies we retained, pregnancy rates after ectopic pregnancy were satisfactory whatever treatment was used, with laparoscopy being the gold standard. Medical treatment was at least as effective as surgical treatment. Associated infertility factors appeared to be the most important for fertility outcome. It is unfortunate that so few study have analyzed outcome in these patients without considering risks factors of EP, infertility factors and the proportion of women who attempted to conceive again.

Unlabelled: The aim of this retrospective study was to evaluate the rate of recurrence and the reproductive outcome after surgical conservative treatment of low malignant ovarian tumors (LMOT)., Material and Methods: Sixty-eight patients with 50 Stage I LMOT and 18 LMOT with peritoneal implants treated conservatively at institut Gustave-Roussy, between January 1969 and December 2000. Fifty-nine patients had an unilateral adnexectomy (associated twelve times with a contralateral cystectomy), Seven had a bilateral cystectomy and two an unilateral cystectomy. Five patients received adjuvant therapy., Results: With a median follow-up of 71.5 months, 16 patients recurred and one had evolutive peritoneal disease. The histologic pattern of ovarian recurrences was always of borderline type. The histologic patterns of peritoneal recurrence was similar to those initially diagnosed except in one case. Peritoneal implants, exophytic tumor and serous type tumor were significatively associated with a higher 5-year recurrence rate. Recurrence was more frequent after cystectomy than unilateral adnexectomy (p = 0.13). None of patients treated conservatively recurred under the form of ovarian carcinoma. None patient died of tumor. Nineteen patients experienced 26 pregnancies: 24 were spontaneous in a median delay of 19 months. Seven infertile patients underwent ovarian stimulation. None recurred after infertility treatments. The 2-year and 5-year cumulative pregnancy rate were respectively 41.9% and 59.8%. Four patients experienced a pregnancy after a conservative treatment of their recurrence., Conclusion: Despite a high recurrence rate, especially in stage II and III serous LMOT, conservative treatment of LMOT does not affect survival and should be considered in young patients. Such treatment is not advised in case of invasive peritoneal implants. Spontaneous pregnancy rate is good but the frequent infertility associated with these tumors can afterwards require ovarian stimulation. Limited number of stimulation cycles is acceptable in such patients.

Aims: This study was designed to assess the proportion of adult patients with celiac disease who had had undiagnosed symptoms during childhood and to determine the consequences of such diagnostic delay., Patients and Methods: One hundred eighty-four patients with celiac disease (56 males, 128 females, age range 17-88 years) were classified according to diagnosis and symptoms of celiac disease during childhood. Prevalence of short stature, low fertility, clinical osteoporosis, cancer, and autoimmune disease were assessed in each celiac group and compared with a control group matched for gender and age., Results: Compared with the control group, patients with celiac disease were shorter (men 171.4 +/- 9.0 cm vs 176.4 +/- 6.9 cm, P<0.01; women 159.7 + 7.3 cm vs 162.7 +/- 6.2 cm, P<0.01) and had a higher prevalence of symptomatic osteoporosis (5%) cancer (10%), and autoimmune disease (25%). Compared with matched controls and with patients whose celiac disease had been diagnosed during childhood (n=36), or who had remained symptom-free (n=95), patients who had undiagnosed symptomatic celiac disease during childhood exhibited higher prevalence of short stature (26%), low female fertility or low birth weight (36%). Multivariate analysis showed that short stature and low fertility correlated with duration of symptoms before diagnosis; osteoporosis and cancer correlated with age. The prevalence of autoimmune disease was unrelated to early onset of symptoms or delay to diagnosis., Conclusions: Missing the diagnosis of celiac disease in a symptomatic child may lead to short stature and low female fertility.

The aims of this work were the evaluation of the reproductive outcome after ectopic pregnancy, and the assessment of the role of infertility risk factors and treatment's strategy. All patients in the population-based register of the urban area around Lille, Northern France, were followed-up. 345 women treated between April 1994 and March 1997, who were trying to become pregnant were interviewed by telephone every 6 months and then every year. The cumulative pregnancy rates were calculated by the Kaplan-Meier estimation. Associations between infertility risk factors and intrauterine pregnancy were tested by the logrank test, and by a Cox model for multivariate analysis. The mean duration of follow-up was 22 months, and 228 (66%) women had obtained a new pregnancy at the time of the analysis. 23 (10%) of the first pregnancies were recurrences. For women for whom EP occurred with an IUCD (17 patients), the 1 year intrauterine pregnancy (IUP) reached 67%. For the others, the 1 year IUP rate was 56%, and reached 67% after 2 years. After adjusting factors associated with fertility with a Cox regression, 3 factors seemed to lower reproductive performances: age > 35 years, previous history of infertility, and anterior tubal damage. More than half the women treated for EP obtained spontaneously a normally progressive pregnancy after 1 year. Reproductive performances are associated with characteristics of the patients, but do not depend on radical or conservative treatment.

Background: Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance., Methods: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent., Results: Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women., Conclusions: Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.

An ecopathological approach for examining nutrition-induced health disorders in dairy herds in France is described. Bovine dairy herds were surveyed for 4 yr to detect nutritional risk factors that discriminated between high and low disease incidence rates for retained placenta, milk fever, calf perimortality, metritis, liver disorders and infertility. In the cow, preventive feeding helps avoid nitrogen overnutrition, and reduces the requirements of Ca in the late gestation period, gives a satisfactory balance in polyunsaturated fatty acids before calving. The absence of feedstuffs including toxic components and a feeding system with few feedstuffs and few diet changes are also beneficial factors.

A new echogenic contrast medium, SHU-454 is a new method for direct imaging of fallopian tube passage in tubal diagnostics using transvaginal B-mode echography. Clinical studies in over 1,600 patients have shown that this product offers a reproducible echogenic contrast, significantly amplifies Doppler signal and is well tolerated. SHU-454 is injected through the cervix into the uterus and fallopian tubes using the same technique as for radiologic hysterosalpingography. This examination is easily performed in 5 to 10 minutes. Results, compared with two conventional methods, hysterosalpingography and chromolaparoscopy, in 115 women show that HyCoSy is a reliable procedure for detecting tubal patency. HyCoSy results totally agree with the results from the conventional methods in case of tubal patency. This technique may be suitable as an easy, quick and low-risk outpatient examination. It does not involve radiation exposure and is unlikely to cause allergic reactions such as those known to occur with iodinated contrast media. Transvaginal HyCoSy can be used to assess tubal patency early in sterility diagnostics, before adnexal or uterine (myoma) surgery or when tubes and uterine appendages cannot be seen during chromolaparoscopy.

The injection of methotrexate is an alternative to laparoscopic surgical treatment of unruptured ectopic pregnancy. An experimental trial on rabbits was designed to evaluate this new approach. In situ injection of methotrexate does not cause either real tubal epithelial impairment, nor an adverse effect on treated rabbits' fertility. However, sub-peritoneal injections of methotrexate are responsible for a typical histological lesion. These results are discussed emphasising the importance of the way the administration is carried out.

Nowadays new techniques of laparoscopic surgery make it possible to carry out fimbrioplasties and salpingostomies with results as good as those obtained by microsurgery. We describe a new use for the Fogarty catheter as a means of traction and for demonstrating the ampulla and the fimbrial end of the tube. The pneumatic balloon of the end of the catheter is blown up in the tubal ampulla. This makes it possible to bring the tube close to the laparoscope which makes it possible to carry out precise precise maneuvers with such degrees of enlargement as make it like a form of microsurgery. This kind of procedure helps in these delicate and difficult operations.

The writers draw up the outcome of the medical management of infertiles couples at Dakar's teaching hospital over a period of 7 years (1983-1989). Restrictives factors (low rate incomes, social and psychological obstacles) make that médical management difficult. The responsibilities are shared among the couple with sex ratio of 1 man for 3 women. Among the women the etiologies dominated are the sterility of the Phaloppe tubes (81%) among men with the oligo and the azoospermy (32 and 27%). Sterility within married couples is a problem of public health that becomes more acute every day. A better handling of this problem through preventive medicine and elementary sanitary training is necessary.

Conservative laparoscopic treatment by salpingotomy was performed on 192 patients who presented with a first ectopic pregnancy (EP). The overall fertility results show that 139 patients (72.4%) obtained an Intra Uterine Pregnancy (IUP), whereas only 18 patients (9.4%) suffered a recurrence. The risk of ipsilateral recurrence is 66.7% (12 cases). For the 14 patients presented with two patent tubes after conservative laparoscopic treatment of a first EP, the ipsilateral recurrence rate is 57.1% (8 cases). The side of the recurrence is directly influenced by the patient's previous history. While 88.9% (8 cases) of recurrence are ipsilateral for patients presenting previous tubal history, this rate is only 44.4% (4 cases) when tubal factors are absent (p less than 0.05). This prompts us to recommend laparoscopic salpingectomy for patients with a serious past tubal history. In these patients recurrence is ipsilateral in more than three out of four cases. On the other hand, for patients with no or few tubal factors the treatment has to be conservative.

Fertility after conization appears to be normal if all the endocervical gland tissue has not been excised. The miscarriage and premature delivery rates do not appear to be affected either, and cerclage generally seems to be unnecessary.

A diagnosis of psychogenic sterility implies the absence of any organic causes of sterility, but care must be taken not to confuse psychology with statistics. The fact that pregnancy is a statistical probability does not rule out the possibility of a psychogenic cause. In some cases, a psychological aspect is highly probable (sexual problems, disturbances of the cycle of central origin) it should be realised that in all cases, the management of a sterile couple involves both scientific expertise and human contact, otherwise there is a risk of possible causing psychogenic--and even iatrogenic--sterility.

Gabon has one of the lowest fertility rates in Central Africa (116 children per 1,000 women); and ectopic pregnancy occurs in 1 per 62.5 live births. We have studied fertility following ectopic pregnancy with a 5 years follow-up in a cohort of 145 women treated for an ectopic pregnancy in the general hospital of Franceville, Gabon. 17% of these women had an intra uterine pregnancy, 10% had a repeat ectopic pregnancy and 73% were infertile 5 years after the ectopic pregnancy. We compared the fertile group and the infertile group after ectopic pregnancy: the main factors for fertility were the fertility of these women before the ectopic pregnancy and the staging of the Fallopian tube and pelvic cavity. Pelvic adhesions following pelvic inflammatory diseases were correlated with infertility. The main causative agent of infertility after ectopic pregnancy were sexual transmitted diseases and their sequelae and late diagnosis.

Out of the 503 ectopic pregnancies (EP) dealt with surgically using conservative laparoscopic techniques, 153 (30.42%) occurred in patients with an intrauterine device (IUD) in situ. Examination of the characteristics of the EP reveals that there is a significantly higher proportion located in the isthmus in the group of patients without an IUD, whereas the fimbrial location is more frequent among patients with an IUD. Whereas tube wall condition does not differ according to the presence or absence of an IUD, adhesions and obstructed or not existent contralateral tubes are significantly less frequent among patients with an IUD in situ. 223 patients desired pregnancy, 30 of which had an IUD in situ when the EP was diagnosed. The subsequent fertility for these 30 patients with an IUD resulted in rates for intrauterine pregnancy (IUP), recurrent EP an infertility of 96.7%, 3.3%, and 0% respectively. These results are significantly better than those for women who had no IUD, the figures for their group being 59%, 13.4%, and 27.4% respectively. The favorable prognosis is due solely to the fact that women with an IUD have far less negative antecedents and that the EP probably occurred due to impaired ciliary action, reversible when the IUD is removed.

Twenty-six ectopic pregnancies located strictly within the isthmus were treated surgically using conservative laparoscopic techniques. In each and every case the Triton's monopolar electrode was used to perform salpingostomy which was followed by the aspiration of the trophoblast. This therapeutic approach is very reliable since only one failure was observed (3.9%), requiring a further operation during which salpingectomy was carried out by laparoscopy. It was possible to evaluate subsequent fertility for 11 patients. 7 of whom (63.6%) obtained an intra-uterine pregnancy and only one patient (9.1%) had a recurrence. This highly satisfactory prognosis is perfectly comparable with that obtained with treatment via laparotomy with segmental resection of the isthmic portion of the tube and immediate or delayed anastomosis. These very encouraging results mean that laparoscopic treatment presents a very advantageous alternative to classic surgical treatment for isthmic ectopic pregnancies, in that the patients are spared a laparotomy.

An in vitro fertilisation unit has been working since the 1 st May 1988 in the Notre-Dame Clinic in Charleroi in the Beligium province of Hainaut. This work analyses the practice and results of the first two years activity in which 185 oocytes retrievals were carried out. The account not only deals with the results (according to 8 criteria for evaluation) but also on the factors that modify these results (9 parameters). It is scientific tools that makes it possible to analyse objectively and precisely, the factors leading to success or failure in our technique. The results are compared with those in the literature and in the French national enquiries (these do not exist in Belgium) show that even in modest conditions (2 gynaecologists and a biologist who have other duties) it is possible to carry out in the first year 62 and in the second year 123 oocyte recoveries. The scrupulous attention to technical details in this university centre of reference made it possible from the beginning to achieve worthwhile results (21% pregnancies for all recoveries and 32% pregnancies for all embryo transfers).

The authors have reviewed 118 cases of female genital tuberculosis collected over a 5 year period, from 1st January 1984 up until 31 December 1988, and have compared their results (study group, SG) with those of a similar study (reference group, RG) carried out in the same centre 2 years previously. The following points stand out: the incidence of the disease is stable (6.6 p. cent in the SG versus 5.6 p. cent in the RG); the profile of the woman with genital tuberculosis is that of a young woman of rural origin, generally unvaccinated; sterility is increasingly the predominant motive for consultation (81 p. cent in the SG versus 73 p. cent in the RG); the latent form of genital tuberculosis constitutes 96.4 p. cent of cases in their series versus 93.8 p. cent in the RG; the diagnosis of genital tuberculosis was confirmed histologically in 46 p. cent of cases versus 30 p. cent in the RG, and bacteriologically in 7 p. cent of cases versus 4 p. cent in the RG; medical treatment was initiated for the acute and evolutive forms (35 p. cent of cases). Surgical treatment was indicated for macro-lesional forms which were resistant to medical treatment.

Fertility declined rapidly in France between 1965 and 1976, mainly because of a decrease in the number of births of parity 3 or more. This change was due to both a decline in the desire for children and to a large reduction in the number of unwanted births. The INED national survey of 1988 showed a rapid spread of medical contraceptive techniques (pill and IUD) since 1965. In the same survey, a significant proportion of women reported difficulties in conceiving: these difficulties resulted in a much longer time-interval before conception; in addition women tended to become more and more impatient in this regard.

In Morocco 11.7% of couples are sterile. Even after 3 years the figure is as high as 6%. We have studied in this work 386 cases of tubal sterility which constitute 58.22% of 663 couples who were fully investigated. The mean age of the patients was 29 years. Patients come for assessment late-75% of them after 5 years of sterility. Most of these (54.15%) suffer from primary sterility due to infections acquired before marriage. One-third of all patients have been married more than once, having been divorced because of their sterility. Although tuberculosis is still very frequent in Morocco, not many of our cases were suffering from pelvic tuberculosis. 11% of the patients had had pelvic surgery.