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Aujourd’hui encore, la prise en charge médicale des personnes transgenres pâtit d’une insuffisance d’offre de soins et de formation des soignants. La mise en œuvre d’une hormonothérapie est souvent souhaitée par les personnes transgenres et il est nécessaire qu’un médecin sache l’instaurer et la suivre tout au long de la transition. Nous abordons dans cette revue le traitement hormonal féminisant (THF) chez les femmes transgenres adultes, et le traitement hormonal masculinisant (THM) chez les hommes transgenres adultes.

Data on preimplantation genetic testing (PGT-M) in patients with genetic susceptibility to cancer are scarce in the literature, while there is, in our experience, a growing familiarity with assisted reproduction techniques (ART) among pathogenic variant heterozygotes. We performed a retrospective multicenter study of PGT-M outcomes among French patients with genetic susceptibility to cancer. Our objectives were to collect data on this complex issue, and to help cancer geneticists counsel their patients of reproductive age. We also wanted to increase awareness regarding PGT-M among cancer genetics professionals. Patients from three university hospital cancer genetics clinics who had requested PGT-M between 2000 and 2019 were included retrospectively. Data were extracted from medical records. Patients were then contacted directly to collect missing and up-to-date information. Out of 41 eligible patients, 28 agreed explicitly to participate when contacted and were therefore included. They carried PV in VHL (n = 9), APC (n = 8), CDH1 (n = 5), STK11 (n = 2), AXIN2, BRCA1, MEN1, and FH (n = 1). Seven patients were denied PGT-M based on multidisciplinary team meetings or subsequently by the ART hospital teams, two changed their minds, and two were yet to start the process. PGT-M was successful in seven patients (25%), with a mean age at PGT-M request of 27. Most had von Hippel-Lindau. PGT-M failed in the remaining ten, with a mean age at PGT-M request of 32. The main reason for failure was non-implantation of the embryo. Of these, four patients were pursuing PGT-M at the time of last contact. PGT-M outcomes in patients with cancer susceptibility syndromes were satisfactory. These patients should be informed about PGT-M more systematically, which would imply greater awareness among cancer genetics professionals regarding ART. Our series was not representative of cancer susceptibility syndromes in general; the predominance of cases with syndromes characterized by early-onset, highly penetrant disease is explained by the restrictive French guidelines.

Supplementary Table 1 from Eighteen Insulin-like Growth Factor Pathway Genes, Circulating Levels of IGF-I and Its Binding Protein, and Risk of Prostate and Breast Cancer

Background: Circulating levels of insulin-like growth factor I (IGF-I) and its main binding protein, IGF binding protein 3 (IGFBP-3), have been associated with risk of several types of cancer. Heritable factors explain up to 60% of the variation in IGF-I and IGFBP-3 in studies of adult twins.Methods: We systematically examined common genetic variation in 18 genes in the IGF signaling pathway for associations with circulating levels of IGF-I and IGFBP-3. A total of 302 single nucleotide polymorphisms (SNP) were genotyped in >5,500 Caucasian men and 5,500 Caucasian women from the Breast and Prostate Cancer Cohort Consortium.Results: After adjusting for multiple testing, SNPs in the IGF1 and SSTR5 genes were significantly associated with circulating IGF-I (P < 2.1 × 10−4); SNPs in the IGFBP3 and IGFALS genes were significantly associated with circulating IGFBP-3. Multi-SNP models explained R2 = 0.62% of the variation in circulating IGF-I and 3.9% of the variation in circulating IGFBP-3. We saw no significant association between these multi-SNP predictors of circulating IGF-I or IGFBP-3 and risk of prostate or breast cancers.Conclusion: Common genetic variation in the IGF1 and SSTR5 genes seems to influence circulating IGF-I levels, and variation in IGFBP3 and IGFALS seems to influence circulating IGFBP-3. However, these variants explain only a small percentage of the variation in circulating IGF-I and IGFBP-3 in Caucasian men and women.Impact: Further studies are needed to explore contributions from other genetic factors such as rare variants in these genes and variation outside of these genes. Cancer Epidemiol Biomarkers Prev; 19(11); 2877–87. ©2010 AACR.

Resume Introduction L’IRM mammaire est l’examen de reference pour le depistage chez les patientes a haut risque genetique de cancer du sein. Sa sensibilite et sa specificite, pouvant etre limitees par le rehaussement physiologique glandulaire, il est actuellement recommande d’effectuer l’IRM de depistage dans la deuxieme semaine du cycle menstruel, ce qui peut compliquer programmation. L’objectif de notre etude etait d’evaluer l’interpretation (ou la performance) de l’IRM realisee hors de la periode souhaitee. Methodes Nous avons analyse les IRM consecutives realisees a l’Hopital Tenon chez les patientes a haut risque genetique, sans antecedent de cancer du sein, entre 2006 et 2016. Nous avons analyse le taux de rehaussement genant l’interpretation (RG) – c’est-a-dire les rehaussements de types III et IV –, le taux d’explorations supplementaires realisees (IRM et biopsie) et la survenue d’evenement d’intervalle dans 2 groupes selon les conditions de realisation de l’examen : programmation adequate (j7–j14) et programmation inadequate (en dehors de la periode recommandee). Resultats Au total, 126 IRM ont ete etudiees, realisees chez 62 patientes porteuses d’une mutation genetique predisposant au cancer du sein (BRCA 1 ou 2 : 91 %, autre : 9 %), d’âge moyen 34,5 ans, en programmation adequate (n = 84), et inadequate (n = 42). Le taux de RG etait comparable dans les 2 groupes (respectivement 31 % et 35,7 %, p = 1), ainsi que la realisation d’explorations complementaires (respectivement 31 % et 45 %, p = 0,11). Conclusion Nos resultats suggerent que la programmation de l’IRM de depistage pourrait etre simplifiee dans la population specifique des patientes indemnes a haut risque genetique de cancer du sein.

La contraception d’urgence (CU) évolue depuis les années 1960, devenant de mieux en mieux tolérée par les femmes qui la prennent. Les contraceptions d’urgence hormonales ont ainsi utilisé des doses d’hormones de plus en plus faibles, avec des schémas d’utilisation simplifiés. Les œstrogènes ont finalement été abandonnés, conduisant à la mise en vente de ces contraceptions sans besoin d’une prescription. Le dispositif intra-utérin au cuivre, qui nécessite, quant à lui, le recours à un professionnel de santé, est moins accessible. Pourtant, il permet l’instauration d’une contraception au long cours. Malgré des progrès indéniables, la contraception d’urgence reste encore trop peu utilisée, faute d’une information efficace mais aussi de différents freins.

The evolution of medical care for transgender people currently makes it possible to propose fertility preservation. Fertility preservation should be initiated before the start of hormonal treatments and/or surgical procedures. The “reproductive” aspect and the desire for parenthood among transgender people have long been ignored. However, these aspects are important to consider and fertility preservation should be discussed before the start of the physical transition. The aim of this review is to assess the literature on fertility preservation for transgender women (“male to female”). Many uncertainties remain regarding the impact of hormonal treatments on the reproductive functions of transgender women and their reversibility. However, the significant increase in the number of recently published articles is evidence of the improvement in the conditions of access to these procedures for women starting a transition process. Nevertheless, there are still a number of barriers that can prevent or delay this process., L’évolution de l’accompagnement médical des personnes transgenres permet actuellement de proposer la mise en place de stratégies de préservation de la fertilité, idéalement avant l’instauration des traitements hormonaux et/ou actes chirurgicaux. La dimension « reproductive » et le désir de parentalité chez les personnes transgenres ont longtemps été ignorés. Ces aspects sont pourtant importants à considérer et des mesures de préservation de la fertilité doivent donc être discutées avant le démarrage du parcours médical de transition physique. Cette revue a pour objectif de réaliser un état des lieux de la littérature concernant la préservation de la fertilité des femmes transgenres (« male to female »). De nombreuses incertitudes persistent quant à l’impact des traitements hormonaux sur les fonctions de reproduction des femmes transgenres et leur réversibilité. Cependant, l’augmentation importante du nombre des articles récemment publiés témoigne de l’amélioration des conditions d’accès à ces procédures pour les femmes qui démarrent un parcours de transition. Il reste néanmoins un certain nombre de barrières qui peuvent empêcher ou retarder ce processus.

Resume Les patients presentant un diabete de type 1 (DT1), hommes et femmes, ont une diminution significative de la fertilite, et notamment en cas de diabete apparu precocement, meme si cette tendance tend globalement a s’amenuiser. Les causes de cette baisse de fertilite ont evolue avec le temps et les progres de la prise en charge du DT1, mais aussi avec la progression de l’« epidemie » de surpoids et d’obesite. Les aspects psychosociaux sont egalement un determinant important. Les patients doivent etre informes de la possibilite de cryopreservation de gametes en cas de menace sur la fertilite ulterieure.

Despite considerable advances in recently developed combined oral contraceptives (COCs), resulting in lower rates of adverse events while maintaining contraceptive efficacy, there is interest in further innovation.Estetrol (E4), a native oestrogen, and progestin drospirenone (DRSP) were combined in a new COC. A European expert panel reviewed the pharmacology, efficacy, and safety and tolerability of this combination. Their findings are presented as a narrative review.E4 15 mg/DRSP 3 mg in a 24/4 regimen provided effective contraception with good cycle control, characterised by a predictable regular bleeding pattern and minimal unscheduled bleeding, together with a good safety profile. The combination was associated with high user satisfaction, well-being, and minimal changes in body weight. The effects on endocrine and metabolic parameters were limited, and the combination was found to have a limited impact on liver function and lipid and carbohydrate metabolism. Moreover, its effect on several haemostatic parameters was lower than that of comparators containing ethinyl oestradiol (EE) 20 µg/DRSP 3 mg and EE 30 µg/levonorgestrel 150 µg.E4 15 mg/DRSP 3 mg provides safe and effective contraception, with high user satisfaction and predictable bleeding. Further research will evaluate the long-term safety of the COC.

Points essentiels Transition hormonale et chirurgicale Depuis la loi de 2016, les personnes transgenres ne doivent plus apporter la preuve « irreversible et medicale d’une transformation physique » pour pouvoir effectuer un changement de sexe a l’Etat Civil, ce qui met fin a la sterilisation systematique et ouvre la possibilite d’une transition seulement hormonale. Or, les traitements hormonaux peuvent avoir un impact sur la fertilite des personnes transgenres, compromettant un projet ulterieur de parentalite. Preservation de fertilite Certains centres d’etude et de conservation des œufs et du sperme (CECOS), s’appuyant sur la loi bioethique de 2011, proposent desormais des autoconservations de gametes feminines et masculines avant la mise en place des traitements hormonaux de substitution, ou a l’occasion d’une fenetre therapeutique. Techniques de preservation de la fertilite La preservation de la fertilite chez les femmes transgenres repose essentiellement sur l’autoconservation de spermatozoides. Pour les hommes transgenres, la preservation de la fertilite repose sur la cryoconservation d’ovocytes matures apres stimulation ovarienne. Parentalite Outre l’evaluation de l’impact psychique de la prise en soins afin de prevenir de potentiels effets deleteres, la consultation psychosexologique offre une possibilite d’expression du desir d’enfant, desir souvent longtemps inhibe, ainsi que d’une information sur les possibilites de reutilisation.

BRCA1 and BRCA2 (BReast CAncer susceptibility genes) are two tumor-suppressor genes associated with the hereditary breast and ovarian cancer susceptibility syndrome. Recent studies also suggest an increased lung adenocarcinoma risk in carriers.We conducted a multi-center retrospective study in 18 different French pulmonology and/or oncology departments on medico-administrative and clinical data prospectively collected in the Clinical Data Warehouse (CDW) of Greater Paris University Hospitals (Assistance Publique-Hôpitaux de Paris, AP-HP). Clinical characteristics and outcomes of patients with LC and a previously known BRCA1/2gl variant were retrospectively evaluated.17 patients with LC and known BRCA1/2gl variant were included. Patients were most women, former smokers with localized disease and BRCA2 variants. All LC were adenocarcinoma. For patients with medical history of cancer, median time from the first cancer in the BRCA spectrum and the LC occurrence was 20 years. Median disease-free survival (DFS) and overall survival (OS) in localized tumor (Stage I and II) was not reached and 78.6 months, respectively. In advanced cancer (Stade III and IV) median progression free survival was 9.7 months and median OS was 17.8 months. Univariate OS and DFS/PFS analyses by BRCA status did not find significant differences.Results seem to show particular LC features in carriers of BRCA2 variants: adenocarcinoma subtype, woman, former or non-smoker.

Turner syndrome (TS; ORPHA 881) is a rare condition in which all or part of one X chromosome is absent from some or all cells. It affects approximately one in every 1/2500 liveborn girls. The most frequently observed karyotypes are 45,X (40–50%) and the 45,X/46,XX mosaic karyotype (15–25%). Karyotypes with an X isochromosome (45,X/46,isoXq or 45,X/46,isoXp), a Y chromosome, X ring chromosome or deletions of the X chromosome are less frequent. The objective of the French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins) is to provide health professionals with information about the optimal management and care for patients, based on a critical literature review and multidisciplinary expert consensus. The PNDS, written by members of the French National Reference Center for Rare Growth and Developmental Endocrine disorders, is available from the French Health Authority website. Turner Syndrome is associated with several phenotypic conditions and a higher risk of comorbidity. The most frequently reported features are growth retardation with short adult stature and gonadal dysgenesis. TS may be associated with various congenital (heart and kidney) or acquired diseases (autoimmune thyroid disease, celiac disease, hearing loss, overweight/obesity, glucose intolerance/type 2 diabetes, dyslipidemia, cardiovascular complications and liver dysfunction). Most of the clinical traits of TS are due to the haploinsufficiency of various genes on the X chromosome, particularly those in the pseudoautosomal regions (PAR 1 and PAR 2), which normally escape the physiological process of X inactivation, although other regions may also be implicated. The management of patients with TS requires collaboration between several healthcare providers. The attending physician, in collaboration with the national care network, will ensure that the patient receives optimal care through regular follow-up and screening. The various elements of this PNDS are designed to provide such support.

Introduction : Up to 30% of couples may face secondary infertility. The impact of ectopic pregnancy, spontaneous abortion, pregnancy termination or live birth with caesarean section may impair further fertility in different ways. However, secondary infertility after physiological vaginal life childbirth has been little studied. The aim of this study was to describe the population and the fertility issues and analyze the predictive factors of success in in vitro fertilization in women presenting secondary infertility after a physiological vaginal childbirth. Material and methods : This single-centre retrospective study included women aged 18-43 years consulting between 2013 and 2020 for secondary infertility in a couple having already had previous vaginal life childbirth. Couples’ characteristics, management decision after the first consultation and IVF outcomes were analyzed. Results : Secondary infertility was found in 286 couples, out of whom 138 had a history of vaginal life childbirth. Population was characterized by an advanced female age and overweight. After the first consultation, IVF was performed in only 40% of couples. No predictive factor of live birth was found. Conclusion : Our study shows that in couples with secondary infertility after prior physiological delivery cigarette smoking is frequent in male partners, and ovarian reserve markers are altered. However, no statistically significant predictive factor of live birth after IVF treatment has been identified. Further large prospective studies are necessary.

Objective Fertility-sparing treatment is based on progestin therapy and is known to be safe and effective. International recommendations advise the use of megestrol acetate or medroxyprogesterone acetate. However, chlormadinone acetate has fewer undesirable effects and can be used in patients with a history of thromboembolism who are at high vascular risk. In the present prospective study, we aimed to confirm that the efficiency of the use of chlormadinone acetate for 6 months to obtain remission of atypical hyperplasia or endometrial carcinoma is comparable to that of the use of other fertility-sparing treatments. Method The present study is based on the PREFERE prospective registry. All the patients received three or six months of chlormadinone acetate and were evaluated by hysteroscopic resection and pipelle sampling every three months. Results Ninety-four patients were included. Seventy-nine patients achieved complete remission at 6 months (84%). No patients stopped treatment due to a lack of tolerance. Twenty-four percent of the patients achieved a live birth. Conclusion Chlormadinone acetate is an effective and well-tolerated fertility-sparing treatment. Its benefits over other progestins are its tolerability, and its absence of contraindications which makes chlormadinone acetate a good choice for patients with thromboembolism and high vascular risk.

Research question Does mild COVID-19 infection affect the ovarian reserve of women undergoing an assisted reproductive technology (ART) protocol? Design A prospective observational study was conducted between June and December 2020 at the ART unit of Tenon Hospital, Paris. Women managed at the unit for fertility issues by in-vitro fecundation, intracytoplasmic sperm injection (IVF/ICSI), fertility preservation, frozen embryo transfer or artificial insemination, and with an anti-Mullerian hormone (AMH) test carried out within 12 months preceding ART treatment, were included. All the women underwent a COVID rapid detection test (RDT) and AMH concentrations between those who tested positive (RDT positive) and those who tested negative (RDT negative). Results The study population consisted of 118 women, 11.9% (14/118) of whom were COVID RDT positive. None of the tested women presented with a history of severe COVID-19 infection. The difference between the initial AMH concentration and AMH concentration tested during ART treatment was not significantly different between the COVID RDT positive group and COVID RDT negative group (–1.33 ng/ml [–0.35 to –1.61) versus –0.59 ng/ml [–0.15 to –1.11], P = 0.22). Conclusion A history of mild COVID-19 infection does not seem to alter the ovarian reserve as evaluated by AMH concentrations. Although these results are reassuring, further studies are necessary to assess the effect of COVID-19 on pregnancy outcomes in women undergoing ART.

International audience; The molecular responses to hormonal stimuli in the endometrium are modulated at the transcriptional and post-transcriptional stages. Any imbalance in cellular and molecular endometrial homeostasis may lead to gynecological disorders. MicroRNAs (miRNAs) are involved in a wide variety of physiological mechanisms and their expression patterns in the endometrium are currently attracting a lot of interest. miRNA regulation could be hormone dependent. Conversely, miRNAs could regulate the action of sexual hormones. Modifications to miRNA expression in pathological situations could either be a cause or a result of the existing pathology. The complexity of miRNA actions and the diversity of signaling pathways controlled by numerous miRNAs require rigorous analysis and findings need to be interpreted with caution. Alteration of miRNA expression in women with endometriosis has been reported. Thus, a potential diagnostic test supported by a specific miRNA signature could contribute to early diagnosis and a change in the therapeutic paradigm. Similarly, specific miRNA profile signatures are expected for RIF and endometrial cancer, with direct implications for associated therapies for RIF and adjuvant therapies for endometrial cancer. Advances in targeted therapies based on the regulation of miRNA expression are under evaluation.

Introduction Recurrent miscarriages are defined as three or more early miscarriages before 12 weeks of gestation. The aim of this study was to describe a cohort of women with unexplained recurrent miscarriages, evaluate several potential biomarkers of immune origin and describe the outcome of pregnancies under immunomodulatory therapies METHODS: Women having a history of at least 3 early miscarriages without any etiology were recruited from 3 university hospitals. Results Among 101 women with recurrent miscarriages, overall, 652 pregnancies have been included in the analysis. Women which experienced miscarriages were older (33.3 ± 5.4 versus 31.9 ± 6.7; p = 0.03), with history of more pregnancies (4 (2-6) versus 3.5 (1-5.75); p 0.0008), and less frequently the same partner (406 (74%) versus 79 (86%); p=0.01). There was no difference in the level and frequencies of biomarkers of immune origin (NK, lymphocyte, gammaglobulins and blood cytokine levels and endometrial uNK activation status), except the higher rates of positive antinuclear antibodies in women with live birth (12 (13%) versus 36 (7%); p=0.03). Among the 652 pregnancies, 215 (33%) have been treated and received either aspirin/low weighted molecular heparin (LMWH) and/or combined to different lines of immunomodulatory treatment. Patients with pregnancy under treatment had a significantly higher rate of cumulative live birth rate that those with untreated ones (43.0% vs 34.8%; p = 0.04). When compared to patients with untreated pregnancies, patients with steroids during the pregnancy had twice more chances to obtain live birth (OR 2.0, CI95% 1.1 - 3.7, p = 0.02). Conclusions Unexplained recurrent miscarriages could have improved obstetrical outcome under immunomodulatory therapies and in particular steroids.

Objective To describe strategy and results of fertility preservation (FP) in patients with malignant and borderline ovarian tumors. Methods Consecutive cohort study of 43 women with malignant or borderline ovarian tumors who underwent FP between February 2013 and July 2019. The study was conducted in national expert center in Tenon University Hospital, Sorbonne University: French ESGO-certified ovarian cancer center and pregnancy-associated cancer network (CALG). Main outcome measure was FP technique proposed by multidisciplinary committee, FP technique used, time after surgery, number of fragments, histology and follicle density (if ovarian tissue freezing), number of expected, retrieved and frozen oocytes (if ovarian stimulation). Results Pathological diagnosis was malignant epithelial ovarian tumor in five women (11.6%), rare malignant ovarian tumor in 14 (32.6%), borderline in 24 (55.8%), and mostly unilateral (79.1%) and stage I (76.7%). Mean age at diagnosis was 26.8 ± 6.9 years and mean tumor size 109.7 ± 61 mm. Before FP, mean AFC was 11.0 ± 6.1 and AMH levels were 2.7 ± 4.6 ng/mL. Six ovarian tissue-freezing procedures were performed (offered to 13). Twenty-four procedures of ovarian stimulation and oocyte freezing were performed after surgical treatment for 19 women (offered to 28) with a median interval of 188 days. The mean number of mature oocytes retrieved per stimulation was 12.4 ± 12.8. At least 10 mature oocytes were frozen for 52.6% of the women. No FP was offered to five women. Conclusion Oocyte and ovarian tissue cryopreservation should be offered to patients with malignant and borderline ovarian tumors. More data are needed to confirm ovarian stimulation and ovarian tissue grafting safety.

Recurrent implantation failure is defined as the absence of pregnancy after at least three transfers of good-quality embryos after in vitro fecundation/intracytoplasic sperm injection.The aim of this study was to describe a multicentre cohort of women with unexplained RIF, to analyse the factors associated with clinical pregnancy and to evaluate the immunomodulatory therapies efficacy.Women were consecutively recruited from university departments with unexplained RIF.Sixty-four women were enrolled with mean age 36 ± 3 years. The rates of clinical pregnancy in 64 women were compared in untreated and treated cycles and according to therapies used during the last prospectively followed embryo transfer. A clinical pregnancy after the transfer was noted in 56 % pregnancies on intralipids and in 50 % on prednisone, versus 5 % in untreated ones (p0.001). The 340 embryo transfers of these 64 women resulted in 68 clinical pregnancies and 18 live births. Clinical pregnancies were significantly more frequent in treated versus untreated embryo transfers (44 % vs 9 %; p0.001) with odds ratio at 8.13 (95 % CI 4.49-14.72, p0.0001). Cumulative pregnancy rates were higher for steroid-treated transfers than for untreated transfers when considering overall transfers before and after using steroids and also only those under steroids. Cumulative pregnancy rates were not different from steroid- and intralipid-treated embryo transfers CONCLUSIONS: In this multicentre study of women with unexplained RIF, use of immunomodulatory treatments before embryo transfer resulted in higher clinical pregnancy. Randomised, well-designed studies in well-defined population of RIF women are necessary to confirm our preliminary data.

Resume Ces Recommandations pour la pratique clinique en contraception sont les premieres promues par le College national des gynecologues et obstetriciens francais (CNGOF), afin d'aider le praticien a prendre une decision medicale en lui fournissant une synthese des donnees scientifiques existantes sur le sujet. La methodologie de la Haute Autorite de sante (HAS) a ete adoptee. Douze questions pratiques ont ete selectionnees par le comite d'organisation et le groupe de travail. La litterature a ete analysee jusqu'en decembre 2017, des recommandations basees sur le niveau de preuve ont ete proposees affectees d'un grade. Les textes longs, dont cette synthese est issue, ont ete relus par des experts en contraception et des praticiens du secteur prive ou public, ayant une activite en contraception. Des recommandations pratiques sont ainsi proposees pour la conduite de la consultation de contraception, l'information sur les methodes contraceptives, leurs risques et benefices non contraceptifs, la gestion de la contraception hormonale en pratique, la contraception intra-uterine, la contraception d'urgence, les methodes locales et naturelles, la contraception chez les adolescentes, apres 40 ans, en situation a risque vasculaire ou carcinologique. La contraception definitive et l'emploi pour la contraception de molecules ne disposant pas d'une autorisation de mise sur le marche ont ete exclus du champ de ces recommandations. L'avenir de la contraception a court et moyen terme tel qu'il peut etre anticipe aujourd'hui, passe avant tout par le bon usage des moyens dont nous disposons aujourd'hui, l'information des femmes et l'amelioration de l'acces aux contraceptions pour toutes les femmes. C'est l'objectif poursuivi par ces recommandations de pratique clinique du CNGOF.

Background Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples’ pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors. Methods Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for “Parcours Environnement PériConceptionnel en Infertilité”) vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health. Discussion The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention. Trial registration The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.

Results from studies reporting the optimal stimulation duration of IVF-ICSI cycles are inconsistent. The aim of this study was to determine whether, in the presence of early ovulation-triggering criteria, prolonged ovarian stimulation modified the chances of a live birth. This cross-sectional study included 312 women presenting triggering criteria beginning from D8 of ovarian stimulation. Among the 312 women included in the study, 135 were triggered for ovulation before D9 (D ≤ nine group) and 177 after D9 (D > nine group). The issues of fresh +/− frozen embryo transfers were taken into consideration. Cumulative clinical pregnancy and live-birth rates after fresh +/− frozen embryo transfers were similar in both groups (37% versus 46.9%, p = 0.10 and 19.3% versus 28.2%, p = 0.09, respectively). No patient characteristics were found to be predictive of a live birth depending on the day of ovulation trigger. Postponing of ovulation trigger did not impact pregnancy or live-birth rates in early responders. A patient’s clinical characteristics should not influence the decision process of ovulation trigger day in early responders. Further prospective studies should be conducted to support these findings.

Introduction The effect of coronavirus disease (COVID-19) on pregnancy outcome in women with sickle cell disease (SCD) is unknown. Objectives To analyze the severity of the SARS-CoV-2 infection in pregnant women with SCD and its impact on pregnancy. Methods This retrospective cohort study included SCD pregnant women tested positive for COVID-19 between March 2020 – February 2021. The primary endpoint was the severity of the COVID-19 infection. Secondary endpoints were pregnancy complications and fetal outcomes. Results During the study period among 82 pregnant women with SCD, 8 have presented symptoms suggestive of COVID-19 and were tested positive. A common mild clinical presentation was observed in 6 women (75%), one woman was asymptomatic and one required oxygen. The latter was admitted to the Intensive Care Unit and a cesarean section was performed in the context of an ongoing vaso-occlusive crisis and acute chest syndrome together with incidental preeclampsia. Labor was induced in another patient who developed a vaso-occlusive crisis after COVID-19 remission. Fetal outcomes were good with an average Apgar score of 10 and normal umbilical blood pH at birth. Two newborns were small-for-gestational-age as expected on the ultrasound follow-up before occurrence of COVID-19. Conclusion COVID-19 infection in our population of pregnant women with SCD had typical presentation and rarely triggered a sickle cell crisis or other complications. Fetal outcomes were good and did not seem to be directly influenced by the SARS-CoV-2 virus. Further studies are required to confirm these observations as compared to the population of women with SCD without COVID-19 infection.

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS). As a second line, desogestrel progestin only pills, etonogestrel implants, GnRH analogs (GnRHa) with add back therapy and dienogest can be offered. Add back therapy should include estrogens to prevent bone loss and improve quality of life, it can be introduced before the third month of treatment to prevent side effects. The literature does not support preoperative hormonal treatment for the sole purpose of reducing complications or recurrence, or facilitating surgical procedures. After surgical treatment, hormonal treatment is recommended to prevent pain recurrence and improve quality of life. COCs or LNG IUS are recommended as a first line. To prevent recurrence of endometriomas COC is advised and maintained as long as tolerance is good in the absence of pregnancy plans. In case of dysmenorrhea, postoperative COC should be used in a continuous scheme. GnRHa are not recommended in the sole purpose of reducing endometrioma recurrence risk.

Resume Historiquement, le depistage du cancer du sein s’est base quasi exclusivement sur le facteur de risque âge pour determiner la strategie d’exploration par mammographie. En France, le critere densite mammaire a egalement ete pris en consideration pour decider d’ajouter une echographie mammaire en cas de seins de type denses ou tres denses. L’emergence de la tomosynthese mammaire associee a la mammographie reconstruite devrait permettre d’optimiser le nombre de cancers du sein detectes tout en reduisant un grand nombre de faux positifs et en limitant la dose d’irradiation, facteurs a l’origine d’une importante controverse actuelle sur la valeur du depistage mammographique par tomosynthese. Hormis, la categorie des patientes a tres haut risque (risque genetique identifie) ou une strategie specifique par IRM mammaire est validee, il est actuellement difficile d’affiner de facon objective la strategie d’exploration en se basant sur la combinaison de facteurs de risque de plus faible impact (antecedents familiaux, nulliparite, impregnation alcoolique, etc.). Aussi, de nouvelles strategies basees sur une evaluation du risque plus personnalise (s’integrant dans une medecine dite de precision) sont a l’etude en Europe (etude « My PEBS ») et aux Etats-Unis (etude « WISDOM ») afin de mieux adapter les examens de depistages a chaque patiente pour maximiser le nombre de cancers detectes en diminuant le nombre de faux positifs.

Resume Objectif L’objectif de ce travail est d’evaluer la place des nouveaux traitements dans la prise en charge de l’endometriose en dehors du contexte d’infertilite. Methodes Une revue de la litterature a ete effectuee en consultant les donnees Medline jusqu’en juillet 2017. Resultats Le dienogest est efficace par rapport au placebo a court terme (NP2) et long terme (NP4) pour le traitement de l’endometriose douloureuse. En comparaison aux agonistes de la GnRH, le dienogest est aussi efficace en termes de diminution de douleur et d’amelioration de la qualite de vie chez les patientes non operees (NP2), de meme que pour la recidive des lesions d’endometriose et la symptomatologie en postoperatoire (NP2). Les donnees concernant les antagonistes de la GnRH, les modulateurs selectifs des recepteurs a la progesterone de meme que les inhibiteurs selectifs (anti-TNF-α, inhibiteurs des metalloproteases matricielles, inhibiteurs des facteurs de croissance de l’angiogenese) sont insuffisantes pour apporter une preuve de l’interet en pratique clinique pour la prise en charge de l’endometriose douloureuse (NP3). Conclusion Le dienogest est recommande en seconde intention pour la prise en charge de l’endometriose douloureuse (Grade B). En l’absence de donnees suffisantes, les anti-aromatases, l’elagolix, les SERM, les SPRM et les anti-TNF-α ne sont pas recommandes pour la prise en charge de l’endometriose douloureuse (Grade C).

Resume Introduction Les tumeurs malignes rares de l’ovaire regroupent les tumeurs borderline complexes, les tumeurs germinales, les tumeurs des cordons sexuels et les tumeurs epitheliales rares. Les indications et modalites de preservation de la fertilite, la prise en charge d’une infertilite, les possibilites de contraception et de traitement hormonal de la menopause sont des questions frequentes en pratique clinique. Un groupe d’experts du reseau national dedie aux cancers gynecologiques rares (TMRG/TMRO) associe a des experts nationaux de la fertilite, des traitements hormonaux et de la contraception se sont reunis pour proposer des recommandations nationales. Methodes Un panel de 39 experts de differentes specialites a participe a l’elaboration des recommandations, en suivant la methode DELPHI (consensus formalise d’experts). Apres revue systematique de la litterature, des recommandations ont ete redigees puis soumises a deux tours successifs de cotations. Resultats Trente-cinq recommandations ont ete retenues, precisant les indications de preservation de la fertilite, les situations contre-indiquant une stimulation ovarienne (en preservation de la fertilite ou dans la prise en charge d’une infertilite), les possibilites de contraceptions (notamment hormonales) et de traitement hormonal de la menopause pour chaque type tumoral. De facon generale, une prudence a ete retenue pour les tumeurs potentiellement hormonosensibles comme les tumeurs des cordons sexuels, les adenocarcinomes sereux et endometrioides de bas grade, ainsi que pour les tumeurs borderline avec criteres histologiques pejoratifs. Discussion Dans le contexte d’une litterature pauvre, ces recommandations etablies via consensus formalise d’experts devraient constituer une aide aux cliniciens dans la prise en charge de ces patientes.

Resume Objectif Etablir des recommandations de bonne pratique pour la prise en charge medicale de l’endometriose douloureuse chez les patientes sans infertilite. Methodes Revue de la litterature depuis 2006, etablissement des niveaux de preuve, relecture externe et gradation des recommandations par un groupe d’expert selon la methodologie de la HAS. Resultats Les traitements hormonaux recommandes en premiere intention pour le traitement de l’endometriose douloureuse sont la contraception par oestro-progestatifs (COP) et le systeme intra-uterin au levonorgestrel 52 mg (SIU au LNG) (grade B). Les traitements recommandes en deuxieme intention sont la contraception microprogestative au desogestrel, l’implant a l’etonogestrel, les agonistes de la GnRH (GnRHa) et le dienogest (grade C). En cas de prescription de GnRHa, il est recommande de prescrire une add-back therapie comportant un estrogene (grade B). En postoperatoire, hors desir de grossesse, il est recommande de prescrire un traitement hormonal par COP ou SIU au LNG en premiere intention (grade B). Apres chirurgie d’endometriome, la COP est recommandee pour reduire le risque de recidive (grade B) mais la prescription de GnRHa n’est pas recommandee dans ce but (grade C). La COP en prise continue est recommandee en cas de dysmenorrhee (grade B). Chez les adolescentes, la prescription de GnRHa n’est pas recommandee en premiere intention en raison des risques de demineralisation osseuse (grade B). L’endometriose est responsable de douleurs chroniques dont la prise en charge necessite une evaluation interdisciplinaire. Les therapeutiques non-medicamenteuses ameliorant la qualite de vie peuvent etre proposees (accord d’expert). D’autres therapeutiques medicamenteuses sont actuellement en cours d’evaluation.

Hyperparathyroidism-jaw tumor (HPT-JT) is an autosomal dominant disorder responsible for benign and/or malignant tumors. Affected women often present life-threatening menorrhagia that leads to the identification of uterine tumors, and experience miscarriages and infertility. Overall though, fewer data concerning gynecological pathologies related to HPT-JT syndrome are available. We report the case of a 32-year-old woman with HPT-JT syndrome, referred for recurrent vaginal bleeding, with a history of repeated endometrial polyps and infertility. We also review the literature that explores medical options for these women.

Selective progesterone receptor modulators (SPRMs) are steroid progesterone receptor ligands able to induce agonistic or antagonistic activities. Mifepristone, the class leader, was primarily used for pregnancy termination from the 1980s. Emergency contraception with extended activity was the second major development 30 years later, with mifepristone in some countries and ulipristal acetate world-wide. More recently, ulipristal acetate was released for the treatment of myoma-related uterine bleeding. In addition to a very rapid cessation of bleeding, SPRMs allow a decrease in myoma volume, as do gonadotropin releasing hormone analogs. However, estradiol secretion is not blunted by SPRMs. This offers new alternatives for myoma treatment, especially in women close to menopause. In conclusion, use of SPRMs has allowed significant progress in emergency contraception and treatment of myoma-related symptoms. Numerous future perspectives in women's health care are currently under evaluation.

Deep infiltrating endometriosis is the most severe form of the disease, defined by infiltration beneath the peritoneum greater than 5mm. It affects several anatomical locations including the bladder, the vesico-uterine cul-de-sac, the torus uterinum, the uterosacral ligament, rectovaginal septum and the colon-rectum. Deep infiltrating endometriosis is associated with infertility. Surgery performed for deep infiltrating endometriosis in the context of pain offers good pregnancy rates either spontaneously or after assisted reproductive technologies. The results are less favorable when digestive tract is involved. IVF performed in the context of deep infiltrating endometriosis allows very satisfactory results and does not entail risks of aggravation of the pathology. There is currently no clear evidence to support either IVF or surgery to manage infertility associated with deep infiltrating endometriosis, but patients should be informed, although a risk of severe complication exists, that surgery is the only way to increase the chances of spontaneous fertility.

Points essentiels L’endometriose est une pathologie frequente avec une incidence elevee des formes profonde et complexe pouvant affecter 20 % des patientes avec endometriose. L’incidence de l’infertilite associee a l’endometriose peut atteindre 50 %. La complexite de la prise en charge impose la creation de centres experts travaillant en reseaux avec les praticiens de ville. Des criteres pour definir ces centres experts sont en cours d’elaboration reposant a la fois sur des criteres structurels (reunion de concertation pluridisciplinaire), lien avec des structures d’assistance medicale a la procreation et des criteres d’activite pour les formes severes et complexes (nombre d’intervention par centre et par chirurgien).

Resume Contexte L’endometriose pelvienne est une pathologie chronique, dont l’axe therapeutique premier en l’absence de souhait de grossesse est le plus souvent medical. Il repose principalement sur les traitements hormonaux. Objectif Ce texte est une synthese d’analyse de la litterature posterieure a 2006 sur l’efficacite antalgique des traitements hormonaux chez les patientes operees ou non, l’impact potentiel du traitement hormonal sur l’evolution des lesions et la prevention des recidives postoperatoires. Sources documentaires Bases de donnees Medline (Pubmed), the Cochrane Library, ainsi que dans les recommandations sur le traitement de l’endometriose de l’European Society of Human Reproduction and Embryology (ESHRE), du National Institute for health and Care Excellence (NICE), de l’American College of Obstetricians and Gynecologists (ACOG), du Royal College of Obstetricians and Gyneacologists (RCOG) et de la Societe des Obstetriciens et Gynecologues du Canada (SOGC). Selection des etudes Les meta-analyses et essais cliniques publies en francais et en anglais ont ete inclus. Resultats Globalement la qualite des etudes est heterogene. Les traitements hormonaux permettent inconstamment le controle de la douleur et la recidive des endometriomes et des nodules de la cloison rectovaginale. Les differentes molecules et modalites d’utilisation et les elements de la balance benefice risque sont mis en perspective. Les donnees sur les therapeutiques du futur sont actuellement trop limitees pour permettre leur utilisation en routine. Conclusion Le traitement hormonal de l’endometriose repose en fonction du terrain sur les estroprogestatifs, les progestatifs notamment le systeme intra-uterin (SIU) au levonorgestrel et en dernier lieu sur les analogues de la GnRH associes a une add-back therapie 6 . Differentes options alternatives sont en developpement clinique ou preclinique.

Background or objective Endometriosis is common in women referred for infertility. In vitro fertilization provides good results but the choice of the best-controlled ovarian hyperstimulation protocol remains a subject of debate. The objective of this retrospective study was to compare pregnancy outcomes in women with endometriosis-associated infertility after COH with a long agonist protocol or a six-week oral contraception-antagonist protocol. Material and methods Retrospective analysis of a prospective database identified 284 COH cycles – 165 with GnRH-agonist protocol (GnRH-agonist group) and 119 with GnRH-antagonist protocol (GnRH-antagonist group) – in 218 women, with endometriosis from January 2013 to October 2015. Results No difference in the epidemiological characteristics was found between the groups. Per started cycle, pregnancy and live-birth rates after fresh embryo transfer were higher with the GnRH-agonist protocol (25% vs. 13%, P = 0.02 and 18% vs. 8%, P = 0.04, respectively). Considering analysis per cycle with embryo transfer, the pregnancy rate was similar in both groups while the live-birth rate was higher in the GnRH-agonist group (29% vs. 17%, P = 0.053 and 22% vs. 10%, P = 0.02, respectively). No difference was observed between the groups with freeze-thaw embryo transfer. Subgroup analysis (endometrioma alone, deep infiltrating endometriosis with and without endometrioma, endometriosis with and without adenomyosis) revealed no difference between the groups for either pregnancy or live-birth rates. Conclusion A GnRH-agonist protocol appears to result in higher pregnancy and live-birth rates after fresh embryo transfer in women with endometriosis-associated infertility, suggesting that a GnRH-antagonist protocol might negatively impact endometrial receptivity.

The aim of the ISY study was to investigate the prevalence of menstrual-related symptoms prior to and/or during menstrual or withdrawal bleeding among women from 12 European countries.A 15-min quantitative online survey was conducted in two waves from February to September 2015 among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive, including regular combined oral contraceptives (COCs) (CHC group, n = 2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n = 2989).The prevalence of at least one menstrual-related symptom was high in CHC users (93%) and in non-HC users (95%) (p .0001) and the average number of symptoms reported was 5.3 vs. 5.9, respectively, (p .0001). Pelvic pain, bloating/swelling, irritability and mood swing were reported in more than half of the women in both groups. Although generally modest, symptom severity was higher in non-HC users, except for headache. Overall, during the last four cycles, 60-75% of women did not require a treatment for most symptoms but headaches and pelvic pain. Mood swings/irritability, water retention/weight gain, lack of energy/mood swings and lack of energy/irritability were common symptoms that frequently co-occurred. No associations were reported between symptoms and age, educational qualifications or women's desire to reduce the frequency of menstruation.Premenstrual and menstrual symptomatology was less frequent, less numerous and less severe (except for headache) in women using CHCs; however, it remains a common concern. Reducing the frequency of menstrual periods could reduce withdrawal-related symptoms.

Resume Objectifs Etude prospective evaluant l’impact clinique du traitement osteopathique sur les symptomes et la qualite de vie (QV) chez les patientes presentant une endometriose colorectale. Methodes Quarante-six patientes presentant une endometriose colorectale ont complete les questionnaires de symptomes et de qualite de vie SF-36 (composante physique et composante mentale) avant et apres traitement osteopathique. Une analyse comparative puis en cluster a ete effectuee pour identifier les sous-groupes de patientes en fonction de leur gain au traitement osteopathique. Resultats L’âge moyen (deviation standard) 32 ± 6,2 ans. Une chirurgie pour endometriose avait ete faite chez 73,9 % des patientes mais aucune pour endometriose profonde. Pres des trois quarts des patientes etaient nullipares. Apres une periode moyenne de 28 jours (15–63), une amelioration significative de la composante physique ( p p Conclusions Nos resultats confirment que le traitement osteopathique peut ameliorer les symptomes et la qualite de vie en cas d’endometriose colorectale. De plus, l’identification de profils distincts de symptomes et de reponse au traitement osteopathique permet d’envisager un essai randomise.

Resume Objectif Comparer les caracteristiques epidemiologiques, histologiques, therapeutiques et le pronostic de patientes ayant un cancer du sein diagnostique pendant la grossesse a ceux diagnostiques en post-partum dans un centre national de reference, reseau cancer associe a la grossesse. Methodes Etude retrospective de 108 patientes ayant un cancer du sein associe a la grossesse entre 2002 et 2016 avec comparaison du groupe cancer diagnostique en cours de grossesse ( n = 51) et du groupe cancer diagnostique dans le post-partum correspondant aux cancers diagnostiques dans l’annee suivant un accouchement ( n = 57). Resultats L’âge gestationnel median au diagnostic etait de 16 semaines d’amenorrhee (SA). La taille mediane ( p = 0,92), l’atteinte axillaire initiale ( p = 0,29), le type histologique ( p = 0,33) et l’expression des recepteurs hormonaux ( p = 0,93), etaient similaires dans les 2 groupes. Les cancers diagnostiques en cours de grossesse surexprimaient moins souvent HER2 (12 % vs 36 %, p = 0,003), etaient moins proliferants (Ki67 ≥ 15 % ; 64 % vs 75 %, p = 0,018) et moins traites par mastectomie (45 % vs 70 %, p = 0,008). La procedure du ganglion sentinelle a ete realisee 8 fois pendant la grossesse. Moins de patientes avec cancer diagnostique en cours de grossesse ont beneficie d’un traitement par trastuzumab 12 % vs 37 %, p = 0,003. Le terme median d’accouchement etait de 37 SA. Le suivi median etait de 3,2 vs 5,6 annees ( p = 0,002) et le taux de recidive etait de 12 % vs 32 % ( p = 0,01) pour les cancers diagnostiques en cours de grossesse et du post-partum respectivement. Nos resultats soulignent des differences des caracteristiques histologiques, des traitements chirurgicaux et adjuvants imposant de differencier au sein des cancers associes a la grossesse ceux diagnostiques pendant la grossesse de ceux diagnostiques en post-partum.

International audience; Objectives: Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions.Methods: The article comprises a narrative review of the literature.Results: Forgetting one to three pills per cycle is a frequent problem among 15–51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are ‘escape ovulations’ and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression.Conclusions: For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.

International audience; Preeclampsia (PE) results in placental dysfunction and is one of the primary causes of maternal and fetal mortality and morbidity. During pregnancy, estrogen is produced primarily in the placenta by conversion of androgen precursors originating from maternal and fetal adrenal glands. These processes lead to increased plasma estrogen concentrations compared with levels in nonpregnant women. Aberrant production of estrogens could play a key role in PE symptoms because they are exclusively produced by the placenta and they promote angiogenesis and vasodilation. Previous assessments of estrogen synthesis during PE yielded conflicting results, possibly because of the lack of specificity of the assays. However, with the introduction of reliable analytical protocols using liquid chromatography/mass spectrometry or gas chromatography/mass spectrometry, more recent studies suggest a marked decrease in estradiol levels in PE. The aim of this review is to summarize current knowledge of estrogen synthesis, regulation in the placenta, and biological effects during pregnancy and PE. Moreover, this review highlights the links among the occurrence of PE, estrogen biosynthesis, angiogenic factors, and cardiovascular risk factors. A close link between estrogen dysregulation and PE occurrence might validate estrogen levels as a biomarker but could also reveal a potential approach for prevention or cure of PE.

Resume Objectif Analyser la litterature sur le traitement de l’endometriose douloureuse de l’adolescente. Methode Revue de la litterature entre janvier 2006 et decembre 2017. La recherche bibliographique etait realisee sur les bases de donnees Medline (Pubmed) et Cochrane database. Les meta-analyses, revues de la litterature, essais randomises controles, etudes de cohorte et etudes retrospectives etaient retenues. Les etudes traitant des dysmenorrhees de l’adolescente sans endometriose etaient exclues. Resultats Les etudes sont de qualite heterogene. Le dienogest et les agonistes de la GnRH (GnRHa) sont les seuls traitements evalues specifiquement pour le traitement de l’endometriose chez l’adolescente. Ils permettent une reduction des douleurs liees a l’endometriose. Les contraceptifs oestroprogestifs sont efficaces sur les dysmenorrhee de l’adolescente mais n’ont pas ete etudies dans les contextes d’endometriose. La densite minerale osseuse et la qualite de vie des patientes traitees par GnRHa est significativement meilleure sous add-back therapie comportant un œstrogene. Conclusion Le traitement medical de l’endometriose de l’adolescente comporte des specificites et des risques liees a l’âge. Le choix du traitement doit tenir compte des effets indesirables de chaque molecule.

Introduction/Background Progress in early diagnosis, treatment efficacy have allowed increased life expectancy in cancer patients (1). Therefore, approximately 6% childbearing age individuals are cancer survivors (2). In this specific setting, 20% of malignant epithelial ovarian tumours (MEOT) are diagnosed before the age of 44, with a 91.2% five years survival rate for stage IA and IB (3). Similarly rare malignant ovarian tumors (RMOT) and borderline ovarian tumours (BOT) more frequently occur in women of childbearing age (4). Personalized counseling on post treatment ovarian function and possibilities of fertility preservation (FP) are part of oncological patients‘ care (5). However the safety and efficiency evidence level is currently too limited to allow specific recommendations. Therefore, we report the experience in FP for patients with malignant ovarian tumours, at a French ESGO labeled national expert center and pregnancy-associated cancer network (CALG). Methodology Data from 43 patients with malignant ovarian tumors who underwent a FP between February 2013 and July 2019 were analysed from the prospective unicentric database. Results Pathological diagnosis was 5 (11.6%) MEOT, 14 (32.6%) RMOT, 24 (55.8%) BOT, mostly unilateral (76.5%) and stage I (87.9%). Mean age at diagnosis and tumor size was 26.8 and 97.4 mm respectively. Before fertility preservation, mean antral follicle count and AMH levels were 9 [0–20], and 2.26 ng/ml [0.1–10]. Mean age at fertility preservation was 29.2 [17.4–37.1]. Six ovarian tissue freezing procedures were performed out of 14 proposed. 23 oocyte freezing procedures were performed after tumor surgical treatment out of 26 proposed, with a median delay of 188 days. The mean mature oocytes collected number was 12.9. No FP was proposed for 5 patients. Conclusion Oocyte and ovarian tissue cryopreservation can be offered to patients with malignant ovarian tumor. More data are needed to confirm ovarian stimulation and ovarian tissue grafting safety. Disclosure Nothing to disclose

Resume Objectif Evaluer l’impact de la chirurgie de l’endometriose profonde sans atteinte digestive sur le taux de grossesse en fecondation in vitro (FIV). Methodes Etude retrospective monocentrique de patientes infertiles ayant une endometriose profonde sans atteinte digestive. Les patientes etaient divisees en 2 groupes : « chirurgie » et « sans chirurgie » avant la prise en charge en fecondation in vitro. L’analyse s’est faite en taux de grossesse par patiente et taux de grossesse par cycle de fecondation in vitro. Resultats Soixante-douze patientes ont ete incluses, 35 patientes dans le groupe « chirurgie » et 37 dans le groupe « sans chirurgie ». Les donnees etaient comparables dans les 2 groupes en ce qui concerne les caracteristiques cliniques des patientes, l’atteinte endometriosique a l’IRM ainsi que les caracteristiques de la fecondation in vitro. On retrouvait des taux de grossesse clinique cumules par patiente similaires dans les deux groupes : 40 % dans le groupe « chirurgie » et 41 % dans le groupe « sans chirurgie » ( p = 1). Les taux de grossesse clinique par cycles etaient aussi comparables : 24 % dans le groupe « chirurgie » et 28 % dans le groupe « sans chirurgie » ( p = 0,67). Les caracteristiques de la chirurgie etaient comparables entre les patientes ayant eu une grossesse et celles n’en ayant pas eu. Seul l’âge etait significativement plus eleve chez les patientes n’ayant pas eu de grossesse ( p = 0,01) avec significativement plus de grossesse chez les patientes de moins de 35 ans ( p = 0,04). Conclusion Chez les patientes presentant une endometriose profonde sans atteinte digestive, la chirurgie ne diminue pas les resultats en FIV. Le choix therapeutique entre la chirurgie premiere et la fecondation in vitro devrait donc etre guide par d’autres criteres, tels que la symptomatologie douloureuse, l’âge, la permeabilite tubaire, la reserve ovarienne, les caracteristiques spermatiques du conjoint et la priorite de la patiente afin de determiner s’il existe des chances de grossesse spontanee apres chirurgie de l’endometriose profonde.

Resume Objectifs Quantifier et discuter la prevalence des metastases ganglionnaires occultes thyroidiennes decouvertes sur les pieces de curages ganglionnaires cervicaux realises pour un carcinome epidermoide des voies aerodigestives superieures (CE-VADS) et discuter les consequences therapeutiques. Type d’etude Etude retrospective menee entre mai 2004 et janvier 2007. Lieu d’etude CHU. Methodes Les resultats histologiques des curages ganglionnaires cervicaux effectues au cours du traitement chirurgical d’un CE-VADS ont ete analyses sur un total de 329 curages chez 266 patients operes consecutivement. Resultats Vingt et un patients presentaient des metastases ganglionnaires d’un cancer thyroidien (prevalence 7,9 %) : carcinome papillaire dans 13 cas et carcinome folliculaire dans 8 cas. Parmi ces 21 patients, 5 avaient eu, de principe, avec le curage classique, un curage recurrentiel avec lobectomie unilaterale ; aucun foyer tumoral thyroidien n’y a ete retrouve. Treize patients ont beneficie d’une radiotherapie dans le cadre de leur CE-VADS. Le suivi consistait a realiser annuellement une echographie du cou et de la thyroide chez les 21 patients. Dans 5 cas, une thyroidectomie totale a ete decidee, conduisant a retrouver chez un seul patient, trois microcarcinomes papillaires (traitement complementaire par I 131 ). Aucun carcinome thyroidien n’a ete retrouve pour les 4 autres. Aucun deces lie au carcinome thyroidien n’est survenu au cours de la periode de suivi (moyenne de 41 mois). Conclusion La prevalence des metastases ganglionnaires de carcinome thyroidien retrouvee lors d’un curage cervical dans la prise en charge d’un CE-VADS apparait plus elevee (7,9 %) que le taux rapporte dans la litterature (0,3 a 1,6 %). Cette difference peut etre liee aux methodes histopathologiques utilisees. La prise en charge doit etre discutee en fonction des resultats de l’echographie thyroidienne et du pronostic du CE-VADS.

Objectives To quantify and discuss the prevalence of unsuspected thyroid lymph node metastases discovered in specimens from neck dissection for head and neck squamous cell carcinoma (HNSCC) and discuss the impact on patient management. Study design Retrospective study between May 2004 and January 2007. Setting University hospital. Methods Pathological analysis of cervical lymph node dissection performed during surgery for HNSCC in a total of 349 neck dissections in 266 consecutive patients. Results Twenty-one patients showed metastatic lymph nodes from thyroid cancer (prevalence 7.9%): 13 cases were metastatic from a papillary thyroid carcinoma and 8 cases from a follicular carcinoma. In 5 of the 21 patients, classical dissection was associated to recurrent nerve dissection and unilateral lobectomy; no thyroid carcinoma was found. Thirteen patients received radiotherapy for HNSCC. Follow-up comprised annual ultrasonographic examination of the neck and thyroid in these 21 patients. Total thyroidectomy was decided on in 5, with discovery of 3 micro-papillary thyroid carcinomas, in a single patient (complementary 131 I treatment). No thyroid carcinomas were found for the other 4 patients. No patient s died from thyroid carcinoma during follow-up (mean: 41 months). Conclusion The prevalence of lymph node metastasis from thyroid carcinoma in cervical lymph node dissection during treatment of HNSCC seems higher (7.9%) than rates reported in the literature (0.3 to 1.6%). This may be due to the histopathological methods employed. Management of patients should be discussed in the light of thyroid ultrasonography and prognosis of HNSCC.

Los moduladores selectivos del receptor de la progesterona (SPRM) ejercen una accion progestagena o antiprogestagena en funcion del tejido diana. Se usan en obstetricia para la interrupcion de embarazo y en ginecologia para la anticoncepcion de urgencia y el tratamiento medico de los miomas. Las perspectivas de desarrollo se centran en la anticoncepcion de larga duracion, el tratamiento de la endometriosis y la prevencion del cancer de mama. Los efectos endometriales especificos estan en evaluacion.

Los moduladores selectivos de los receptores estrogenicos (MSRE) son moleculas con un perfil especial debido a su capacidad de ejercer, en funcion del tejido considerado y de la molecula, efectos estrogenicos o antiestrogenicos. Se concibieron y se desarrollaron inicialmente a lo largo de varias generaciones en busca de efectos beneficiosos en todos los tejidos y actualmente tienen tres indicaciones principales: el tratamiento (y la prevencion en Estados Unidos) del cancer de mama hormonodependiente, la induccion de la ovulacion y la prevencion de las fracturas osteoporoticas. Los MSRE dan lugar a un aumento de riesgo de trombosis venosa y oleadas de calor. En el endometrio, el aumento de riesgo de cancer depende del MSRE evaluado.