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Objective: To evaluate the efficacy of semi natural cycle as option of treatment for the patients who have a poor prognosis to controlled ovarian hyperstimulation (COH)., Patients and Methods: Prospective study. Sixty-six patients with an ovulatory cycle who presented either altered ovarian status (AOS) or implantation failure (IMF) and had carried out a total of 133 semi natural IVF cycles were included. Once follicular dominance was established, the growth of this follicule was controlled by administration of the GnRH antagonist with exogenous gonadotrophins., Results: Groups AOS (n = 47) and IMF (n = 19) were similar with regard to oocyte pickup rate (81.2% and 81.1%), the oocyte recovery rate (61.4% and 64.8%) and clinical pregnancies per oocyte pickups rate (15.4% and 16.6%), respectively., Conclusions: The semi natural cycle appears as option of treatment for patients who have a poor prognosis for successful in vitro fertilization.

Premature LH and progesterone surges are associated with different factors and hormonal modulators. The aim of the present study was (i) to investigate the clinical and laboratory factors and (ii) to highlight the importance of different stimulation protocols in associated premature LH and progesterone surges in intrauterine insemination (IUI) cycles. The study involved a retrospective investigation of 75 patients undergoing IUI for infertility treatment (135 IUI cycles) between 1996 and 2000, with initial serum LH concentrations >10 mIU/ml during ovarian stimulation. Ultrasound characteristics, follicular sizes, serum oestradiol, progesterone and LH concentrations and ovarian stimulation protocols were measured. There was a wide range of oestradiol serum concentrations (93-2245 pg/ml) and follicular size (12-25 mm). In 49.6% of cycles, the dominant follicle was <16.5 mm. Patients with >2 follicles measuring <15 mm had higher oestradiol serum concentrations (P = 0.008). Multiple regression analyses revealed no association between these variables and premature LH/progesterone surge. In conclusion, LH/progesterone surges cannot be predicted utilizing clinical parameters normally employed, e.g. ultrasound serum oestradiol assay or ovarian stimulation protocol. Patients with follicles >14 mm or more and with high numbers of small follicles and high oestradiol are at risk of a spontaneous LH surge. These variables can be used to time the administration of GnRH antagonist administration until better predictive factors are demonstrated.

Objectives: Show the different surgical approaches for the treatment of polycystic ovarian syndrome (SOPK)., Patients and Methods: Seventy-one patients treated by ovarian drilling by laparoscopy and 47 by hydrolaparoscopy. The main inclusion criterion was the absence of response after 6 months of stimulation by clomifene citrate for oligo-amenorrheic patients., Results: After a review of surgical series published of ovarian drilling, we found 73% pregnancy rate after laparoscopic treatment and 61 % after hydrolaparoscopy., Discussion and Conclusion: Ovarian drilling appears as an alternative to ovarian hyperstimulation with intra-uterine insemination after failure of clomifène citrate and/or metformine. Surgical treatment decreases multiple pregnancies and miscarriages. Hydrolaparoscopy is more efficient than laparoscopy with less morbidity in particular in obese patients.

The contractile activity of the nonpregnant uterus plays an important role in the human reproduction process. Noticeable variation in uterine contractility occurs during the menstrual cycle to meeting some physiologic requirements of the female reproductive system. During the follicular phase, stimulation of uterine contractions by estrogens fosters sperm transport toward the fertilization site. After ovulation, contractility decreases in response to progesterone, a phenomenon that is probably involved in the embryo implantation mechanism. The comprehension of uterine contractility regulation and physiologic roles has been considerably extended during recent years by the development of direct and noninvasive assessment tools, in particular, ultrasound. Today, not only the artificial stimulation of uterine contractions, aiming at promoting sperm transport during the pre-ovulatory phase, but also their attenuation to provide optimum conditions for embryo implantation during the luteal phase, represent innovating, promising issues in the optimization of assisted reproduction treatments.

Introduction: To assess ultrasonic data in the context of repeated failure of implantation in assisted reproduction medicine., Materials and Methods: We reviewed ultrasonic data (uterine score at follicular and luteal phase). The same ultrasound exploration was repeated for two consecutive cycles to assess the changes in abnormalities observed and compare findings in 16 patients with repeated failure of implantation and in 14 controls. The controls were women who became pregnant within the three months following the exploration. We then introduced acetylsalicylic acid and prednisolone as first line treatment and nitroglycerin as second line treatment to measure the effects induced in 14 pathological uterine scores., Results: The score obtained under hormonal treatment was representative of other cycles (r = 0.812, p < 0.0014). The score was significantly lower and the luteal uterine artery pulsatility index was significantly higher in the repeated failure group than in the control group (p < 0.0001 and p = 0.008 respectively). For the 14 patients, treatment improved the uterine score in 8 with acetylsalicylic acid and prednisolone and in 4 with nitroglycerin. Two patients did not respond to treatment. Concerning the effect of therapy, of 14 patients, 8 had an improved uterine score with A + P, and with T; 2 patients did not respond to any treatment., Conclusion: The uterine score and luteal artery pulsatility index may be valuable tools for patients with implantation failure who all do not respond to the same therapy.

In France, all embryos obtained after ovum donation have to be frozen. We present a brief background on this policy and expose our results, then discuss the rationale of such a policy in order to upgrade knowledge on the mechanism of vertical HIV transmission.