1
|
Maignien C, Bourdon M, Parpex G, Ferreux L, Patrat C, Bordonne C, Marcellin L, Chapron C, Santulli P. Endometriosis-related infertility: severe pain symptoms do not impact assisted reproductive technology outcomes. Hum Reprod 2024; 39:346-354. [PMID: 38142239 DOI: 10.1093/humrep/dead252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/06/2023] [Indexed: 12/25/2023] Open
Abstract
STUDY QUESTION Do severe endometriosis-related painful symptoms impact ART live birth rates? SUMMARY ANSWER Severe pain symptoms are not associated with reduced ART live birth rates in endometriosis patients. WHAT IS KNOWN ALREADY ART is currently recognized as one of the main therapeutic options to manage endometriosis-related infertility. Presently, no data exist in the literature regarding the association between the core symptom of the disease, e.g. pain and ART reproductive outcomes. STUDY DESIGN, SIZE, DURATION Observational cohort study of 354 endometriosis patients, who underwent ART at a tertiary care university hospital, between October 2014 and October 2021. Diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging, and histologically confirmed in women who had a previous history of endometriosis surgery (n = 127, 35.9%). PARTICIPANTS/MATERIALS, SETTING, METHODS The intensity of painful symptoms related to dysmenorrhea (DM), dyspareunia (DP), noncyclic chronic pelvic pain, gastrointestinal (GI) pain, or lower urinary tract pain was evaluated using a 10-point visual analog scale (VAS), before ART. Severe pain was defined as having a VAS of 7 or higher for at least one symptom. The main outcome measure was the cumulative live birth rate (CLBR) per patient. We analyzed the impact of endometriosis-related painful symptoms on ART live births using univariable and multivariate analysis. MAIN RESULTS AND THE ROLE OF CHANCE Three hundred and fifty-four endometriosis patients underwent 711 ART cycles. The mean age of the population was 33.8 ± 3.7 years, and the mean duration of infertility was 3.6 ± 2.1 years. The distribution of the endometriosis phenotypes was 3.1% superficial endometriosis, 8.2% ovarian endometrioma, and 88.7% deep infiltrating endometriosis. The mean VAS scores for DM, DP, and GI pain symptoms were 6.6 ± 2.7, 3.4 ± 3.1, and 3.1 ± 3.6, respectively. Two hundred and forty-two patients (68.4%) had severe pain symptoms. The CLBR per patient was 63.8% (226/354). Neither the mean VAS scores for the various painful symptoms nor the proportion of patients displaying severe pain differed significantly between patients who had a live birth and those who had not, based on univariate and multivariate analyses (P = 0.229). The only significant factors associated with negative ART live births were age >35 years (P < 0.001) and anti-Müllerian hormone levels <1.2 ng/ml (P < 0.001). LIMITATIONS, REASONS FOR CAUTION The diagnosis of endometriosis was based on imaging rather than surgery. This limitation is, however, inherent to the design of most studies on endometriosis patients reverting to ART first. WIDER IMPLICATIONS OF THE FINDINGS Rather than considering a single argument such as pain, the decision-making process for choosing between ART and surgery in infertile endometriosis patients should be based on a multitude of aspects, including the patient's choice, the associated infertility factors, the endometriosis phenotypes, and the efficiency of medical therapies in regard to pain symptoms, through an individualized approach guided by a multidisciplinary team of experts. STUDY FUNDING/COMPETING INTEREST(S) No funding; no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- C Maignien
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - M Bourdon
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - G Parpex
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - L Ferreux
- Faculté de Santé, Université de Paris, Paris, France
- Department of Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Patrat
- Faculté de Santé, Université de Paris, Paris, France
- Department of Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Bordonne
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Radiology (Professor Dion), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France
| | - L Marcellin
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - C Chapron
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| | - P Santulli
- Faculté de Santé, Université de Paris, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), Paris, France
| |
Collapse
|
2
|
Maignien C, Bourdon M, Marcellin L, Laguillier-Morizot C, Borderie D, Chargui A, Patrat C, Plu-Bureau G, Chapron C, Santulli P. Low serum progesterone affects live birth rate in cryopreserved blastocyst transfer cycles using hormone replacement therapy. Reprod Biomed Online 2021; 44:469-477. [PMID: 34980570 DOI: 10.1016/j.rbmo.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 01/25/2023]
Abstract
RESEARCH QUESTION Does serum progesterone concentration on the day of vitrified-warmed embryo transfer affect live birth rate (LBR) with hormonal replacement therapy (HRT) cycles? DESIGN Observational cohort study of patients (n = 915) undergoing single autologous vitrified-warmed blastocyst transfer under HRT using vaginal micronized progesterone. Women were included once, between January 2019 and March 2020. Serum progesterone concentration was measured by a single laboratory on the morning of embryo transfer. The primary end point was LBR. Univariate and multivariate logistic regression models were used for statistical analyses. RESULTS Median (25th-75th percentile) serum progesterone concentration on the day of embryo transfer was 12.5 ng/ml (9.8-15.3). The LBR was 31.5% (288/915) in the overall population. No significant differences were found in implantation rates (40.7% versus 44.9%); LBR was significantly lower in women with a progesterone concentration ≤25th percentile (≤9.8 ng/ml) (26.1% versus 33.2%, P = 0.045) versus women with a progesterone concentration >25th percentile. This correlated with a significantly higher early miscarriage rate (35.9% versus 21.6%, P = 0.005). After adjusting for potential confounding factors in multivariate analysis, low serum progesterone levels (≤9.8 ng/ml) remained significantly associated with lower LBR (OR 0.68 95% CI 0.48 to 0.97). CONCLUSION A minimum serum progesterone concentration is needed to optimize reproductive outcomes in HRT cycles with single autologous vitrified-warmed blastocyst transfer. Whether modifications of progesterone administration routes, dosage, or both, can improve pregnancy rates needs further study so that treatment of patients undergoing HRT cycles can be further individualized.
Collapse
Affiliation(s)
- Chloé Maignien
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France
| | - Mathilde Bourdon
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Louis Marcellin
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Christelle Laguillier-Morizot
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Biological Endocrinology (Professor Guibourdenche), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Didier Borderie
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Automated Biological Diagnosis (Professor Borderie), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Ahmed Chargui
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Histology and Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France
| | - Catherine Patrat
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Histology and Reproductive Biology (Professor Patrat), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France
| | - Geneviève Plu-Bureau
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Equipe EPOPE, INSERM U1153
| | - Charles Chapron
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Pietro Santulli
- Université de Paris, Faculté de Santé, 12 Rue de l'Ecole de Médecine 75006 Paris, France; Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal 75014 Paris, France; Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques 75014 Paris, France.
| |
Collapse
|
3
|
Ferreux L, Bourdon M, Chargui A, Schmitt A, Stouvenel L, Lorès P, Ray P, Lousqui J, Pocate-Cheriet K, Santulli P, Dulioust E, Toure A, Patrat C. Genetic diagnosis, sperm phenotype and ICSI outcome in case of severe asthenozoospermia with multiple morphological abnormalities of the flagellum. Hum Reprod 2021; 36:2848-2860. [PMID: 34529793 DOI: 10.1093/humrep/deab200] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/11/2021] [Indexed: 01/13/2023] Open
Abstract
STUDY QUESTION Are ICSI outcomes impaired in cases of severe asthenozoospermia with multiple morphological abnormalities of the flagellum (MMAF phenotype)? SUMMARY ANSWER Despite occasional technical difficulties, ICSI outcomes for couples with MMAF do not differ from those of other couples requiring ICSI, irrespective of the genetic defect. WHAT IS KNOWN ALREADY Severe asthenozoospermia, especially when associated with the MMAF phenotype, results in male infertility. Recent findings have confirmed that a genetic aetiology is frequently responsible for this phenotype. In such situations, pregnancies can be achieved using ICSI. However, few studies to date have provided detailed analyses regarding the flagellar ultrastructural defects underlying this phenotype, its genetic aetiologies, and the results of ICSI in such cases of male infertility. STUDY DESIGN, SIZE, DURATION We performed a retrospective study of 25 infertile men exhibiting severe asthenozoospermia associated with the MMAF phenotype identified through standard semen analysis. They were recruited at an academic centre for assisted reproduction in Paris (France) between 2009 and 2017. Transmission electron microscopy (TEM) and whole exome sequencing (WES) were performed in order to determine the sperm ultrastructural phenotype and the causal mutations, respectively. Finally 20 couples with MMAF were treated by assisted reproductive technologies based on ICSI. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients with MMAF were recruited based on reduced sperm progressive motility and increased frequencies of absent, short, coiled or irregular flagella compared with those in sperm from fertile control men. A quantitative analysis of the several ultrastructural defects was performed for the MMAF patients and for fertile men. The ICSI results obtained for 20 couples with MMAF were compared to those of 378 men with oligoasthenoteratozoospermia but no MMAF as an ICSI control group. MAIN RESULTS AND THE ROLE OF CHANCE TEM analysis and categorisation of the flagellar anomalies found in these patients provided important information regarding the structural defects underlying asthenozoospermia and sperm tail abnormalities. In particular, the absence of the central pair of axonemal microtubules was the predominant anomaly observed more frequently than in control sperm (P < 0.01). Exome sequencing, performed for 24 of the 25 patients, identified homozygous or compound heterozygous pathogenic mutations in CFAP43, CFAP44, CFAP69, DNAH1, DNAH8, AK7, TTC29 and MAATS1 in 13 patients (54.2%) (11 affecting MMAF genes and 2 affecting primary ciliary dyskinesia (PCD)-associated genes). A total of 40 ICSI cycles were undertaken for 20 MMAF couples, including 13 cycles (for 5 couples) where a hypo-osmotic swelling (HOS) test was required due to absolute asthenozoospermia. The fertilisation rate was not statistically different between the MMAF (65.7%) and the non-MMAF (66.0%) couples and it did not differ according to the genotype or the flagellar phenotype of the subjects or use of the HOS test. The clinical pregnancy rate per embryo transfer did not differ significantly between the MMAF (23.3%) and the non-MMAF (37.1%) groups. To date, 7 of the 20 MMAF couples have achieved a live birth from the ICSI attempts, with 11 babies born without any birth defects. LIMITATIONS, REASONS FOR CAUTION The ICSI procedure outcomes were assessed retrospectively on a small number of affected subjects and should be confirmed on a larger cohort. Moreover, TEM analysis could not be performed for all patients due to low sperm concentrations, and WES results are not yet available for all of the included men. WIDER IMPLICATIONS OF THE FINDINGS An early and extensive phenotypic and genetic investigation should be considered for all men requiring ICSI for severe asthenozoospermia. Although our study did not reveal any adverse ICSI outcomes associated with MMAF, we cannot rule out that some rare genetic causes could result in low fertilisation or pregnancy rates. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study and there are no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Lucile Ferreux
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France
| | - Mathilde Bourdon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Paris, France
| | - Ahmed Chargui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France
| | - Alain Schmitt
- Université de Paris, Institut Cochin, U1016, INSERM, CNRS, Paris, France
| | - Laurence Stouvenel
- Université de Paris, Institut Cochin, U1016, INSERM, CNRS, Paris, France
| | - Patrick Lorès
- Université de Paris, Institut Cochin, U1016, INSERM, CNRS, Paris, France
| | - Pierre Ray
- Université Grenoble Alpes, Institut pour l'avancée des Biosciences, INSERM, CNRS, Grenoble, France
| | - Johanna Lousqui
- APHP.nord-Université de Paris, Hôpital Bichat, Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France
| | - Khaled Pocate-Cheriet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France
| | - Pietro Santulli
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Paris, France
| | - Emmanuel Dulioust
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France.,Université de Paris, Institut Cochin, U1016, INSERM, CNRS, Paris, France
| | - Aminata Toure
- Université Grenoble Alpes, Institut pour l'avancée des Biosciences, INSERM, CNRS, Grenoble, France
| | - Catherine Patrat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Centre-Université de Paris, Hôpital Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France.,Université de Paris, Institut Cochin, U1016, INSERM, CNRS, Paris, France
| |
Collapse
|
4
|
Santulli P, Bourdon M, Koutchinsky S, Maignien C, Marcellin L, Maitrot-Mantelet L, Pocate Cheriet K, Patrat C, Chapron C. Fertility preservation for patients affected by endometriosis should ideally be carried out before surgery. Reprod Biomed Online 2021; 43:853-863. [PMID: 34649771 DOI: 10.1016/j.rbmo.2021.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION What prognostic factors relate to a high oocyte yield in fertility preservation for women affected by endometriosis? DESIGN Observational cohort study conducted in a tertiary care university hospital between April 2015 and January 2019. Women who had undergone fertility preservation with ovarian stimulation for oocytes and embryo vitrification for endometriosis were included. Prognostic factors associated with the number of oocytes retrieved after the first ovarian stimulation were analysed. RESULTS A total of 146 women who had undergone 258 ovarian stimulation cycles were included; 82 (56.2%) had undergone more than one ovarian stimulation cycle; 72.6% had at least one endometrioma lesion; and 36.3% had previously undergone surgery for endometriosis. After adjustment by multiple linear regression, the factors that significantly reduced the number of oocytes retrieved were previous history of surgery for ovarian endometriosis (coefficient -1.08; 95% CI -2.02 to -0.15; P = 0.024); women's age (-0.21; 95% CI -0.41 to -0.01; P = 0.039); and total dose of gonadotrophin used (-0.01; 95% CI -0.01 to -0.00; P = 0.047). Anti-Müllerian hormone serum level and gravidity positively correlated with an increase in the number of oocytes retrieved (1.65; 95% CI 1.13 to 2.17; P < 0.001 and 3.30; 95% CI 0.91 to 5.68; P = 0.007, respectively) after the first ovarian stimulation cycle. CONCLUSION A history of surgery for ovarian endometriosis was associated with significantly lower oocyte yields. Fertility preservation should be integrated into endometriosis management. Fertility preservation should ideally be made available to the patient before surgery.
Collapse
Affiliation(s)
- Pietro Santulli
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France.
| | - Mathilde Bourdon
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France
| | - Sonia Koutchinsky
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France
| | - Chloé Maignien
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France
| | - Louis Marcellin
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France
| | - Lorraine Maitrot-Mantelet
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France
| | - Khaled Pocate Cheriet
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris 75014, France
| | - Catherine Patrat
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris 75014, France
| | - Charles Chapron
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin - Bâtiment Port Royal, 123 Boulevard de Port-Royal 75679 Paris 14, France; Université de Paris, Department 'Infection, Immunity, Inflammation', INSERM U1016, Institut Cochin, Paris, France
| |
Collapse
|
5
|
Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates. Fertil Steril 2020; 115:692-701. [PMID: 33276963 DOI: 10.1016/j.fertnstert.2020.09.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the assisted reproductive technology (ART) cumulative live-birth rate (LBR) in a cohort of bowel endometriosis patients with no prior history of surgery for endometriosis. DESIGN Prospective cohort study. SETTING University hospital. PATIENT(S) One hundred and one consecutive infertile bowel-endometriosis patients with no prior history of surgery for endometriosis in whom the diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging. INTERVENTION(S) First-line ART. MAIN OUTCOME MEASURE(S) Cumulative LBR, with statistical analysis via Kaplan Meier method with a "conservative" method, whereby it was assumed that no live births took place for patients who did not return. RESULT(S) Between January 2016 and December 2018, 101 bowel endometriosis patients underwent 176 ART cycles. The mean number of deep-infiltrating endometriosis lesions per patient was 3 ± 0.9, with a mean number of bowel lesions of 1.3 ± 0.6. Seventy-three percent of the patients had associated endometriomas, and 88.1% had associated adenomyosis. Overall, the cumulative LBR after four ART cycles was 64.4%, using the conservative Kaplan-Meier method. CONCLUSION(S) The ART cumulative LBR was very satisfactory (64.4%) in bowel endometriosis patients with no prior history of surgery for endometriosis. In light of these data, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery because as first-line ART appears to offer satisfactory results.
Collapse
|
6
|
Pocate-Cheriet K, Santulli P, Kateb F, Bourdon M, Maignien C, Batteux F, Chouzenoux S, Patrat C, Wolf JP, Bertho G, Chapron C. The follicular fluid metabolome differs according to the endometriosis phenotype. Reprod Biomed Online 2020; 41:1023-1037. [PMID: 33046374 DOI: 10.1016/j.rbmo.2020.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
RESEARCH QUESTION Is there a follicular fluid-specific metabolic profile in deep infiltrating endometriosis (DIE) depending on the presence of an associated ovarian endometrioma (OMA) that could lead to the identification of biomarkers for diagnosis and prognosis of the disease? DESIGN In this prospective cohort study, proton nuclear magnetic resonance (1H-NMR) experiments were carried out on 50 follicular fluid samples from patients presenting with DIE, associated or not associated with an OMA, and 29 follicular fluid samples from patients with infertility caused by a tubal obstruction. RESULTS Concentrations of glucose, citrate, creatine and amino acids such as tyrosine and alanine were lower in women with DIE than control participants, whereas concentrations of lactate, pyruvate, lipids and ketone bodies were higher. Metabolic analysis revealed enhanced concentrations of glycerol and ketone bodies in patients with OMA, indicative of an activation of lipolysis followed by beta-oxidation. Concentrations of lactate and pyruvate were increased in patients without OMA, whereas the concentration of glucose was decreased, highlighting activation of the anaerobic glycolysis pathway. Differences in concentrations of amino acids such as threonine and glutamine were also statistically relevant in discriminating between the presence or absence of OMA. CONCLUSIONS Results indicate a mitochondrial dysregulation in endometriosis phenotypes, with a modified balance between anaerobic glycolysis and beta-oxidation in OMA phenotypes that could affect the fertility of women with endometriosis. As the composition of the follicular fluid has been shown to be correlated with oocyte development and outcome of implantation after fertilization, these findings may help explain the high level of infertility in these patients.
Collapse
Affiliation(s)
- Khaled Pocate-Cheriet
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France; Département "Développement, Reproduction et Cancer", Institut Cochin, INSERM U1016, Université de Paris, Paris, France.
| | - Pietro Santulli
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Département "Développement, Reproduction et Cancer", Institut Cochin, INSERM U1016, Université de Paris, Paris, France; Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France
| | - Fatiha Kateb
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologiques, UMR 8601-CNRS, Université de Paris, Campus Saint-Germain-des-Prés, Paris, France
| | - Mathilde Bourdon
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Département "Développement, Reproduction et Cancer", Institut Cochin, INSERM U1016, Université de Paris, Paris, France; Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France
| | - Chloé Maignien
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France
| | - Frédéric Batteux
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Département "Développement, Reproduction et Cancer", Institut Cochin, INSERM U1016, Université de Paris, Paris, France; Service d'Immunologie Biologique, Paris, France
| | - Sandrine Chouzenoux
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Département "Développement, Reproduction et Cancer", Institut Cochin, INSERM U1016, Université de Paris, Paris, France
| | - Catherine Patrat
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France
| | - Jean Philippe Wolf
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Service d'Histologie-Embryologie-Biologie de la Reproduction, Paris, France
| | - Gildas Bertho
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Laboratoire de Chimie et Biochimie Pharmacologiques et Toxicologiques, UMR 8601-CNRS, Université de Paris, Campus Saint-Germain-des-Prés, Paris, France
| | - Charles Chapron
- Université de Paris, Faculté de Médecine, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin (HUPC), Centre Hospitalier Paris Centre, Paris, France; Département "Développement, Reproduction et Cancer", Institut Cochin, INSERM U1016, Université de Paris, Paris, France; Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France
| |
Collapse
|
7
|
Bourdon M, Ferreux L, Maignien C, Patrat C, Marcellin L, Pocate-Cheriet K, Chapron C, Santulli P. Tobacco consumption is associated with slow-growing day-6 blastocysts. F S Rep 2020; 1:30-36. [PMID: 34223209 PMCID: PMC8244283 DOI: 10.1016/j.xfre.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate if there are any obvious clinical factors associated with delayed blastulation at day 6 (D6) compared with day 5 (D5). Design Monocentric observational cohort study from November 2012 to December 2018. Setting Tertiary-care academic medical center. Patient(s) A total of 941 women with an entire cohort of exclusively D5 blastocysts compared with 162 patients with a cohort of exclusively D6 blastocysts. Intervention(s) None. Main Outcome Measure(s) Clinical characteristics and data related to the ovarian stimulation protocols. Result(s) After univariate analysis, a significantly higher proportion of women who were active smokers was found in the D6 group compared with the D5 group (n = 22/162 [13.6%] vs. n = 82/941 [8.7%]). In addition, the women in the D6 group had a higher rank number of assisted reproductive technology (ART; total no. of ART cycles performed: 2.1 ± 1.4 vs. 1.6 ± 1.1) and a lower antral follicle count (AFC; 18.7 ± 11.3 vs. 22.2 ± 12.8). Moreover, fertilization with the use of intracytoplasmic sperm injection was used more frequently in the D6 group compared with the D5 group. Logistic regression analysis adjusted for confounders highlighted several independent predictors for reaching blastocyst stage at D6 rather than D5: being an active smoker, previous ART cycles, and a lower AFC. Conclusion(s) Obtaining an exclusively D6 blastocyst cohort is independently associated with women who are active smokers, previous ART cycles, and a lower AFC. These findings provide evidence, to be confirmed by further studies, that women who are active smokers could greatly benefit from smoking cessation before undergoing ART.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| | - Lucile Ferreux
- Service d'Histologie-Embryologie-Biologie de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris, France
| | - Chloé Maignien
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris
| | - Catherine Patrat
- Service d'Histologie-Embryologie-Biologie de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris, France
| | - Louis Marcellin
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| | - Khaled Pocate-Cheriet
- Service d'Histologie-Embryologie-Biologie de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris, France
| | - Charles Chapron
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| | - Pietro Santulli
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, Faculté de Médecine, Sorbonne Paris Cité, Université de Paris, Assistance Publique-Hôpitaux de Paris Centre, Cochin, Paris.,Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Sorbonne Paris Cité, Université de Paris, Paris
| |
Collapse
|
8
|
Bourdon M, Ouazana M, Maignien C, Pocate-Cheriet K, Patrat C, Marcellin L, Chapron C, Santulli P. Impact of Supraphysiological Estradiol Serum Levels on Birth Weight in Singletons Born After Fresh Embryo Transfer. Reprod Sci 2020; 27:1770-1777. [DOI: 10.1007/s43032-020-00174-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/21/2020] [Indexed: 01/09/2023]
|
9
|
Bourdon M, Santulli P, Kefelian F, Vienet-Legue L, Maignien C, Pocate-Cheriet K, de Mouzon J, Marcellin L, Chapron C. Prolonged estrogen (E2) treatment prior to frozen-blastocyst transfer decreases the live birth rate. Hum Reprod 2019. [PMID: 29529202 DOI: 10.1093/humrep/dey041] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION How does the duration of estrogen (E2) treatment prior to frozen-blastocyst transfers affect the live birth rate (LBR)? SUMMARY ANSWER Prolonged E2 exposure as part of artificial endometrial preparation (AEP) significantly decreases the LBR after autologous frozen-thawed blastocyst transfer. WHAT IS KNOWN ALREADY One effective method for endometrial preparation prior to frozen embryo transfer is AEP, a sequential regimen with E2 and progesterone, which aims to mimic the endocrine exposure of the endometrium in a normal cycle. Nevertheless, the optimal duration of E2 administration prior to transfer remains unknown. STUDY DESIGN, SIZE, DURATION An observational cohort study was conducted in a tertiary care university hospital between 01/07/2012 and 31/12/2015. The main inclusion criteria was having a single frozen-thawed blastocyst transfer with an AEP using exogenous E2. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1377 frozen-thawed blastocyst transfers were assigned to four groups according to the duration of the E2 administration prior to the embryo transfers. These comprised a '≤21 days' group (n = 330), a '22-28 days' group (n = 665), a '29-35 days' group (n = 289) and a '36-48 days' group (n = 93). The '≤21 days' group' was taken as the reference group. The main measured outcome was the LBR following frozen-thawed blastocyst transfers. Statistical analysis was conducted using univariate and multivariate logistic regression models. MAIN RESULTS AND THE ROLE OF CHANCE LBR significantly decreased when the E2 exposure prior to the frozen-thawed blastocyst transfer exceeded 28 days: OR = 0.66; 95% CI [0.46-0.95]; P = 0.026 and OR = 0.49 [0.27-0.89]; P = 0.018, respectively, for the '29 to 35 days' group and for the '36 to 48 days' group compared to the reference group. Early pregnancy loss rates significantly increased when the E2 exposure lasted more than 35 days prior to the frozen-thawed blastocyst transfer (OR = 2.37 [1.12-5.05]; P = 0.025 vs. the reference group). After multivariate logistic regression, E2 exposure lasting more than 28 days prior to the frozen-thawed blastocyst transfer was associated with a decrease in the LBR, for the '29-35 days' group (OR = 0.65; [0.45-0.95]; P = 0.044) as for the '36-48 days' group (OR = 0.49; [0.26-0.92]; P = 0.035), vs. the reference group. LIMITATIONS, REASONS FOR CAUTION One limitation is linked to the observational design of this study. WIDER IMPLICATIONS OF THE FINDINGS In order to give patients the best chance to obtain a live birth after frozen-thawed blastocyst transfer, the length of E2 exposure prior to the frozen-blastocyst transfer should not exceed 28 days. This study provides new insight in regard to endometrial preparation using AEP prior to frozen-blastocyst transfer. STUDY FUNDING/COMPETING INTEREST(S) No funding and no competing interest.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département 'Stress oxydant, prolifération cellulaire et inflammation', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département 'Stress oxydant, prolifération cellulaire et inflammation', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| | - Fleur Kefelian
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France
| | - Laurine Vienet-Legue
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France
| | - Chloé Maignien
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France
| | - Khaled Pocate-Cheriet
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, 53 avenue de l'Observatoire, 75014 Paris, France
| | - Jacques de Mouzon
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Epidemiology, Paris, France
| | - Louis Marcellin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département 'Stress oxydant, prolifération cellulaire et inflammation', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département de 'Génétique, Développement et Cancer', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| | - Charles Chapron
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département de 'Génétique, Développement et Cancer', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| |
Collapse
|
10
|
Bourdon M, Santulli P, Chen Y, Patrat C, Pocate-Cheriet K, Maignien C, Marcellin L, Chapron C. The Deferred Embryo Transfer Strategy Seems Not to be a Good Option After Repeated IVF/ICSI Cycle Failures. Reprod Sci 2018; 26:1210-1217. [DOI: 10.1177/1933719118811648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: The aim of this study was to assess whether a deferred frozen–thawed embryo transfer (Def-ET) offers any benefits compared to a fresh ET strategy in women who have had 2 or more consecutive in vitro fertilization (IVF)/intracytoplasmic injection (ICSI) cycle failures. Design: An observational cohort study in a tertiary referral care center including 416 cycles from women with a previous history of 2 or more consecutive IVF/ICSI failures cycles. Both Def-ET and fresh ET strategies were compared using univariate and multivariate logistic regression models. The main outcome measured was the cumulative live birth rate (CLBR). Results: A total of 416 cycles were included in the analysis: 197 in the fresh ET group and 219 in the Def-ET group. The CLBR was not significantly different between the fresh and Def-ET groups (58/197 [29.4%] and 57/219 [26.0%], respectively, P = .437). In addition, after the first ET, there was no significant difference in the live birth rate between the fresh ET and Def-ET groups (50/197 [25.4%] vs 44/219 [20.1%], respectively). Multivariate logistic regression analysis indicated that compared to the fresh strategy, the Def-ET strategy was not associated with a higher probability of live birth. Conclusions: In cases with 2 or more consecutive prior IVF/ICSI cycle failures, a Def-ET strategy did not result in better ART outcomes than a fresh ET strategy.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Faculté de Médecine, Département de gynécologie, obstétrique II et médecine de la reproduction, Assistance Publique–Hôpitaux de Paris (AP–HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, Laboratoire d’immunologie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Faculté de Médecine, Département de gynécologie, obstétrique II et médecine de la reproduction, Assistance Publique–Hôpitaux de Paris (AP–HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, Laboratoire d’immunologie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Yulian Chen
- Faculté de Médecine, Département de gynécologie, obstétrique II et médecine de la reproduction, Assistance Publique–Hôpitaux de Paris (AP–HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Catherine Patrat
- Faculté de Médecine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Service d’Histologie-Embryologie-Biologie de la Reproduction, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Khaled Pocate-Cheriet
- Faculté de Médecine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Service d’Histologie-Embryologie-Biologie de la Reproduction, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Chloé Maignien
- Faculté de Médecine, Département de gynécologie, obstétrique II et médecine de la reproduction, Assistance Publique–Hôpitaux de Paris (AP–HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Louis Marcellin
- Faculté de Médecine, Département de gynécologie, obstétrique II et médecine de la reproduction, Assistance Publique–Hôpitaux de Paris (AP–HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, Laboratoire d’immunologie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut Cochin, Inserm U1016, Département de “Génetique, Développement et Cancer”, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Faculté de Médecine, Département de gynécologie, obstétrique II et médecine de la reproduction, Assistance Publique–Hôpitaux de Paris (AP–HP), Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, Laboratoire d’immunologie, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Institut Cochin, Inserm U1016, Département de “Génetique, Développement et Cancer”, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
11
|
Endometriosis and ART: A prior history of surgery for OMA is associated with a poor ovarian response to hyperstimulation. PLoS One 2018; 13:e0202399. [PMID: 30125306 PMCID: PMC6101383 DOI: 10.1371/journal.pone.0202399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/02/2018] [Indexed: 12/20/2022] Open
Abstract
Background Many women whose fertility may have been impaired by endometriosis require assisted reproductive technology (ART) in order to become pregnant. However, the influence of ovarian endometriosis (OMA) on ovarian responsiveness to hyperstimulation has not been clearly established. Objective To evaluate the risk of a poor ovarian response (POR) to stimulation and ART outcomes in women with OMA. Materials and methods We conducted a large observational controlled matched cohort study in a tertiary care university hospital between 01/10/2012 and 31/12/2015. After matching by age and anti-Müllerian hormone (AMH) levels, 201 infertile women afflicted with OMA (the OMA group) and 402 disease-free women (the control group) undergoing an ART procedure were included in the study. The main outcomes that we measured were a POR to hyperstimulation (i.e., ≤ 3 oocytes retrieved, or cancelled cycles), the clinical pregnancy rate, and the live birth rate. All of the women with endometriosis underwent a pre-ART work-up, in order to obtain an accurate diagnosis and staging of their disease. An OMA diagnosis was based on published imaging criteria (obtained by transvaginal sonography or magnetic resonance imaging) or on histological analysis for patients with a prior history of endometriosis surgery. The statistical analyses were conducted using univariate and multivariate logistic regression models. Results The incidence of a POR to hyperstimulation was significantly higher for the OMA group than for the control group [62/201 (30.8%) versus 90/402 (22.3%), respectively; p = 0.02]. However, no significant differences were found between the OMA and the control group in terms of the clinical pregnancy rate [53/151 (35%) versus 134/324 (41.3%), respectively; p = 0.23] and the live birth rate [39/151 (25.8%) versus 99/324 (30.5%), respectively; p = 0.33]. By multivariate analysis, a prior history of surgery for OMA was found to be an independent factor associated with a POR to stimulation [OR = 2.1; 95% CI: 1.1–4.0], unlike OMA without a prior history of surgery [OR: 1.5; 95% CI: 0.9–2.2]. Conclusion The presence of OMA during ART treatment increased the risk of a POR to hyperstimulation, although the live birth rate was not affected. Furthermore, having OMA and having previously undergone surgery for OMA was identified as an independent risk factor for a POR.
Collapse
|
12
|
Bourdon M, Santulli P, Maignien C, Gayet V, Pocate-Cheriet K, Marcellin L, Chapron C. The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study. PLoS One 2018; 13:e0194800. [PMID: 29630610 PMCID: PMC5890985 DOI: 10.1371/journal.pone.0194800] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Controlled ovarian stimulation in assisted reproduction technology (ART) may alters endometrial receptivity by an advancement of endometrial development. Recently, technical improvements in vitrification make deferred frozen-thawed embryo transfer (Def-ET) a feasible alternative to fresh embryo transfer (ET). In endometriosis-related infertility the eutopic endometrium is abnormal and its functional alterations are seen as likely to alter the quality of endometrial receptivity. One question in the endometriosis ART-management is to know whether Def-ET could restore optimal receptivity in endometriosis-affected women leading to increase in pregnancy rates. Objective To compare cumulative ART-outcomes between fresh versus Def-ET in endometriosis-infertile women. Materials and methods This matched cohort study compared def-ET strategy to fresh ET strategy between 01/10/2012 and 31/12/2014. One hundred and thirty-five endometriosis-affected women with a scheduled def-ET cycle and 424 endometriosis-affected women with a scheduled fresh ET cycle were eligible for matching. Matching criteria were: age, number of prior ART cycles, and endometriosis phenotype. Statistical analyses were conducted using univariable and multivariable logistic regression models. Results 135 in the fresh ET group and 135 in the def-ET group were included in the analysis. The cumulative clinical pregnancy rate was significantly increased in the def-ET group compared to the fresh ET group [58 (43%) vs. 40 (29.6%), p = 0.047]. The cumulative ongoing pregnancy rate was 34.8% (n = 47) and 17.8% (n = 24) respectively in the Def-ET and the fresh-ET groups (p = 0.005). After multivariable conditional logistic regression analysis, Def-ET was associated with a significant increase in the cumulative ongoing pregnancy rate as compared to fresh ET (OR = 1.76, CI95% 1.06–2.92, p = 0.028). Conclusion Def-ET in endometriosis-affected women was associated with significantly higher cumulative ongoing pregnancy rates. Our preliminary results suggest that Def-ET for endometriosis-affected women is an attractive option that could increase their ART success rates. Future studies, with a randomized design, should be conducted to further confirm those results.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Chloé Maignien
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Vanessa Gayet
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Khaled Pocate-Cheriet
- Department of Histology-Embryology and Reproductive Biology, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Louis Marcellin
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|