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Saint-André-lez-Lille, France

Collier F.,Hopital Jeanne de Flandre

Objectives: To review the knowledge we have on changes that take place in a couple's sex-life when the desired pregnancy does not take place immediately, and fertility treatment is prescribed. Method: A review of recent literature was conducted, and compared to observations usually made on the subject, in addition to those of the author, a gynaecologist and sexologist, in charge of a medically-assisted reproduction (MAR) centre for 15 years. Results and discussion: Having a baby is still one of the most effective ways of feeling completely fulfilled from a human point of view, and few couples decide to forgo this experience. Once the decision has been taken, the desire to conceive can become extremely strong, and the consequences if it does not happen straight away can lead to a serious emotional crisis. The stronger the desire, the greater the frustration, materially, professionally and in the couple's relationship. It is clear that, in the middle of such turmoil, it cannot be easy to avoid sexual consequences, and manage to preserve an arousing and erotic environment, and avoid focusing one's sexuality on frantic activity in the middle of the ovulation cycle. And after all the efforts, if the couple does prove to be infertile, how easy is it to recover a mutually appealing sexual balance? Conclusion: Better cooperation between practitioners specializing in reproduction and the other parties involved in sexology and sexual health would certainly help these couples preserve a better quality of sexual life and quality of life in general, and probably also improve the quality and the results of infertility treatment. © 2010. Source

Escobar-Morreale H.F.,University of Alcala | Carmina E.,University of Palermo | Dewailly D.,Hopital Jeanne de Flandre | Gambineri A.,University of Bologna | And 7 more authors.
Human Reproduction Update

Background: Hirsutism, defined by the presence of excessive terminal hair in androgen-sensitive areas of the female body, is one of the most common disorders in women during reproductive age. Methods: We conducted a systematic review and critical assessment of the available evidence pertaining to the epidemiology, pathophysiology, diagnosis and management of hirsutism. Results: The prevalence of hirsutism is ~10% in most populations, with the important exception of Far-East Asian women who present hirsutism less frequently. Although usually caused by relatively benign functional conditions, with the polycystic ovary syndrome leading the list of the most frequent etiologies, hirsutism may be the presenting symptom of a life-threatening tumor requiring immediate intervention. Conclusions: Following evidence-based diagnostic and treatment strategies that address not only the amelioration of hirsutism but also the treatment of the underlying etiology is essential for the proper management of affected women, especially considering that hirsutism is, in most cases, a chronic disorder needing long-term follow-up. Accordingly, we provide evidence-based guidelines for the etiological diagnosis and for the management of this frequent medical complaint. © The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. Source

Wittmeyer V.,Hopital Jeanne de Flandre | Merrot T.,Marseille University Hospital Center | Mazet B.,French National Center for Scientific Research
Neurogastroenterology and Motility

Background Gastrointestinal motility is dependent on neural influences that largely involve the enteric nervous system (ENS). The main motor patterns that occur in the fasted and fed state are noticeably different in children compared with adults. Although the development of the ENS continues after birth, there is no data on the contractile activity of segments of small intestine from young children. This study was designed to provide data on the development of muscle control by the human ENS with particular attention to acetylcholine (ACh) and nitric oxide (NO) as the primary neurotransmitters of enteric motor neurons, respectively. Methods Small intestinal specimens were obtained from 11 children and six adults undergoing surgery for various diseases. The mechanical activity of the circular muscle was recorded in vitro. The effects of N-nitro-L-arginine methyl ester hydrochloride, an inhibitor of NO synthesis, and of atropine, an antagonist of muscarinic receptors, were tested on the spontaneous motility and responses to nerve stimulation. Key Results Spontaneous motility was observed in all preparations. Responses to nerve stimulation were identical in child and adult. No tonic cholinergic excitation of small intestinal motility was observed either in child or in adult. Inhibition of NO synthesis induced a major disinhibition of motility in child but not in adult. Conclusions & Inferences Spontaneous intestinal motility and cholinergic and nitrergic neurotransmission are present from birth. NO provides a tonic inhibition of intestinal motility only in child. Our study indicates that NO may be a major player in shaping the ontogenic development of intestinal motility in human. © 2010 Blackwell Publishing Ltd. Source

Boulvain M.,University of Geneva | Senat M.-V.,University Paris - Sud | Perrotin F.,Pole de Gynecologie obstetrique | Winer N.,Hopital Mere enfant | And 16 more authors.
The Lancet

Background Macrosomic fetuses are at increased risk of shoulder dystocia. We aimed to compare induction of labour with expectant management for large-for-date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia. Methods We did this pragmatic, randomised controlled trial between Oct 1, 2002, and Jan 1, 2009, in 19 tertiary-care centres in France, Switzerland, and Belgium. Women with singleton fetuses whose estimated weight exceeded the 95th percentile, were randomly assigned (1:1), via computer-generated permuted-block randomisation (block size of four to eight) to receive induction of labour within 3 days between 37+0 weeks and 38+6 weeks of gestation, or expectant management. Randomisation was stratified by centre. Participants and caregivers were not masked to group assignment. Our primary outcome was a composite of clinically significant shoulder dystocia, fracture of the clavicle, brachial plexus injury, intracranial haemorrhage, or death. We did analyses by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00190320. Findings We randomly assigned 409 women to the induction group and 413 women to the expectant management group, of whom 407 women and 411 women, respectively, were included in the final analysis. Mean birthweight was 3831 g (SD 324) in the induction group and 4118 g (392) in the expectant group. Induction of labour significantly reduced the risk of shoulder dystocia or associated morbidity (n=8) compared with expectant management (n=25; relative risk [RR] 0·32, 95% CI 0·15-0·71; p=0·004). We recorded no brachial plexus injuries, intracranial haemorrhages, or perinatal deaths. The likelihood of spontaneous vaginal delivery was higher in women in the induction group than in those in the expectant management group (RR 1·14, 95% CI 1·01-1·29). Caesarean delivery and neonatal morbidity did not differ significantly between the groups. Interpretation Induction of labour for suspected large-for-date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects of early-term induction of labour. Funding Assistance Publique-Hôpitaux de Paris and the University of Geneva. © 2015 Elsevier Ltd. Source

De Landsheere L.,CHR la Citadelle | Lucot J.P.,Hopital Jeanne de Flandre | Foidart J.M.,CHR la Citadelle | Cosson M.,Hopital Jeanne de Flandre
International Urogynecology Journal and Pelvic Floor Dysfunction

Introduction and hypothesis The aim of this study was to evaluate, retrospectively, the place of sub-urethral mesh readjustment when treating recurrent stress urinary incontinence (SUI) after TVT-O. Methods Between August 2006 and August 2008, eight patients had recurrent or persistent SUI. They were treated surgically by tightening the pre-implanted sling. Results Medium delay between first surgery and mesh adjustment was 6 months. One patient needed a second TVT-O for rupture of the pre-implanted mesh during adjustment. Among the seven patients who underwent a mesh readjustment, three were cured, three improved, there was one failure. Mean follow-up was 25 months. Conclusions The sub-urethral mesh readjustment is a simple and safe procedure for patients with recurrent SIU after TVT-O procedure. Success rates are high, surgery minimally invasive but long-term follow-up is needed to evaluate efficiency. © The International Urogynecological Association 2010. Source

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