Dewailly D.,Hopital Jeanne de Flandre |
Dewailly D.,Lille University of Science and Technology |
Pigny P.,Lille University Hospital Center |
Soudan B.,Lille University Hospital Center |
And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010
Context: It is still debated whether clinical and/or biological indices of hyperandrogenism (HA) should be present to qualify a patient as having polycystic ovary syndrome (PCOS). We hypothesized that excessive follicle number (FN) assessed by ovarian ultrasonography and/or serum anti-Müllerian hormone (AMH) concentrations may be used as surrogates for the classical markers of HA. Design and Methods: Data were obtained from a database of clinical, hormonal, and ultrasound features that were consecutively recorded in 270 women with PCOS (defined using the Rotterdam Criteria) and 217 infertile nonhyperandrogenic normoovulatory women. These variables were submitted to principal component analysis, a multivariable statistical procedure that transforms a number of possibly correlated variables into a smaller number of uncorrelated variables called principal components (PC). Variables that aggregate in the same PC capture the same information. Results: In the control group, as expected, three independent PCs were identified: 1) the markers of the metabolic (i.e. insulin resistance) status; 2) those of the androgen status; and 3) those of the follicle status. In the PCOS group, the metabolic variables also aggregated in a first PC. Ovarian androgen and follicle markers aggregated in a second independent PC, with FN and serum AMH having the strongest correlation coefficients. A third PC summarized the adrenal contribution to the HA of PCOS. In both groups, the free androgen index correlated equally to the first and second PCs. Conclusions: The similarity of the first PC between controls and PCOS supports the hypothesis that the metabolic anomaly of PCOS is neither intrinsic nor specific. Conversely, by gathering the androgen and follicle variables, the second PC in PCOS may be viewed as summarizing a specific ovarian anomaly. Because both FN and/or serum AMH were strongly correlated to the second PC along with androgens, they may be used equally as surrogates for the classical markers of ovarian HA. This reconciles the Rotterdam Consensus and other definitions for PCOS, especially in women having the Rotterdam PCOS phenotype without HA. We thus propose a simple strategy for the diagnosis of PCOS in clinical practice. Copyright © 2010 by The Endocrine Society.
De Landsheere L.,Hopital Jeanne de Flandre |
Ismail S.,Hopital Jeanne de Flandre |
Ismail S.,Royal Sussex County Hospital |
Lucot J.-P.,Hopital Jeanne de Flandre |
And 3 more authors.
American Journal of Obstetrics and Gynecology | Year: 2012
The aim of this study was to explore the nature and rate of surgical intervention after transvaginal Prolift mesh repair for pelvic organ prolapse. This was a retrospective study of all patients who underwent Prolift mesh repair between January 2005 and January 2009. Patient data were obtained from medical records, and patients were telephoned to check if they had surgery in other hospitals. A total of 600 consecutive patients were identified. Of these, 524 patients (87.3%) were included in the study, with a median follow-up duration of 38 months (range, 1563). Global reoperation rate was 11.6%. Indications of intervention were surgery for urinary incontinence (6.9%), mesh-related complications (3.6%), or prolapse recurrence (3%). The global reoperation rate after transvaginal Prolift mesh repair was 11.6%, with urinary incontinence surgery being the most common indication. Rates of mesh complications and prolapse recurrence are relatively low in an experienced team.
Escobar-Morreale H.F.,University of Alcalá |
Carmina E.,University of Palermo |
Dewailly D.,Hopital Jeanne de Flandre |
Gambineri A.,University of Bologna |
And 7 more authors.
Human Reproduction Update | Year: 2012
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.
Boulvain M.,University of Geneva |
Senat M.-V.,University Paris - Sud |
Perrotin F.,Pole de Gynecologie Obstetrique |
Winer N.,Departement de Gynecologie Obstetrique |
And 16 more authors.
The Lancet | Year: 2015
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.
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 | Year: 2010
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.
Wittmeyer V.,Hopital Jeanne de Flandre |
Merrot T.,Marseille University Hospital Center |
Mazet B.,French National Center for Scientific Research
Neurogastroenterology and Motility | Year: 2010
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.
Dewailly D.,Hopital Jeanne de Flandre |
Contestin M.,Hopital Jeanne de Flandre |
Gallo C.,Hopital Jeanne de Flandre |
Catteau-Jonard S.,Hopital Jeanne de Flandre
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010
Objective To verify whether the adult threshold for an abnormally decreased high-density lipoprotein cholesterol (HDL-C) serum level (0.5 g/l) is appropriate in young women with polycystic ovary syndrome (PCOS). Design Retrospective analysis of a database. Setting Academic Hospital. Population A total of 854 women aged 16-40 years having PCOS according to Rotterdam criteria. Methods Criteria defining the metabolic syndrome (MetS) (increased waist circumference, systolic and/or diastolic blood pressure, triglycerides, fasting glycaemia and decreased HDL-C) were separately analysed and compared in three different subgroups (16-20 years, 20-30 years and 30-40 years). The prevalence of the MetS was calculated using two different thresholds (0.5 and 0.4 g/l) for HDL-C in the 16-20 years group. Main outcomes measures Prevalence of MetS. Results The prevalence of an abnormal HDL-C (<0.5 g/l) was higher in the youngest women (60%), whereas frequencies of abnormal waist circumference, systolic and/or diastolic blood pressure, triglycerides and fasting glycaemia were lower than in the two other groups. The prevalence of an abnormal HDL-C dropped to 27% when using a threshold of 0.4 g/l in the 16-20 years subgroup. The prevalence of the MetS in the 16-20 years subgroup was 11%, whatever the threshold, because HDL-C was <0.4 g/l in all women once they scored 3 or more. Conclusions The adult threshold for HDL-C overestimates the prevalence of abnormal HDL-C in young women with PCOS. Until normative data about HDL-C in adult women under 20 years is available, we suggest using a threshold of 0.4 g/l or ignoring this criterion. © 2009 RCOG BJOG An International Journal of Obstetrics and Gynaecology.
Collier F.,Hopital Jeanne de Flandre
Sexologies | Year: 2010
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.
Desforges-Bullet V.,Hopital Jeanne de Flandre |
Gallo C.,Hopital Jeanne de Flandre |
Lefebvre C.,Hopital Jeanne de Flandre |
Pigny P.,Lille University of Science and Technology |
And 2 more authors.
Fertility and Sterility | Year: 2010
Objective: To confirm the increased levels of anti-Müllerian hormone (AMH) in preovulatory follicles from patients with polycystic ovary syndrome (PCOS) and to study the role of other hormones involved in folliculogenesis in this increased secretion. Design: Prospective study. Setting: University hospital in France. Patient(s): Twenty-two patients with PCOS and 20 controls undergoing IVF. Intervention: On the day of oocyte retrieval, follicular fluid (FF) from one small follicle (8-13 mm) (SF) and one large follicle (16-23 mm) (LF) was collected in each patient. Main Outcome Measure(s): Per-follicle AMH, FSH, estradiol, androstenedione, hCG, and progesterone levels, and pregnancy rate. Result(s): In FF from both SF and LF of PCOS patients, AMH level was significantly increased, and FSH level was significantly decreased when compared with controls. Both hormone levels were negatively and significantly related in controls but not in PCOS. The AMH levels from SF and LF were significantly lower in patients who began a pregnancy. Conclusion(s): Our findings suggest that the granulosa cells from polycystic ovaries continue to produce elevated levels of AMH, possibly because of impaired access of FSH to follicles. Such an excess in FF AMH may have harmful consequences on oocyte quality and final maturation through unknown mechanisms. © 2010 American Society for Reproductive Medicine.
Peigne M.,Hopital Jeanne de Flandre |
Decanter C.,Hopital Jeanne de Flandre
Reproductive Biology and Endocrinology | Year: 2014
Anti-Müllerian hormone (AMH) is a very sensitive indicator of the ovarian follicular content. Chemotherapeutic agents are notoriously ovariotoxic in that they damage follicles. The aim of this systematic review was to investigate the interest of serum AMH variations in determining the acute and long-term effects of chemotherapy on the ovarian reserve. According to the PRISMA guidelines, searches were conducted on PubMed for all English language articles until December 2013. Fifteen articles that focused on dynamic variations of AMH levels before and after chemotherapy were selected. Cancer patients have significantly lower AMH after chemotherapy than age-matched controls. Longitudinal studies of AMH variations before, during and after chemotherapy provide information about the degree of follicle loss for each patient according to different chemotherapy regimens. Different patterns of AMH levels during the ovarian recovery phase make it possible to discriminate between high and low gonadotoxic chemotherapy protocols. In addition, pretreatment AMH levels are shown to predict the long-term ovarian function after the end of treatment. These results may help to better understand the ovarian toxicity mechanisms of chemotherapy and to predict the degree of the ovarian follicle loss. Therefore, it can be useful for fertility preservation strategies, fertility counseling and future family planning. © 2014 Peigné and Decanter; licensee BioMed Central Ltd.