Institute Of Medecine Of La Reproduction

Saint-Sauveur-en-Rue, France

Institute Of Medecine Of La Reproduction

Saint-Sauveur-en-Rue, France
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Quarello E.,Unite dEchographies Obstetricales et de Diagnostic Antenatal | Quarello E.,Institute Of Medecine Of La Reproduction | Lafouge A.,Cabinet de Gynecologie et Obstetrique | Fries N.,Collège de France | Salomon L.J.,University of Paris Descartes
Ultrasound in Obstetrics and Gynecology | Year: 2017

Objective: First-trimester fetal cardiac screening examinations in low-risk populations should not have to meet the specifications required for high-risk populations. Our aim was to evaluate a simplified fetal echocardiographic (‘basic heart’) examination for early detection of severe congenital heart defects in a low-risk population. Methods: This was a first-trimester national ‘flash study’, performed over a 2-week period. Each observer was requested to perform simplified echocardiography without modifying the time and methods deemed necessary for the routine first-trimester ultrasound examination, in fetuses with crown–rump length between 45 and 84 mm. This basic heart assessment used targeted cross-sections of the four-chamber view (4CV) and of the three vessels and trachea (3VT) view, using color and/or directional power Doppler. All examinations were then reviewed offline and scored for quality by a qualified expert. Results: Sixty observers performed a total of 597 first-trimester ultrasound examinations, each performing an average of 10 (range, 1–26) procedures. Examinations were conducted transabdominally (79%; 472/597), transvaginally (3%; 17/597) or both (18%; 108/597). In 8% (45/597) of cases, the fetal back was anterior, in 18% (108/597) it was on the left side, in 63% (377/597) it was posterior and in 11% (67/597) it was on the right side. It became clear during scoring by the expert that, unlike the Herman quality score for nuchal translucency measurement, it was difficult to assess the quality of these images without taking into account normality of the heart itself. Analysis of scores showed that the 4CV was obtained successfully and was deemed normal in 86% (512/597) of the patients, in 7% (41/597) it was deemed technically infeasible and in 7% (44/597) it was deemed feasible but atypical, which may have been due to the presence of an abnormality or to poor quality of the image. The 3VT view was obtained successfully and was normal in 79% (472/597) of the patients, in 13% (78/597) it was technically infeasible and in 8% (47/597) it was deemed feasible but atypical. Both the 4CV and the 3VT view were obtained successfully and were normal in 73% (435/597) of patients. Conclusion: It is possible for a trained operator to perform simplified fetal echocardiography during the routine first-trimester ultrasound examination in a low-risk population. In most cases, our basic heart examination can be used to reassure parents or identify potential problems to be clarified as early as possible in the second trimester. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Porcu G.,Institute Of Medecine Of La Reproduction | Lehert P.,University of Mons | Lehert P.,University of Melbourne | Colella C.,Merck Serono s.a.s. | Giorgetti C.,Institute Of Medecine Of La Reproduction
Reproductive Biology and Endocrinology | Year: 2013

Background: Women having experienced several consecutive failing IVF cycles constitute a critical and particular subset of patients, for which growing perception of irremediable failure, increasing costs and IVF treatment related risks necessitate appropriate decision making when starting or not a new cycle. Predicting chances of LB might constitute a useful tool for discussion between the patient and the clinician. Our essential objective was to dispose of a simple and accurate prediction model for use in routine medical practice. The currently available predictive models applicable to general populations cannot be considered as accurate enough for this purpose.Methods: Patients with at least four consecutive Failing cycles (CFCs) were selected. We constructed a predictive model of LB occurrence during the last cycle, by using a stepwise logistic regression, using all the baseline patient characteristics and intermediate stage variables during the four first cycles.Results: On as set of 151 patients, we identified five determinant predictors: the number of previous cycles with at least one gestational sac (NGS), the mean number of good-quality embryos, age, male infertility (MI) aetiology and basal FSH. Our model was characterized by a much higher discrimination as the existing models (C-statistics=0.76), and an excellent calibration.Conclusions: Couples having experienced multiple IVF failures need precise and appropriate information to decide to resume or interrupt their fertility project. Our essential objective was to dispose of a simple and accurate prediction model to allow a routine practice use. Our model is adapted to this purpose: It is very simple, combines five easily collected variables in a short calculation; it is more accurate than existing models, with a fair discrimination and a well calibrated prediction. © 2013 Porcu et al.; licensee BioMed Central Ltd.

Quarello E.,Unite Dechographie de Diagnostic Prenatal | Quarello E.,Institute Of Medecine Of La Reproduction | Quarello E.,Center Europeen Of Recherche En Imagerie Medicale Cerimed | Lacoste R.,French National Center for Scientific Research | And 3 more authors.
Gynecologie Obstetrique Fertilite | Year: 2015

Objectives. - To evaluate tissue characteristics of the placenta by transabdominal ShearWave Elastography in pregnant baboon. Materials and method. - For 9 months (03/2013-12/2013) two operators (EQ, GG) performed ultrasound of the placenta during pregnancy pregnant baboons station partner primatology project. The identification of the placenta was performed previously in 2D ultrasound. The elastography method was then activated. Three measurements were carried out by operator for each placenta. The intraclass correlation coefficients within and between observers were calculated for the objective assessment (elastography) of placental maturity. Results. - During the study period, 21 pregnant baboons were included and ultrasounds were performed between 1 and 3 times each. The measurements have been carried out by two operators in 100% of cases. The intra- and inter-observer ICC for single values are respectively 0.657 - 95% CI (0.548 to 0.752) and 0.458 - 95% CI (0.167 to 0.675). The intra- and inter-observer ICC for average values are respectively 0.852 - 95% CI (0.784 to 0.901) and 0.628 - 95% CI (0.286 to 0.806). Conclusion. - The study by transabdominal ShearWave Elastography of placenta's pregnant baboons is possible. The intra- and inter-operator reproducibility of this method is good using the average of three measurements. The objective study via elastography ShearWave of the degree of placental maturity seems not yet be used in clinical practice. Studies of larger cohorts are needed. © 2015 Elsevier Masson SAS.

Quarello E.,Service de Gynecologie Obstetrique | Quarello E.,Institute Of Medecine Of La Reproduction | Stos B.,Center Chirurgical Marie Lannelongue | Fermont L.,Institute Of Puericulture
Gynecologie Obstetrique Fertilite | Year: 2011

Coarctations of the aorta can be associated with severe neonatal consequences. Screening for and diagnosis of this prenatal malformation remain difficult. We review the various tools currently available to us, and their respective limits, to minimize the rate of false negatives and false positives associated with prenatal screening for this situation. © 2011 Publié par Elsevier Masson SAS.

Courbiere B.,Obstetrics | Courbiere B.,Aix - Marseille University | Courbiere B.,French National Center for Scientific Research | Decanter C.,Lille University Hospital Center | And 12 more authors.
Human Reproduction | Year: 2013

STUDY QUESTIONWhat are the outcomes of French emergency IVF procedures involving embryo freezing for fertility preservation before gonadotoxic treatment?SUMMARY ANSWERPregnancy rates after emergency IVF, cryopreservation of embryos, storage, thawing and embryo transfer (embryo transfer), in the specific context of the preservation of female fertility, seem to be similar to those reported for infertile couples undergoing ART.STUDY DESIGN, SIZE, DURATIONA French retrospective multicentre cohort study initiated by the GRECOT network - the French Study Group for Ovarian and Testicular Cryopreservation. We sent an e-mail survey to the 97 French centres performing the assisted reproduction technique in 2011, asking whether the centre performed emergency IVF and requesting information about the patients' characteristics, indications, IVF cycles and laboratory and follow-up data. The response rate was 53.6% (52/97).PARTICIPANTS/MATERIALS, SETTING, METHODSFourteen French centres reported that they performed emergency IVF (56 cycles in total) before gonadotoxic treatment, between 1999 and July 2011, in 52 patients.MAIN RESULTS AND THE ROLE OF CHANCEThe patients had a mean age of 28.9 ± 4.3 years, and a median length of relationship of 3 years (1 month-15 years). Emergency IVF was indicated for haematological cancer (42%), brain tumour (23%), sarcoma (3.8%), mesothelioma (n = 1) and bowel cancer (n = 1). Gynaecological problems accounted for 17% of indications. In 7.7% of cases, emergency IVF was performed for autoimmune diseases. Among the 52 patients concerned, 28% (n = 14) had undergone previous courses of chemotherapy before beginning controlled ovarian stimulation (COS). The initiation of gonadotoxic treatment had to be delayed in 34% of the patients (n = 19). In total, 56 cycles were initiated. The mean duration of stimulation was 11.2 ± 2.5 days, with a mean peak estradiol concentration on the day on which ovulation was triggered of 1640 ± 1028 pg/ml. Three cycles were cancelled due to ovarian hyperstimulation syndrome (n = 1), poor response (n = 1) and treatment error (n = 1). A mean of 8.2 ± 4.8 oocytes were retrieved, with 6.1 ± 4.2 mature oocytes and 4.4 ± 3.3 pronuclear-stage embryos per cycle. The mean number of embryos frozen per cycle was 4.2 ± 3.1. During follow-up, three patients died from the consequences of their disease. For the 49 surviving patients, 22.5% of the couples concerned (n = 11) requested embryo replacement. A total of 33 embryos were thawed with a post-thawing survival rate of 76%. Embryo replacement was finally performed for 10 couples with a total of 25 embryos transferred, leading to one biochemical pregnancy, one miscarriage and three live births. Clinical pregnancy rate and live birth per couple who wanted a pregnancy after cancer were, respectively, 36% (95% CI = 10.9-69.2%) and 27% (95% CI = 6.0-61%).LIMITATIONS, REASONS FOR CAUTIONThe overall response rate for clinics was 53.6%. Therefore, it is not only that patients may not have been included, but also that those that were included were biased towards the University sector with a response rate of 83% (25/30) for a small number of patients.WIDER IMPLICATIONS OF THE FINDINGSAccording to literature, malignant disease is a risk factor for a poor response to COS. However, patients having emergency IVF before gonadotoxic treatment have a reasonable chance of pregnancy after embryo replacement. Embryo freezing is a valuable approach that should be included among the strategies used to preserve fertility. © The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Quarello E.,Unite dEchographies Obstetricales | Quarello E.,Institute Of Medecine Of La Reproduction | Molho M.,Center Hospitalier Intercommunal Of Poissy St Germain | Garel C.,Service de Radiologie Pediatrique | And 6 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2014

Joubert syndrome and related disorders (JSRD) are characterized by absence or underdevelopment of the cerebellar vermis and a malformed brainstem. This family of disorders is a member of an emerging class of diseases called ciliopathies. We describe the abnormal features of the brain, particularly the fourth ventricle, in seven fetuses affected by JSRD. In three cases abnormality of the fourth ventricle was isolated and in four cases there were associated malformations. The molar tooth sign (MTS) was always present and visible on two-dimensional ultrasound and, when performed, on three-dimensional ultrasound and magnetic resonance imaging. The fourth ventricle was always abnormal, in both axial and sagittal views, presenting pathognomonic deformities. It is important to identify JSRD, preferably prenatally or at least postnatally, due to its high risk of recurrence of about 25%. A detailed prenatal assessment of the fourth ventricle in several views may help to achieve this goal. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

MacE P.,Unite dEchographies Obstetricales et de Diagnostic Prenatal | Quarello E.,Unite dEchographies Obstetricales et de Diagnostic Prenatal | Quarello E.,Institute Of Medecine Of La Reproduction
Gynecologie Obstetrique Fertilite | Year: 2016

The diagnosis of an abnormal fetal posterior fossa is usually done during the second trimester scan. However, some forms of open spina bifida with Arnold-Chiari malformation can be detected from the first trimester ultrasound with a precise examination of the posterior fossa and intracranial translucency. Furthermore, other abnormalities of the posterior fossa such as cystic malformations also seem to be accessible to early detection. This work detailed the possible usual and unusual aspects of the posterior fossa individualized during the first trimester ultrasound scan. Identifying an unusual appearance may identify high-risk fetus to present an abnormality of the posterior fossa. Then, thorough analysis of the fetal brain from 18weeks will often differentiate a normal variant of a real brain malformation. © 2015 Elsevier Masson SAS.

PubMed | Center for Prenatal Diagnosis and Human Genetics, Institute Of Medecine Of La Reproduction and Center dechographies Ambroise Pare
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2014

Congenital heart disease (CG) are mostly from a low-risk population. Their screening should be based on reproducible and easy to use methods. Prenatal echocardiographic analysis is based primarily on the analysis of the four chambers and great vessels. The study of general admission pathways generalized since the 1980s is performed on an axial section while that of great vessels is performed in most countries more recently using several views and remains difficult. We review the features, under normal circumstances, of the three-vessel and tracheal view that allows via an axial section of the fetal thorax to assess at the same time the trunk of the main pulmonary artery and its branches, the convergence of the ductus arteriosus and the aortic arches, the superior vena cava, and the trachea. Furthermore, the use of color Doppler mode optimizes the information obtained by this view.

PubMed | BVBA and Institute Of Medecine Of La Reproduction
Type: Journal Article | Journal: Gynecologie, obstetrique & fertilite | Year: 2015

Pentoxifylline has been used to improve sperm motility in Assisted Reproductive Technology mainly by initiating sperm motility in immotile spermatozoa samples obtained surgically. Indeed, as Intracytoplasmic Sperm Injection leads to very poor results when using immotile gametes, pentoxifylline gives better results by easing the selection of viable sperm mobilized after incubation. In 2011, the French Haute Autorit de sant decided that pentoxifylline used for in vivo purpose proposed Insufficient Medical Service and pentoxifylline was thus withdrawn from the French materia medica. We here assessed the efficacy on spermatozoa motility and the safety of papaverine, another phosphodiesterase inhibitor, for the replacement of pentoxifylline.Sixteen frozen-thawed epididymal or testicular samples displaying no or very poor spontaneous motility (5% total motility) were subjected to both pentoxifylline (3.6mM) and papaverine (93M). A duplicate Mouse Embryo Assay and an In Vitro Fertilization Mouse Assay in duplo were used to discard any toxic effect of papaverine.Papaverine gave better results than pentoxifylline (mean total motility: 27% vs 23%, P<0.05). No Effect Level were observed in the two different Mouse Embryo Assays performed.Papaverine is a useful tool to replace pentoxifylline in ICSI programs to select viable spermatozoa in frozen-thawed sperm samples displaying no or very poor motility.

Quarello E.,Unite dEchographies Obstetricales | Quarello E.,Institute Of Medecine Of La Reproduction | Saada J.,University Paris - Sud | Desbriere R.,Unite dEchographies Obstetricales | And 2 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2011

The prenatal diagnosis of esophageal atresia is challenging. The length of the defect of the esophageal atretic portion is one of the parameters affecting outcome and prenatal evaluation of this length has not, to our knowledge, been described previously. We report on seven fetuses assessed prospectively which were suspected to have esophageal atresia. Targeted ultrasound examination of both fetal cervical and thoracic structures was performed in each case in order to assess prenatally the atretic portion. The length of the defect was assessed both directly, by visualizing the interruption of the hyperechoic lines representing the walls of the esophagus in a mid-sagittal view (n = 4), and indirectly, by means of the 'tracheal print' (n = 5). Both methods were used in three cases. Prenatal results were compared with postnatal or postmortem findings. The prenatal diagnosis of esophageal atresia was made correctly in six of the seven cases and in all of these there was concordance between prenatal and postnatal estimates of the esophageal defect lengths. Direct or indirect sonographic assessment of the esophagus in cases of suspected prenatal esophageal atresia improves the specificity of its diagnosis and aids prenatal evaluation. © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

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