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Le Touquet – Paris-Plage, France

Dessolle L.,University of Nantes | Freour T.,University of Nantes | Barrire P.,University of Nantes | Darai E.,Service de gynecologie obstetrique et medecine de la reproduction | And 3 more authors.
Human Reproduction | Year: 2010

Background: Extended culture for blastocyst transfer is thought to result in embryos with high implantation potential, enabling the transfer of fewer embryos and the reduction of multiple pregnancies after in vitro fertilization (IVF). However, one major drawback of extended culture is the risk of transfer cancellation if no blastocyst develops by Day 5, despite the observation of adequate early embryo development. We set out to develop a model to predict blastocyst transfer cancellation. Methods: The model was built from 562 consecutive first IVF cycles and tested on an independent validation cohort. Multivariable logistic regression analysis was used to test the association of patient and cycle characteristics with the presence of cultured blastocysts on Day 5 and to create a nomogram. The model's performance was quantified by discrimination and calibration and clinical utility was evaluated for various thresholds. Results: Fertilization technique, number and quality ratio of the Day 3 embryos and female age were independently associated with blastocyst development. The final prediction model showed an area under the curve (AUC) of 0.75 in the training set (95 confidence interval (CI): 0.73-0.77) and was well calibrated. The AUC for the validation data set was 0.80 (95 CI: 0.78-0.83) and calibration was acceptable. Using a decision threshold of 0.55, the model showed a negative predictive value of 80.5 and a false positive rate of 17. Conclusion: A cycle-based model could prove clinically-relevant for reducing the incidence of cancelled Day 5 transfers. Source


Dessolle L.,Nantes University Hospital Center | Freour T.,Nantes University Hospital Center | Ravel C.,Service dHistologie et Biologie de la Reproduction | Jean M.,Nantes University Hospital Center | And 3 more authors.
Human Reproduction | Year: 2011

Background: Blastocyst culture and elective single embryo transfer programmes are increasingly used to reduce multiple pregnancies after IVF. To optimize the Results, there is a need to better select embryos, to implement efficient cryopreservation programmes and to refine selection criteria. In the present study, we set out to identify relevant clinical predictors of healthy term birth (HTB) after single blastocyst transfer (SBT).MethodsDesign: analysis of prospectively collected database. Setting: University IVF centre in Nantes, France. In 872 infertile women undergoing their first IVF cycle with SBT between January 2007 and December 2008, multivariable analysis and logistic regression were used to identify predictive factors of HTB, i.e. delivery of a live born term singleton of <2500 g, surviving at least 28 days with no reported congenital anomaly.ResultsOf 304 deliveries, there were 16 twin pairs (5.5) and no high order deliveries. The rate of HTB was 266/872 (30.5). Univariate analysis showed that the probability of HTB was significantly higher in women under 35 years [odds ratio (OR):1.75, 0.95 confidence interval (CI): 1.22.5, P 0.001], in women with a BMI < 30 kg/m 2 (OR: 3.0, 0.95 CI: 1.55.9, P 0.001), in non-smoking women (OR: 2.2, 0.95 CI: 1.53.2, P< 0.0001), and after Day 5 compared with after Day 6 transfer (OR: 2.65, 0.95 CI: 1.83.8, P< 0.0001). Multivariable analysis showed that BMI, smoking and day of embryo transfer were independent predictors of HTB, regardless of female age. Conclusions After SBT, female obesity and smoking reduce the chance of HTB, independent of female age. Day 6 transfer should be avoided. © 2011 The Author. Source


Sermondade N.,Service dHistologie et Biologie de la Reproduction | Sermondade N.,University Pierre and Marie Curie | Elloumi H.,Service dHistologie et Biologie de la Reproduction | Elloumi H.,University Pierre and Marie Curie | And 9 more authors.
Reproductive BioMedicine Online | Year: 2010

This is a report of a 6-year follow-up of a male patient's semen parameters during heavy chronic alcohol intoxication and after withdrawal. A slowly progressive negative impact of alcohol could be observed: isolated moderate teratozoospermia was firstly noted followed by oligoasthenoteratospermia. Then a severe worsening resulted in cryptozoospermia and ultimately in azoospermia. At this moment, the histological analysis of a testicular biopsy revealed a maturation arrest of the germinal cells at the pachytene stage with no mature sperm cells. Alcohol withdrawal was then obtained, allowing a very fast and drastic improvement of semen characteristics; strictly normal semen parameters were observed after no more than 3 months. Taking into consideration these data, patients should be questioned about their alcohol intake before assisted reproductive technology and should be informed about this adverse effect. Moreover, this case report emphasizes how quickly benefits can be obtained after withdrawal, even in the case of heavy chronic alcohol intake. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. Source


Sermondade N.,Service dHistologie et Biologie de la Reproduction | Sermondade N.,University Pierre and Marie Curie | Delarouzire V.,Service dHistologie et Biologie de la Reproduction | Delarouzire V.,University Pierre and Marie Curie | And 9 more authors.
Reproductive BioMedicine Online | Year: 2012

Some patients in IVF programmes repeatedly display an abnormal embryonic development characterized as soon as day 2 post fertilization by a high rate (>60%) of highly fragmented embryos (≥40% of cytoplasmic fragments) leading to recurrent IVF failures. This study postulated that, for various maternal reasons, some embryos were unable to withstand the in-vitro environment and an early pronucleate-stage transfer was proposed to these couples. Fifty-three patients with recurrent IVF failures (a mean of 2.8 ± 1.0 previous attempts) characterized by low embryonic quality (a mean of 62.7% of the embryos with extended fragmentation) were included this transfer protocol. As in previous cycles, the mean number of oocytes retrieved and the fertilization rate were normal. The mean number of zygotes per transfer was 2.24. Fourteen clinical pregnancies were obtained, representing a pregnancy rate and a delivery rate per oocyte retrieval of 26.4% and 18.9%, respectively. Recurrent heavy and early embryo fragmentation in vitro characterizes around 3% of IVF couples and leads to lack of transfer or implantation failure. These data on fresh zygote transfers are encouraging and may provide a valid alternative solution for some of these patients. Some patients in IVF programmes repeatedly display an abnormal embryonic development characterized as soon as day 2 post fertilization by a high rate of highly fragmented embryos, leading to recurrent IVF failures. We hypothesized that, for various reasons, some embryos were unable to withstand the in-vitro environment and an early pronucleate stage transfer was proposed to these couples. Fifty-three patients with recurrent IVF failures characterized by low embryonic quality were included in this transfer protocol. As in previous cycles, the mean number of oocytes retrieved and the fertilization rate were normal. The mean number of zygotes per transfer was 2.24. Fourteen clinical pregnancies were obtained, representing a pregnancy rate and a delivery rate per oocyte retrieval of 26.4% and 18.9%, respectively. Recurrent early and heavy embryo fragmentation in vitro characterizes around 3% of IVF couples and leads to lack of transfer or implantation failure. Our data on fresh zygote transfers are encouraging and may provide a valid alternative solution for these patients. © 2012, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved. Source

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