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Résumé Objectif Évaluer notre politique de transfert électif d’un embryon à 48/72 h et rechercher des facteurs prédictifs de grossesse après transfert d’embryons congelés (TEC). Méthodes Étude des 289 transferts électifs d’un embryon (eSET) effectués chez une population sélectionnée au centre d’AMP du CHU de la Conception à Marseille de janvier 2005 à décembre 2011, ainsi que des 325 TEC réalisés dans cette population entre mai 2005 et décembre 2012. Résultats Les taux cumulés de grossesses débutantes/ponction (après transferts frais et TEC) ont été de 62,6 % ; 45 % des couples ont obtenu la naissance d’au moins un enfant. Pendant cette période, les taux cumulés de grossesses et d’accouchements/tentative dans la population générale sont restés stables alors que les taux d’accouchement multiple/accouchement ont nettement chuté. Le TEC électif d’un embryon a donné des résultats satisfaisants (24,6 % grossesse/TEC) seulement en l’absence de lyse ou en cas de lyse modéré (de 1 à 25 %) de l’embryon transféré. Conclusion Notre politique d’eSET donne des résultats satisfaisants, dépendant en grande partie de la qualité embryonnaire. En proposant le transfert électif à une population bien ciblée, choisie à la fois sur des critères cliniques et biologiques, une réduction nette des taux cumulés d’accouchements multiples dans notre centre a été obtenue sur cette période, sans diminution globale des taux cumulés de grossesses/tentative. La qualité embryonnaire est un facteur essentiel de succès, surtout lors de la congélation/décongélation. Le TEC électif d’un embryon devrait être envisagé uniquement si la lyse embryonnaire après décongélation n’excède pas 25 %. Objectives To evaluate our elective single embryo transfer policy performed at 48/72 h and define predictive factors of pregnancy after frozen/thawed embryo transfer. Methods Analysis of 289 elective single embryo transfers (eSET) performed in a selected population in the ART center of Marseille University Hospital from January 2005 to December 2011, as well as the 325 following frozen/thawed embryo transfers performed in this population between May 2005 and December 2012. Results Cumulative pregnancy rate/oocyte retrieval was of 62.6%; 45% of the couples obtained the birth of at least one child. During this studied period, cumulative pregnancy and delivery rates in the whole population remained stable while multiple delivery rate/delivery clearly decreased. Elective single embryo after frozen/thawed transfer gave satisfying results (24.6% pregnancy/transfer) only in the lack of lysis or in case of mild lysis (1–25%) of the transferred embryo. Conclusion The implementation of an eSET policy gives satisfying results, depending largely on embryo quality. By proposing eSET to a well-targeted population, chosen both on clinical and biological criteria, a clear reduction of cumulative multiple delivery rate/delivery was obtained in our center over this period, without any global decrease of cumulative pregnancy rate/attempt. Embryo quality is a major factor of success, especially in frozen/thawed cycles. The elective single embryo frozen/thawed transfer should be carried out only if embryo lysis after thawing does not exceed 25%. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We want to highlight the risk of infertility and failure of Assisted Reproductive Technologies due to the presence of macrocephalic spermatozoa (MS) in the sperm at rate equalling or superior to 20% in at least one semen analysis. Patients and methods: We did a retrospective analysis of 19 infertile patients presenting MS at average rate between 14.3 and 49.7%. For each patient, at least one semen analysis showed a MS rate equal or superior to 20%. We did an automated analysis of the spermatozoa surface for 13 patients and a detailed analysis of the MS morphology in 18 patients. Thirteen couples benefited of one or more IVF with or without ICSI. Results: The semen analysis shows an impairment of one or more parameter of the sperm in all patients. Three morphological aspects for MS were highlighted: MS with irregular head, MS with regular head, and MS with multiple heads, with a dominance of irregular heads. The spermatozoa surface analysis shows a significant increase of the average surface and of the standard deviation (p <0.0001). The average rate of pregnancies by transfer is decreased compared to usual rates in our laboratories (13% versus 28%). Discussion and conclusion: We want to sensitize biologist and clinical doctors to the existence of partial forms of this syndrome, which could be related to infertility with impaired sperm parameters and low pregnancy rates after FIV or ICSI. [Copyright &y& Elsevier]

Abstract: Recent mutation identification in well-known sperm defects gives proof that there are genetic causes of infertility. Familial forms and some features of the spermograms lead toward the genetic origin of these syndromes. For each syndrome, several clinical aspects and partial forms were described. In these latter, apparently normal spermatozoa coexist with those showing the phenotype of interest. Transmission electron microscopy is the better tool to characterize the specific details of each syndrome. The frequency of genetic teratozoospermia is weak, the most studied syndromes are the globozoospermia, the macrocephaly, the syndrome of decapitated spermatozoa and the dyplasia of the fibrous sheat. A mutation was identified for two from these syndromes, but the two mutations does not account for all the cases from each syndrome. The various clinical aspects observed for each syndrome suggest that either other mutations or other genes are probably involved in these spermatogenic failures. The use of spermatozoa from patients for intra cytoplasmic sperm injection (ICSI) may pose two problems: fertilization problems and genetic risk for the progeny, including chromosomic and genic risk. Except for total macrocephaly which is excluded from ICSI because of sperm chromosomal abnormalities, these syndromes are consistent with assisted fertilization, but with uncertain rates of fertilization and pregnancy. [Copyright &y& Elsevier]

Abstract: Objective. – Our aim was to analyse the results of a donor insemination program using ovarian stimulation, swim-up sperm preparation and intrauterine insemination proposed to women with a maximum age of 39. Incidence of several clinical and biological parameters on success rates was investigated. Patients and methods. – Retrospective analysis of the results of 249 cycles performed in 106 couples during a four-year period is reported. Results. – Overall pregnancy rate of 28.1% and delivery rate of 22% per cycle were achieved, with a multiple pregnancy rate of 11.4%. Most of the pregnancies (84%) were obtained before the fourth insemination. Among the different parameters studied the total number of motile sperm inseminated was found to be the most important factor for success rate: pregnancy rate per cycle reached 40.4% if more than 1.5 million progressive sperm were inseminated vs. 24.7% if they were less than 1.5 million (P <0.05). Discussion and conclusion. – In precise conditions, outcome of inseminations with donor semen can reach satisfying pregnancy rates, being a valuable help for couples suffering of long-time infertility. [Copyright &y& Elsevier]