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Onset of malignancy during pregnancy is distressing for the future parents and raises thorny problems for the oncologist and obstetric gynecologist. Many diagnostic and therapeutic approaches cannot be used. Some first-line reference treatments are known to cause fetal loss or severe birth defects, yet any delay in treatment may unacceptably worsen the maternal prognosis. In the absence of large randomized trials and cohort studies, it is difficult to know how best to manage these patients. An estimated one in ten thousand pregnancies are associated with malignancies, especially gynecologic tumors (cervix, breast, ovary), lymphomas, melanomas, brain tumors and leukemia. The obstetrician, in close collaboration with the oncologist, has a major role in choosing the most appropriate diagnostic and therapeutic strategy, and must keep the couple fully informed. Importantly, improvements in cancer cure rates and the development of conservative treatments mean that many of these young women can hope to start a new pregnancy after their treatment. The optimal interval between cure and conception must be carefully weighed up by a multidisciplinary team including oncologists and obstetric gynecologists. Chemotherapy, pelvic radiation therapy, and gynecologic surgery can impact not only on fertility but also on the course of a next pregnancy (increased risk of miscarriage and premature delivery, etc.). The obstetrician must take these risks into account.

Gradient-echo MR imaging (MRI) was evaluated for the diagnosis of ovarian mature cystic teratomas (MCTs). The FLASH technique was applied to T1-weighted images with and without fat suppression in 18 surgical operated patients with 19 MCTs, and findings were compared to those of conventional spin-echo (SE) T1-weighted-SE. Seventeen out of 19 MCTs were correctly diagnosed using FLASH and SE T1-weighted MR images with and without fat saturation. This study suggests that gradient-echo MRI can replace conventional SE T1-weighted MRI for the diagnosis of ovarian MCTs.

Introduction Women undergoing assisted reproductive techniques (ART) are given gonadotrophins to promote the development of multiple follicles within their ovaries. This treatment may be associated with a risk of ovarian hyperstimulation syndrome and venous or arterial thrombosis. The association of clinical and biological criteria of hypercoagulability might contribute to the identification of patients at risk and probably could predict success of ART. The aim of this study was to evaluate thrombin generation, thrombomodulin activity, tissue factor (TF) activity, and procoagulant phospholipids in selected women undergoing ART. We also assessed the potential correlation between the levels of the studied biomarkers and the outcome of the ART. Material and Method A cohort of 27 infertile women eligible for ART and 30 healthy age matched women was studied. All patients were Caucasian aged 33.75 ± 3.52 years and weight 61.08 ± 8.10 kg. Women included in the study did not present any personal or family history of VTE or known thrombophilia. They did not present any signs of hemorrhagic syndrome and did not suffer from any known autoimmune disease. Blood samples were taken under fasting conditions at the following time-points: at the inclusion (T0), between the 5th and 8th day of ovarian stimulation with gonadotrophines (T1) and at the day of HCG administration (T2). Thrombin generation (TG) in plasma was assessed using the Calibrated Automated Thrombogram assay (using, PPP-Reagent-5pM TF from Diagnostica Stago, France), Plasma levels of thrombomodulin activity (TMa), and TF activity (TFa) were measured by home-made tests, Procoagulant phospholipids (PPL) dependent clotting time was measured using a factor Xa-based assay (STA-R Procoag-PPL, Diagnostica Stago, France). Results The endogenous thrombin potential (ETP), PPL, TMa and TFa were significantly higher in the ART-T0 group as compared to the control group. At ART-T2 a significant increase of TG was observed as compared to ART-T0. At ART-T0 44.5%, 44.4 % and 33.3 % of women had ETP, TFa and TMa higher than the Upper Normal Limit respectively (UNL = mean+2 S.D.). Among with negative ART 89% and 91.7% showed TMa and TFa levels > UNL at ART-T0. At T1 50% of women had a least one parameter of TG higher than the UNL. At ART T2 65.2 % of women had TG > UNL. At the same time, 87.5% and 83.4% of women with negative ART had levels of TMa and TFa > UNL. Conclusion This study analyzed the profile of thrombin generation in infertile women eligible for ART and investigated the influence of hormone treatment with gonadotropins and HCG on TG and levels of TMa and TFa. Hypercoagulability, in terms of increased ETP is present in 46% of infertile women eligible for ART. These women remain in a hypercoagulable state throughout the entire period of hormone treatment. The most significant finding of this study was that 33% of patients show a value superior to the UNL for thrombomodulin and 45% for tissue factor. Interestingly 89%of women with negative ART had TMa higher than the UNL. Respectively 91% of women with negative ART had TFa levels higher than the UNL Disclosures: No relevant conflicts of interest to declare.

The maturation of the preovulatory human follicle larger than 16 mm is described between 0 and 36 hours after human chorionic gonadotropin (hCG) administration. The nuclear evolution of the oocyte is timed: prophase at 14 hours, germinal vesicle breakdown at 15 hours, metaphase I at 20 hours; metaphase II is complete by 35 hours. The quantified expansion of the cumulus is related to nuclear evolution. Almost complete expansion may already be observed 18 hours before ovulation (20 hours after hCG). The specific action of clomiphene citrate, human menopausal gonadotropin, and hCG stimulation on the granulosa induces a more rapid luteinization than is found after other means of stimulation or in spontaneous cycles. Oocytes from follicles less than or equal to 16 mm on preovulatory ovaries often show a reaction to hCG that may be related to their subsequent quality.

After ovarian stimulation with clomiphene citrate combined with human menopausal gonadotropin, 24 large (greater than 16 mm) and 16 medium (7 to 15 mm) human follicles were classified according to plasmatic estradiol (E2), luteinizing hormone (LH), and histology of the follicle and oocytes (in thin sections). An asynchronism of several hours between the stage of development of the largest and large cohort follicles is observed; overripeness of oocyte cumulus complex (OCC) is revealed. An asynchronous response to gonadotropins in granulosa and cumulus is also seen in the cohort of medium follicles of the same ovary, but not resumption of nuclear maturation of the oocyte. The efficiency of these oocytes after fertilization is discussed.

Du protoplasma végétal