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Most women in reproductive age diagnosed with breast cancer receive (neo)adjuvant chemotherapy. Fertility preservation is part of the standard of care for these young women. Patients and methods We report preliminary results of a prospective multicentric cohort evaluating ovarian reserve during and after chemotherapy and fertility preservation in young (≤ 38 years old) in women aged ≤ 38 years, treated for a breast cancer with (neo)adjuvant anthracyclins and taxanes based chemotherapy, between July 2011 and December 2016. Fertility preservation was offered in patients (pts) who received adjuvant chemotherapy. The median duration of follow up was 2,6 years (4 months-5,3 years). The aim of this study was to evaluate the ovarian reserve assessed by antimullerian hormone and antral follicular count. The incidence of amenorrhea (defined by absence of menses ≥ 3 months), ovarian failure (absence of menses ≥ 12 months), chemotherapy induced menopause (absence of menses ≥ 24 months) was collected. Results One hundred and thirty-two pts were included in 10 centers. Data are available for 127 pts. For 4 pts, the scheduled chemotherapy was not received. One pt withdrew her consent. Chemotherapy was neoadjuvant for 43 pts and adjuvant for the 84 others. Fifty-eight asked for fertility preservation and received ovarian stimulation (all in adjuvant setting). Median age was 32 years (23-37). Eighty pts had a previous pregnancy. Three of them remained nulliparous. Among the 77 others, 36 had 1 child, 31 had 2 children and 10 pts 3 or more children respectively. At the time of diagnosis, 90% had regular menses and 75% had a contraception. The median initial antral follicular count was 21.5 (Min 1- Max 100). The AMH level significantly decreased during chemotherapy with no secondary return to baseline value over the first 9 months after end of treatment: median of 20.9 pmol/l (0.5-223) before chemotherapy, 12,8 (0,5-120) at the second cycle of chemotherapy (C2), 3 (0,5-20) at C4, 0,5 (0,5-4,4) at C6, 0,5 (0,5-25,1) 3 months after the end of chemotherapy (M3), 0,6 (0,5-29) at M6, and 3 (0,5-29,8) at M9. At last follow-up, 46% of pts experienced amenorrhea, 7% an ovarian failure and 3% a chemo-induced menopause. The highest incidence of amenorrhea (61%) was at M3. At M12, 7% of pts remained amenorrhoeic. The AMH initial level was not significantly lower in pts who experienced amenorrhea compared to those who did not (25.5 versus 35.1, p = 0,087). Ovarian stimulation and BRCA status did not impact risk of amenorrhea. At 2 years, overall survival rate was 96% and progression free survival rate was 90% (6 deaths and 18 progression events). Conclusion (Neo)adjuvant sequential breast cancer chemotherapy is associated with a decrease of AMH level and amenorrhea. Our results suggest a significant risk of premature ovarian failure. Fertility preservation has to be proposed to these young patients. Citation Format: Mailliez A, Pigny P, Bogart E, Diomande S, Jeazet Tiotsia H, Bonneterre J, Le Deley MC, Decanter C. Systematic evaluation of ovarian reserve in young breast cancer patients treated by sequential chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-06.

Background: 6300 new cases of breast cancer arise in young women under 40 each year in France. Some of them are BRCA 1 or 2 mutation carriers. Most of them receive a potentially gonadotoxic chemotherapy while they have not yet completed their family. Since 2011, a systematic proposal of ovarian reserve follow-up and fertility preservation by oocyte freezing is provided to each young early breast cancer (BC) patients (pts) of our program (NCT 01614704). Preliminary results were presented at the SABCS in 2013. We now investigate the impact of BRCA mutation on the ovarian reserve and the ovarian response to simulation. Methods: 115 young BC pts were systematically referred to a reproductive medicine centre before starting chemotherapy. Inclusion criteria were age 18 to 38, histologically confirmed invasive breast carcinoma, absence of metastases. According to their personal and familial history, genetic counselling was performed and if the patient met the criteria and agreed, BRCA genes were analysed. Pts in an adjuvant setting and who were asking for fertility preservation underwent COH during the interval between complete surgery and start of adjuvant chemotherapy. Ovarian stimulation protocol consisted in a conventional antagonist protocol with recombinant FSH starting on day 2 of the menstrual cycles. The GnRh antagonist was started on day of the COH and the final oocyte maturation was achieved by an injection of triptorelin 0.2 mg when at least 3 follicles reached 18 mm of diameter. All pts gave their informed consent for COH, egg/embryo freezing and follow-up. Results: 115 pts achieved pre-treatment AMH and AFC assessment. 60 (52,1%) were eligible for COH in order to cryopreserve egg or embryos. BRCA analysis was performed in 83 pts. 23 did not meet the criteria or refused. 9 analyses are still in process. 17 (20.4%) pts were positive for BRCA mutation (BRCA1: 13; BRCA2: 4) and 66 were not. In the mutation carriers group (n=17), median age was 32 years (Range 25-37). Median initial AMH levels and AFC were 23 pmol/l (5.1–223) and 20 (6-100), respectively. Eight pts underwent COH. Median duration of stimulation was 9,5 days (8-13) with a median cumulative dose of gonadotropins of 2875 UI (1200-5450). The median number of vitrified oocytes was 5,5 (0-15). Two patients chose frozen embryo preservation (1 and 2 eggs respectively). In the non-carriers group (n=66), median age was 31 years (24-37). Median initial AMH levels and AFC were 23.4 pmol/l (0.8-136) and 24 (1-68). 27 pts underwent COH. Median duration of stimulation was 10 days (7-14). Dose of gonadotropins was 2700 UI (1365-5600). The median number of vitrified oocytes was 6 (0-18). The 3 patients chose eggs preservation (0.0 and 3 eggs respectively). There was no significant difference in the two groups. Discussion/ Conclusion: Few studies stated that BRCA1 mutation may be associated with reduced ovarian reserve in healthy BRCA mutation carriers. Meirow and al concluded that both healthy and BC BRCA mutation carriers demonstrated normal ovarian response in vitro fertilization cycles. Our results show that ovarian reserve of BRCA 1/2 mutations BC carriers do not differ from that of non-carriers. Response to COH seems similar in both groups too. Citation Format: Mailliez A, Keller L, Menu-Hespel S, Plouvier P, D'Orazio E, Basson L, Pigny P, Bonneterre J, Decanter C. Ovarian reserve and response to controlled ovarian hyperstimulation (COH) in breast cancer women with and without BRCA mutation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-09-06.

The question of pregnancy prognosis after radio chemotherapy is unaddressed. We report here the case of three successive spontaneous pregnancies 17 years after the management of a thigh rhabdomyosarcoma treated by radiochemotherapy. In 2018 the patient aged 22 presented with a spontaneous miscarriage. In 2019, she obtained a new spontaneous pregnancy. At 21 W G, she presented with threatened late miscarriage and gave birth to a live girl who would die. Three months after delivery, she had spontaneous pregnancy. At 18 W G, emergency cervical cerclage was performed. At 35 W G the ultrasound found severe intrauterine growth retardation. Cesarean section was performed allowing the birth of a girl in good health status. Childbirth was complicated by 1L8 postpartum hemorrhage secondary to uterine atony, controlled after surgical revision. To conclude, pregnancy in a patient with a history of pelvic irradiation in childhood must be considered high-risk pregnancy and its management must be multidisciplinary.

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.

Fertility preservation (FP) techniques are progressing rapidly these past few years thanks to the oocyte vitrification. Indication of FP techniques is now extended to non-oncological situation that may induce risk of premature ovarian failure. Ovarian endometriosis can lead to premature ovarian failure and further infertility due to the high risk of ovarian cysts recurrence and surgery. To date, there is no cohort study regarding FP and endometriosis as well as no recommendation. Our purpose is to review the arguments in favor of FP in this specific area and to elaborate strategies according to each clinical form.

The management of endometriosis related infertility requires a global approach. In this context, the prescription of an anti-gonadotropic hormonal treatment does not increase the rate of non-ART (assisted reproductive technologies) pregnancies and it is not recommended. In case of endometriosis related infertility, the results of IVF management in terms of pregnancy and birth rates are not negatively affected by the existence of endometriosis. Controlled ovarian stimulation during IVF does not increase the risk of endometriosis associated symptoms worsening, nor accelerate the intrinsic progression of endometriosis and does not increase the rate of recurrence. However, in the context of IVF management for women with endometriosis, pre-treatment with GnRH agonist or with oestrogen/progestin contraception improve IVF outcomes. There is currently no evidence of a positive or negative effect of endometriosis surgery on IVF outcomes. Information on the possibilities of preserving fertility should be considered, especially before surgery.

Using the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature.This guideline was produced by a group of experts in the field including a thorough systematic search of the literature (from January 1980 to March 2017). Were included only women with endometriosis related to infertility. For each recommendation, a grade (A-D, where A is the highest quality) was assigned based on the strength of the supporting evidence.Management of endometriosis related to infertility should be multidisciplinary and take account into the pain, the global evaluation of infertile couple and the different phenotypes of endometriotic lesions (good practice point). Hormonal treatment for suppression of ovarian function should not prescribe to improve fertility (grade A). After laproscopy for endometriosis related to infertility, the Endometriosis Fertility Index should be used to counsel patients regarding duration of conventional treatments before undergoing ART (grade C). After laparoscopy surgery for infertile women with AFS/ASRM stage I/II endometriosis or superficial peritoneal endometriosis, controlled ovarian stimulation with or without intrauterine insemination could be used to enhance non-ART pregnancy rate (grade C). Gonadotrophins should be the first line therapy for the stimulation (grade B). The number of cycles before referring ART should not exceed up to 6 cycles (good practice point). No recommendation can be performed for non-ART management of deep infiltrating endometriosis or endometrioma, as suitable evidence is lacking.Non-ART management is a possible option for the management of endometriosis related to infertility. Endometriosis Fertilty Index could be a useful tool for subsequent postoperative fertility management. Controlled ovarian stimulation can be proposed.

Oocyte vitrification is a preservation fertility strategy, which can be performed in women after puberty to preserve gametes before beginning a gonadotoxic anticancer treatment. Based on available literature and our personal data, we aim to provide an overview about the feasibility, the clinical and logistic difficulties of oocyte vitrification in the field of oncofertility: limit age for oocyte cryopreservation, time required and protocols for ovarian controlled stimulation, ovarian response to stimulation, for what hopes of pregnancy?

Therapeutic advances in oncology have improved the prognosis for long-term survival of children and young adults. As well as other couples or because of adverse side effects of cancer treatments on reproductive function, some cancer survivors will therefore be brought to use assisted reproductive technologies (intrauterine inseminations, in vitro fertilization, intracytoplasmic sperm injection, oocyte or sperm donation…). The purpose of this review is to summarize available scientific datas regarding success rate of assisted reproductive technologies in cancer survivors.

Background: 6300 new cases of breast cancer arise in young women under 40 each year in France. The majority receives chemotherapy and a lot of them have not completed their family. The incidence of persistent chemotherapy-induced amenorrhea in these patients is approximately 20%. The incidence of infertility, although poorly studied, is probably higher. Besides, there has been a development of techniques of fertility preservation and henceforth physicians have to systematically offer these techniques to these young patients before the onset of chemotherapy. Few studies have addressed the issue of COH for fertility preservation in breast cancer pts. In most of these, letrozole is required during COH in order to limit the estrogen levels increase. In France, the use of letrozole in this specific area is not allowed. The aim of this prospective observational study is to evaluate the benefit/risk of the ovarian stimulation without letrozole for oocyte/embryo freezing in young breast cancer pts undergoing adjuvant chemotherapy. Methods: 28 young breast cancer patients were referred for fertility preservation before chemotherapy. Inclusion criteria were age 18 to 38, histologically confirmed invasive breast carcinoma, absence of metastases. 12 patients (6 due to a neoadjuvant setting and 6 because of the wishes of the patient) had only a follow up of their ovarian reserve. The 16 others patients were in an adjuvant setting and were asking for a fertility preservation. These 16 patients underwent COH during the interval between complete surgery and start of adjuvant chemotherapy. To reduce the risk of ovarian hyperstimulation, ovarian stimulation protocol will use gonadotropins and a GnRH antagonist and a GnRH agonist will do the ovulation trigger. All the patients were then enrolled in a systematic oncologic and reproductive follow-up for 2 consecutive years after the end of chemotherapy. All patients gave their informed consent for COH, egg/embryo freezing and follow-up. Results: Mean age of the study population was 31 years (25-37). Histologic type was invasive ductular carcinoma in all cases, except 1 medullary carcinoma. 14 tumours were hormonal receptors positive, 4 were Her 2 positive. 14 patients had not yet children. Mean initial AMH levels and AFC were respectively 17 (7,7-120) and 21(6-68). Length of stimulation was 12.5 (11-16). Time between surgery and chemotherapy was 46 days (19-95). Time between first consultation in the fertility preservation center and chemotherapy was 25 days (2-73). The mean number of vitrified oocytes was 6,2 (0-14). The mean number of frozen embryo was 2,8 (0-8). Mean duration of follow-up after the end of chemotherapy was 265 days (27-585). To date, no oncologic adverse effects were observed during the study period. Conclusion: These preliminary results confirmed the feasibility of a collaboration between oncologists, reproductive medicine doctor and biologist to allow all the women concerned to have access to a preservation of their fertility. Safety and results of COH had to be confirmed in a larger population. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-19.

The incidence of cancer in young patients as well as survival rates is steadily increasing. The question of fertility capacity is therefore of great importance regarding the quality of life after cancer. According to the ASCO recommendations, every patient should be advised about the chemotherapy-induced ovarian damage and fertility preservation possibilities. Several options can be discussed: embryo and/or oocytes freezing and ovarian tissue cryopreservation. Fertility preservation techniques are progressing rapidly but it still remains difficult to establish precise flow-charts according to age, marital status, type, dose and timing of chemotherapy.

Sao Paulo State Univ UNESP, Ctr Human Reprod Prof Franco Jr, Paulista Ctr Diag Res & Training, Dept Gynecol & Obstet,Botucatu Med Sch, Ribeirao Preto, Brazil

To investigate prospectively the pattern of the follicular growth and to characterize the COH outcome in terms of oocyte number and maturity in patients with voluminous recurrent benign ovarian tumors with a high surgical risk of significant reduction of the ovarian follicular content.The inclusion criteria were: age between 18 and 36, presence of at least one benign ovarian tumor (≥ 5cm) with high risk of recurrence. The fertility preservation cycle was performed at least 3 months after the cyst surgery. The controlled ovarian stimulation was performed after the ovarian reserve was assessed (AMH measurement and sonographic antral follicle count). Triggering was performed by hCG when at least 3 follicles reached 18mm of diameter. Metaphase II oocytes were cryopreserved by the vitrification technique.Twenty-four women with dermoid, endometrioma or seromucinous cysts were included from January 2015 to July 2016. All of them had previous ovarian surgery. Mean AMH levels were 15.3pmol/L. The mean number of total oocytes retrieved was 7±5. The mean number of metaphase II oocytes was 4.4±4. The incidence of low ovarian response was 38%. Among the patients, 86% had less than 8 metaphase II oocytes vitrified. Seven patients asked for a second cycle in order to have more oocytes.We demonstrated the feasibility of the systematic proposal of fertility preservation by oocyte cryopreservation in this group of young patients with recurrent ovarian benign tumors. Taking into account history of previous surgery and high incidence of low ovarian reserve, the ovarian response under stimulation was frequently poor with, as consequence, low retrieved oocyte number per cycle. An oocyte accumulation strategy is then proposed to enhance further pregnancy chances.

The French bio-ethic law concerning ART is more restricted than in other countries. Techniques can only be applied in heterosexual couples presenting a documented infertility. Nevertheless, concerns about fertility planning are numerous in young women, leading to a growing demand of reproductive medicine consultations. Two situations can be distinguished: firstly, single patients wishing sperm donation and, secondly, single patients who wish to preserve their fertility for future parenting project. This latter situation can be discussed in the French legislative context while the other will require soliciting the neighboring European teams.

Introduction: Weight loss amongst women with polycystic ovary syndrome (PCOS) is crucial to reduce the risk of endocrine, reproductive and metabolic complications including hirsutism, menstrual disturbances and cardiovascular disease. With approximately 50% of women with PCOS being overweight or obese, effective dietary management of weight in PCOS is essential. However, there is inconsistent evidence as to whether specifically modified diets (e.g. reduced carbohydrate diets) are more effective at achieving weight loss amongst women with PCOS than are conventional healthy hypocaloric diets. Material and Methods: A systematic review and meta-analysis of randomized controlled trials that had compared weight and BMI between women with PCOS who had undergone either a specifically modified diet or a conventional healthy hypocaloric diet were performed. Six electronic databases were searched, a manual search of the reference lists of the included studies was carried out and authors were contacted for additional information. Nine studies with a total of 395 participants (all with a body mass index [BMI] ≥30) were included in the meta-analysis. The effect size used was the mean difference in post-intervention weight and BMI between participants who had undergone a specifically modified diet and participants who had undergone a conventional healthy hypocaloric diet. Results: There were no differences between groups in post-intervention weight (mean difference 1.26, 95% confidence interval (CI) -0.92 to 3.43, p = .26; heterogeneity I2 = 50%, p = .04) or BMI (mean difference 0.15, 95% CI -0.93 to 1.23, p = 0.79; heterogeneity I2 = 44%, p = 0.10). Subgroup analyses according to the presence of a dietary run-in period (a period at the start of the study during which all participants are placed on an identical diet in order to equalize them on variables influenced by diet), intervention duration and type of diet and a sensitivity analysis according to study quality were not significant. Conclusions: Whilst the results should be interpreted in light of the moderate heterogeneity observed, they suggest that specifically modified diets offer no added benefit for weight loss in women with PCOS over conventional healthy hypocaloric diets. The findings of this meta-analysis may promote the unification of guidelines for the dietary management of PCOS and allow clinicians to be confident in prescribing conventional healthy hypocaloric diets for weight loss amongst their PCOS patients.

Polycystic ovary syndrome (PCOS) is the most common etiology of menstrual disorders and hyperandrogenism. It is characterized by an excess of ovarian follicles. The mechanisms that underlie folliculogenesis disorder in PCOS appear to arise from primitive ovarian hyperandrogenism. This can be modulated by hormonal factors, such as LH or insulin. Ovarian hyperandrogenism results from a real theca cells dysfunction, whose origin is still poorly understood. It seems that complex genetic factors may be involved, but these have not yet been clearly identified. PCOS also results from granulosa cells dysfunction. For example, intra-ovarian factors, such as anti-mullerian hormone, are possibly involved in ovulation's disorders by blocking the physiological process of follicular recruitment. In turn, the oocyte could also be one of the actors possibly involved in the follicular excess in PCOS.

The French bio-ethic law concerning ART is more restricted than in other countries. Techniques can only be applied in heterosexual couples presenting a documented infertility. Nevertheless, concerns about fertility planning are numerous in young women, leading to a growing demand of reproductive medicine consultations. Two situations can be distinguished: firstly, single patients wishing sperm donation and, secondly, single patients who wish to preserve their fertility for future parenting project. This latter situation can be discussed in the French legislative context while the other will require soliciting the neighboring European teams.

Background Steroid pre-treatments may be useful to program GnRH antagonist IVF/ICSI cycles. This prospective study assessed hormonal and ultrasound data collected during the free period after the discontinuation of three different pre-treatments to provide information on the optimal time interval required before starting stimulation. Methods Women were randomized to receive oral contraceptive pill (OCP) [ethinyl estradiol (E(2)) 30 microg + desogestrel 150 microg] (n = 21) or norethisterone 10 mg/day (n = 23) or 17-betaE(2) 4 mg/day (n = 25) or no pre-treatment (n = 24) for one cycle before IVF. Assessments were performed on post-treatment day (PD) 1, 3 and 5, or on spontaneous cycle day (CD) 1 and 3. Results After OCP and progestogen administration, FSH and LH concentrations shifted from strongly suppressed PD1 levels to PD5 values similar to those observed on CD1. Meanwhile, follicle sizes remained small up to PD5. In contrast, estrogen pre-treatment poorly reduced FSH levels on PD1 compared with OCP or progestogen. Consequently, follicle size was more heterogeneous. FSH rebound was maximal on PD3, whereas LH levels were slightly increased up to PD5. Conclusions A 5-day free interval after OCP or progestogen offers the advantages of gonadotrophin recovery and homogeneous follicular cohort, whereas early FSH rebound occurring after estrogen pre-treatment argues for a short free period.

Relationship between infertility and endometriosis is still controversial. Many mechanisms have been reported such as anatomical disorders, biologic and cytological modifications of peritoneal liquid, functional ovarian and endometrial disorders, reduced embryo quality. Management of infertility related to endometriosis is difficult and no consensus has been published yet. Following recent clinical data, therapeutic strategies are discussed.

The number of young cancer women theoretically eligible for fertility preservation before chemotherapy is steadily increasing. Nevertheless, the number of patients who can really benefit from complex ART techniques such as ovarian tissue or oocyte/embryo cryopreservation remains very low mainly because of a too short time-interval between the cancer diagnosis and its treatment. Lack of adequate information regarding post treatment infertility risk and logistical difficulties to access to a highly specialized cryopreservation centre are also reasons of importance. It is now well-established that these patients are at high risk of infertility even if they return to a normal ovarian function. Therefore, for patients who could not benefit from fertility preservation before cancer treatment, and who have recovered spontaneous menstrual cycle, one might raise the question of oocyte freezing once the cancer cured.

Resume Le dosage de la prolactine, de realisation sans doute trop systematique dans le cadre du bilan d’infertilite, pose bien souvent des problemes d’interpretation et de strategie diagnostique. L’elevation plasmatique de la prolactine est de constatation frequente puisque notee dans 20 a 30 % des troubles du cycle et chez 10 % des femmes normalement reglees. Neanmoins, toute hyperprolactinemie ne doit pas faire systematiquement l’objet d’un bilan paraclinique exhaustif meme s’il est parfois difficile de faire la part la part des choses entre hyperprolactinemie « organique », fonctionnelle voire artefactuelle. Il importe donc avant tout d’affirmer la realite de l’hyperprolactinemie avec une methode de dosage rigoureuse, puis ensuite d’utiliser a bon escient les tests dynamiques et l’imagerie de la region hypothalamo-hypophysaire, de facon a evoluer dans l’arbre diagnostique souvent complexe des etiologies d’exces de prolactine.

Breast cancer affects 6300 new patients per year under age 40 per year in France. The new adjuvant chemotherapy protocols have significantly improved the prognosis of these young women who may wish to conceive later. Embryo cryopreservation is the best way to preserve fertility, providing 25 to 35% chance of pregnancy. Oocyte freezing may be an alternative for single patients. This review will focus on: (1) ovarian toxicity of new adjuvant chemotherapy protocols, (2) the place of embryo or oocyte cryopreservation in fertility preservation techniques, (3) indications and protocols.

Oocyte vitrification is a preservation fertility strategy, which can be performed in women after puberty to preserve gametes before beginning a gonadotoxic anticancer treatment. Based on available literature and our personal data, we aim to provide an overview about the feasibility, the clinical and logistic difficulties of oocyte vitrification in the field of oncofertility: limit age for oocyte cryopreservation, time required and protocols for ovarian controlled stimulation, ovarian response to stimulation, for what hopes of pregnancy?

Steroid 21-hydroxylase deficiency is the most common adrenal genetic disease and is also named congenital adrenal hyperplasia. Depending on the severity of CYP21A2 gene mutations, there are severe or "classical" forms and moderate or "nonclassical" forms of 21-hydroxylase deficiency. The enzyme deficiency causes a disruption of adrenal steroidogenesis, which induces hyperandrogenism and elevated plasma levels of progesterone and 17-hydroxyprogesterone, the two substrates of 21-hydroxylase. These endocrine abnormalities will disrupt gonadal axis, endometrial growth and maturation and finally secretion of cervical mucus. All these phenomena contribute to a female hypofertility. Infertility is more severe in classical forms. When to become pregnant, treatment with hydrocortisone or dexamethasone can limit the production of adrenal androgens and progesterone and improves spontaneous pregnancy rates while minimizing the risk of miscarriage, which is usually relatively high in this disease. When planning pregnancy in patients with a 21-hydroxylase deficiency, genotyping the partner is required to screen for heterozygozity (1/50) and to assess the risk of transmission of a classical form in the progeny.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and the leading cause of female infertility. This condition is frequently associated with significant metabolic disorders, including obesity and hyperinsulinemia. Therefore, it seems essential to focus on the pregnancy of these patients and possible obstetric complications. Many studies suggest an increase in the risk of obstetric pathology: early miscarriage, gestational hypertension, preeclampsia, gestational diabetes mellitus diagnosed during early pregnancy, prematurity, low birthweight or macrosomia, neonatal complications and cesarean sections. However, it is difficult to conclude clearly about it, because of the heterogeneity of definition of PCOS in different studies. In addition, many confounding factors inherent in PCOS including obesity are not always taken into account and generate a problem of interpretation. However it seems possible to conclude that PCOS does not increase the risk of placental abruption, HELLP syndrome, liver disease, postpartum hemorrhage, late miscarriage and stillbirth.

The number of young cancer women theoretically eligible for fertility preservation before chemotherapy is steadily increasing. Nevertheless, the number of patients who can really benefit from complex ART techniques such as ovarian tissue or oocyte/embryo cryopreservation remains very low mainly because of a too short time-interval between the cancer diagnosis and its treatment. Lack of adequate information regarding post treatment infertility risk and logistical difficulties to access to a highly specialized cryopreservation centre are also reasons of importance. It is now well-established that these patients are at high risk of infertility even if they return to a normal ovarian function. Therefore, for patients who could not benefit from fertility preservation before cancer treatment, and who have recovered spontaneous menstrual cycle, one might raise the question of oocyte freezing once the cancer cured.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of short and long-term endocrine dysfunction following allogeneic stem cell transplantation. The key aim of this workshop was to give an overview on secondary adrenal insufficiency and osteoporosis post-transplant.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of short and long-term endocrine dysfunction following allogeneic stem cell transplantation. The key aim of this workshop was to give an overview on dyslipidemia and thyroid disorders post-transplant.

Therapeutic advances in oncology have improved the prognosis for long-term survival of children and young adults. As well as other couples or because of adverse side effects of cancer treatments on reproductive function, some cancer survivors will therefore be brought to use assisted reproductive technologies (intrauterine inseminations, in vitro fertilization, intracytoplasmic sperm injection, oocyte or sperm donation…). The purpose of this review is to summarize available scientific datas regarding success rate of assisted reproductive technologies in cancer survivors.

The incidence of cancer in young patients as well as survival rates is steadily increasing. The question of fertility capacity is therefore of great importance regarding the quality of life after cancer. According to the ASCO recommendations, every patient should be advised about the chemotherapy-induced ovarian damage and fertility preservation possibilities. Several options can be discussed: embryo and/or oocytes freezing and ovarian tissue cryopreservation. Fertility preservation techniques are progressing rapidly but it still remains difficult to establish precise flow-charts according to age, marital status, type, dose and timing of chemotherapy.

Women with a breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2) mutation are at increased risk for developing breast and ovarian cancer. Various reproductive and hormonal factors have been shown to modify the risk of breast cancer. These studies suggest that estrogen exposure and deprivation are important in the etiology of hereditary cancer. Many patients are interested in the possibility of an adverse effect of fertility treatment on breast cancer risk. It is important to evaluate whether or not infertility per se or exposure to fertility medications increase the risk of breast cancer in genetically predisposed women.

In the management of asthenozoospermia, the spermogram-spermocytogram plays an important role during diagnosis. It is of major importance to distinguish between necrozoospermia and sperm vitality. An ultrastructural study of spermatozoa is processed in the case of primary infertility without female implication, severe, unexplained and irreversible asthenozoospermia, sperm vitality at least 50 % and normal concentration of spermatozoa. Ultrastructural flagellar abnormalities are numerous and involve most spermatozoa. ICSI provides a suitable solution for patients with sperm flagellar defects to conceive children with their own gametes but the rate of ICSI success may be influenced by the type of flagellar abnormality. Some fertilization and birth rate failures which are related to some flagellar abnormalities might occur.

Breast cancer affects 6300 new patients per year under age 40 per year in France. The new adjuvant chemotherapy protocols have significantly improved the prognosis of these young women who may wish to conceive later. Embryo cryopreservation is the best way to preserve fertility, providing 25 to 35% chance of pregnancy. Oocyte freezing may be an alternative for single patients. This review will focus on: (1) ovarian toxicity of new adjuvant chemotherapy protocols, (2) the place of embryo or oocyte cryopreservation in fertility preservation techniques, (3) indications and protocols.

Relationship between infertility and endometriosis is still controversial. Many mechanisms have been reported such as anatomical disorders, biologic and cytological modifications of peritoneal liquid, functional ovarian and endometrial disorders, reduced embryo quality. Management of infertility related to endometriosis is difficult and no consensus has been published yet. Following recent clinical data, therapeutic strategies are discussed.

Serum prolactin measurement is usually performed in infertility evaluation, even if there's no specific clinical presentation of hyperprolactinemia. High levels of prolactin are noted in 20 to 30% of menstrual abnormalities and in about 10% of regular menses. It is of importance to determine whether hyperprolactinemia is related to pituitary adenoma, drug administration, general diseases, or circulating large forms of prolactin, in order to avoid heavy, expensive, time consuming and unnecessary clinical investigations or therapeutic actions. We must first to confirm the biological diagnosis of hyperprolactinemia with few repeated plasmatic measurements, and, later, if necessary use TRH-metoclopramide test and/or pituitary magnetic resonance imaging.

Schistosomiasis represents the second most endemic diseases following malaria. It is now endemic in 76 countries of the world, and it is estimated that more than 200 million persons are infected. The objective of this work is to help in the improvement of knowledge about Female Genital Schistosomiasis (FSG) effects on the women reproductive. A transversal prospective survey during six months, on women consulting for infertility in the health reproductive center of Niamey. The women included (109 persons) have been asked and consulted in gynecology, cervical smears urine pathology, urine ragent strips test, vesico-renal and gynecologic trans-abdominal ultrasound, hysterosalpingography (HSG) and cervical biopsy on infected patients. The infestation prevalence at S.haematobium was 38,5%. The infected persons have presented more gyneco-obstétrical symptomatology than the non infested ones. The proportion of exocervicite was 31,0% by clinical examination. The cervical biopsy done on 26 bilharziosis patients confirmed the frequence of highs chronic exocervicites (50%) and leucoplasia (11,5%). Echography and HSG noticed that the bilharzios patients can let develop other annexiel pathologies such as: ovary cyst, peri-tuboovary adhesions and wide ovaries. The symptomatology felt by infested women showed the parasitose consequence on women in endemic area. The treatment in o large schaddle by the national program allows to reduce morbidity caused by that infection in Niger.