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This research aims to study the experiences and the maternal representations of infertile women throughout the different steps of a medically assisted procreation (MAP) with oocyte donation. The analysis of collected data (interviews and questionnaires) shows that the resort of egg donation creates psychic adjustment (particularly in terms of maternal representations) that appear specific to this type of procreation.

Today, the good prognosis of girl's cancers raises the question of her future fertility. Several studies have focused on preservation of ovarian function, but the uterus, irradiated in childhood, is a crucial component to bear in mind because the somatic damages, in terms of endometrial and myometrial atrophy, scar fibrosis and hypovascularization, are negative factors for the establishment and maintenance of a pregnancy and for a convenient labour. Consequences for procreation are related to the morphologic uterine sequelae and its altered function: early miscarriages, abnormal placentation etc. In addition to some spontaneous pregnancies reported in literature, a few pregnancies, for women experiencing a premature iatrogenic ovarian failure due to mild irradiation, have been obtained after in vitro fertilization and oocyte donation with increased estrogen treatment. Recently, a real hope has surged in relation to the opportunity to reverse the radio-induced fibrosis and thus to obtain a better trophic uterus, using the antioxidant pathway. So, a treatment combining pentoxifylline 800 mg/d and tocopherol 1000 IU/d for 12 months allowed improvement of local uterine conditions such as endometrial thickness (x2), myometrial dimensions (x1.5) and uterine vascularization in all six sterile women studied, who have received high irradiation in childhood (>or=45 Gy). Moreover, two women mildly irradiated (#20 Gy) with endometrium resisting to physiological estrogen status, became spontaneously pregnant after using this combined treatment, and gave birth to healthy children. Further studies are in progress to assess, among other questions, the interest of this therapeutic direction.

Resume Le don d’ovocytes (DO) est une technique eprouvee de l’assistance medicale a la procreation (AMP) qui a fait depuis 20 ans la preuve de son efficacite dans le traitement palliatif des insuffisances ovariennes exocrines. Ses indications se sont depuis etendues a certaines affections genetiques et aux cas documentes d’insuffisances ovariennes occultes. En France, apres une large deliberation ethique et juridique, sa pratique est reconnue licite et les lois Bioethiques 94-653 et 94-654 du 29 juillet 1994 en encadrent l’exercice. Ses principes generaux essentiels sont le volontariat, la gratuite, l’anonymat et la confidentialite du don ; sur le plan reglementaire la quarantaine sanitaire de six mois des embryons issus de don d’ovocytes. Le fonctionnement des programmes de fecondation in vitro (FIV) avec DO s’effectue dans des organismes autorises sous la responsabilite de praticiens agrees pour le prelevement et le traitement des ovocytes issus de don. La gestion de ces programmes represente la cle de voute du systeme, car elle assume entre autres la verification des indications, des documents legaux, de la securite sanitaire, l’appariement anonyme donneur–receveur et le recensement des resultats. Actuellement, les programmes francais temoignent, selon les annees, de 17 a 22 % de grossesses cliniques par transfert d’embryons congeles–decongeles et les etudes de suivi font etat d’excellents resultats concernant les relations familiales, le developpement physique et psychologique des enfants. Cependant, les difficultes rencontrees dans l’exercice au quotidien du DO ont conduit au rassemblement des praticiens concernes dans un groupe d’etudes pour le don d’ovocytes (GEDO). Celui-ci, travaillant sur differents themes, a pour but d’ameliorer le service aux couples recourant a ce type d’AMP. Nous envisagerons ces quelques points et ce, en comparaison avec les dispositions differentielles europeennes.

Objective: To determine whether combined pentoxifylline (PTX) and tocopherol (vitamin E) treatment can improve uterine radiation-induced sequelae, resulting in an improved embryo implantation rate. Design: Retrospective phase II clinical trial. Setting: Volunteers in an oocyte donation program in a public hospital. Patient(s): Six women aged 31 ± 4 years, who were irradiated 25 years previously for childhood cancer with 20 to 40 Gy including the pelvic area. Intervention(s): Four women had taken hormone replacement therapy for primary amenorrhea, and two had retained their natural cycle. Treatment consisted of at least 12 months of pentoxifylline at 800 mg/day combined with 1000 IU/day of tocopherol. Main Outcome Measure(s): Endometrial thickness, uterine volume, and uterine artery blood flow were assessed by ultrasonography before and after pentoxifylline-tocopherol treatment, under usual estrogen-progesterone (OP) administration. Result(s): This treatment was well tolerated. All six patients improved significantly in endometrial thickness (6.2 ± 0.6 vs. 3.2 ± 1.1 mm), myometrial dimensions (44 [± 5] × 30 [± 3] × 20 [± 2] vs. 30 [± 7] × 22 [± 3] × 16 [± 2] mm), and diastolic uterine artery flow. Conclusion(s): In young women who want to bear children, the combination of pentoxifylline and vitamin E can reduce fibroatrophic uterine lesions after childhood irradiation.

Human interleukin for DA cells/leukaemia inhibitory factor (HILDA/LIF) is a cytokine with pleiotropic effects involved in successful murine implantation. We evaluated human uterine HILDA/LIF production by monitoring its in-vitro secretion by endometrial explant cultures obtained from individuals in either normal or pathological conditions. The cytokine secretion was standardized using the day 5 :day 1 ratio of HILDA/LIF concentration in supernatants of such cultures, hereby termed HILDA/LIF production index (HLPI). Our results confirmed that HILDA/LIF is secreted by the human endometrium as assessed by secretion at every phase of the cycle in either normal fertile women, or women bearing intrauterine devices. This was also the case for samples obtained from infertile women presenting repeated failures of embryonic implantation or unexplained primary sterility. However, the HLPI were significantly lower in those latter two groups when compared to fertile women. These results suggest an abnormal regulation of HILDA/LIF secretion in such circumstances, and the clinical implication of those data is discussed.

The aim of this study was to show the parallel evolution of the pulsatility index of the uterine artery and the one of the median thoracic artery.The study involved seven volunteer women, below 38, suffering from premature ovarian failure, who received E2 and progesterone replacement therapy. Plasma levels of E2, progesterone, follicle stimulating hormone and luteinizing hormone were measured and PI were studied and compared before treatment and on Days 13, 27 and 41.Before treatment, a high-resistance vascular for both arteries is uniformly found. The curves show with the increasing of the E2 plasma levels, a decrease in the PI of UA and MTA with a fall at Day 13. We compared the mean values in MTA and UA PI. No statistical difference between the three mean values in PI obtained at Day -1, Day 13 and Day 41 was demonstrated.The results suggest that median thoracic artery is a target organ artery. Such as the UA, the MTA vascular resistance is according to the variations of plasma levels of E2. In consideration of it rectilinear and superficial type, this led us to study this artery when we use different sorts of replacement therapy, and particularly in the oocyte donation program.

This research aims to study the experiences and the maternal representations of infertile women throughout the different steps of a medically assisted procreation (MAP) with oocyte donation. The analysis of collected data (interviews and questionnaires) shows that the resort of egg donation creates psychic adjustment (particularly in terms of maternal representations) that appear specific to this type of procreation.

Today, the good prognosis of girl's cancers raises the question of her future fertility. Several studies have focused on preservation of ovarian function, but the uterus, irradiated in childhood, is a crucial component to bear in mind because the somatic damages, in terms of endometrial and myometrial atrophy, scar fibrosis and hypovascularization, are negative factors for the establishment and maintenance of a pregnancy and for a convenient labour. Consequences for procreation are related to the morphologic uterine sequelae and its altered function: early miscarriages, abnormal placentation etc. In addition to some spontaneous pregnancies reported in literature, a few pregnancies, for women experiencing a premature iatrogenic ovarian failure due to mild irradiation, have been obtained after in vitro fertilization and oocyte donation with increased estrogen treatment. Recently, a real hope has surged in relation to the opportunity to reverse the radio-induced fibrosis and thus to obtain a better trophic uterus, using the antioxidant pathway. So, a treatment combining pentoxifylline 800 mg/d and tocopherol 1000 IU/d for 12 months allowed improvement of local uterine conditions such as endometrial thickness (x2), myometrial dimensions (x1.5) and uterine vascularization in all six sterile women studied, who have received high irradiation in childhood (or=45 Gy). Moreover, two women mildly irradiated (#20 Gy) with endometrium resisting to physiological estrogen status, became spontaneously pregnant after using this combined treatment, and gave birth to healthy children. Further studies are in progress to assess, among other questions, the interest of this therapeutic direction.

The possibility of offering assisted reproductive technologies (ART) to HIV-positive couples has revived questions concerning the safety of the gametes and embryos cryopreservation in liquid nitrogen tanks.We evaluated the safety of three types of straws - polyvinyl chloride (PVC), polyethylene terephthalate glycol (PETG) and so-called 'high-security' ionomeric resin (IR) - containing HIV-1 under standard conditions of cryopreservation. Potential HIV contamination was assessed by RT-PCR and then nested PCR.Under cryopreservation conditions, the sealed open ends of PVC and PETG straws were not safe. The ultrasound sealing system seems to be the weak link in obtaining total imperviousness of the straws. In contrast, both ends of the IR straws were safe for HIV in the framework of their use for ART.Sealing cryopreservation straws ultrasonically could incur the risk of not assuring their impermeability. Under standard cryopreservation conditions thermosealing of IR straws appears to be safe for HIV.

Oocyte donation (OD), a technique successfully used in Assisted reproductive techniques (ART), has been effective for 20 years as the palliative treatment of certain exocrine ovarian failures. Its indications have also been extended to cover some genetic diseases and documented occult ovarian insufficiency. In France, after an extensive judicial and ethical deliberation, OD was deemed legal and its practice was proscribed in the Bioethics Laws 94-653 and 94-654 of 29 July 1994. Its essential underlying principles are: voluntary, free, anonymous and confidential OD; according to a French decree to meet safety concerns, OD-derived embryos must be quarantined for six months. In vitro fertilization (IVF) programs using donated oocytes are conducted in authorized centers under the responsibility of physicians authorized to retrieve and manipulate donated oocytes. The managers of these programs are the system's keystone, as their role includes, among other, the verification of indications, legal documents, public health safety, anonymous pairing of donor and recipient, and the collection of outcome data. At present, depending of the year, French programs have achieved 17-22% clinical pregnancy rates from transferred OD-derived frozen-thawed embryos, and follow-up studies reported excellent results concerning family relationships, and the physical and psychological development of the children. However, difficulties encountered in the daily practice of OD have led concerned physicians to form the Study group for OD (GEDO) to explore different topics with the aim of improving the overall management of this form of ART. We discussed these points herein, in comparison with the approaches of other European countries.

Advances in antimitotic treatments have improved the prognosis of cancer in young subjects. The resulting increase in life expectancy raises the question of the subject's future fertility, a question that should be posed before beginning any anticancer therapy which could lead to a gonadal failure. If oocyte donation remains the alternative indication proposed for these patients desiring a child, it is important to assess the tissue alterations in the uterus, to verify its vascularization under suitable treatment and appreciate the other alternative directions.

Menopause, conventionally defined as the permanent cessation of menstruation as a result of loss of ovarian follicular activity, is biologically expressed by the collapse of plasma estradiol levels and increased plasma levels of the gonadotrophins FSH (follicle stimulating hormone) and LH (luteinizing hormone). At present, estimation of the ovarian follicle reserve is based on endocrine capacity tests of the ovaries, with increased FSH representing the first sign of exocrine ovarian failure. We report the case of one of our amenorrhoeic patients after chemotherapy, total body radiation and allogenic bone marrow transplantation for acute immunoblastic leukaemia. This patient was included in an in vitro fertilization with oocyte donation (IVF-OD) programme for iatrogenic premature ovarian failure with increased FSH levels. Instead of high levels of gonadotrophins, this young woman recovered spontaneous follicular development, benefited from standard IVF with her own oocytes and brought a twin pregnancy to term. This observation shows that a high FSH level is not a definitive prediction of ovarian exocrine capacity. In young women of child-bearing age such as these wanting a child and showing signs of endogenous estrogen impregnation, evaluation of the existence and quality of follicular development is an important factor.

Human interleukin for DA cells/leukaemia inhibitory factor (HILDA/LIF) is a cytokine with pleiotropic effects involved in successful murine implantation. We evaluated human uterine HILDA/LIF production by monitoring its in-vitro secretion by endometrial explant cultures obtained from individuals in either normal or pathological conditions. The cytokine secretion was standardized using the day 5:day 1 ratio of HILDA/LIF concentration in supernatants of such cultures, hereby termed HILDA/LIF production index (HLPI). Our results confirmed that HILDA/LIF is secreted by the human endometrium as assessed by secretion at every phase of the cycle in either normal fertile women, or women bearing intrauterine devices. This was also the case for samples obtained from infertile women presenting repeated failures of embryonic implantation or unexplained primary sterility. However, the HLPI were significantly lower in those latter two groups when compared to fertile women. These results suggest an abnormal regulation of HILDA/LIF secretion in such circumstances, and the clinical implication of those data is discussed.

By acting on the neuroendocrine system during the stress response, life events may greatly affect homeostasis and favor the appearance of disease. Here, we describe a relationship between stressful life events and premature ovarian failure. From a mechanistic point of view, we suggest an autoimmune origin for such premature ovarian failure on the basis of the role of cytokines in folliculogenesis and of their increased production during stressful life events.

We have studied from birth up to the 3rd year the psychological attitude of 33 in-vitro fertilization (IVF) children compared to two other groups: children born after ovarian stimulation without IVF (n = 33) and children conceived naturally (n = 33) during the same period. Fourteen children, born by oocyte donation, were also studied by the same methodology. In the IVF group, we found some feeding difficulties and sleep disorders in the infants at 9 months and some signs of depression in mothers. All these symptoms disappeared afterwards. The development of all the children is satisfactory and the relationship with their mother is excellent. In this preliminary study, we conclude that the method of assisted reproduction has no bad influence on the psychomotor development of these children.

We report the first case of full-term pregnancy arising from donated oocytes in a 36-year-old woman with chronic myeloid leukemia (CML), 6 years after allogeneic bone marrow transplantation (BMT) following total body irradiation (TBI) (12 Gy) and cyclophosphamide 120 mg/kg. The first attempt at implantation with her own cryopreserved ovocytes was unsuccessful. Thereafter, she became pregnant after donated oocyte implantation using estradiol and progesterone support replacing the defective ovarian function. The baby was normal. Unfortunately, 6 months later, she relapsed in chronic phase of CML.

Antimitotic chemotherapy and/or radiation therapy can induce a premature ovarian failure in women. The improvement of the prognosis of cancer and the increasing in long-term survival mean that preservation of fertility should be considered before initiating therapy. An embryo cryopreservation can be proposed if the circumstances allow that possibility. Ten young women were included in our program and benefited from an oocyte retrieval before cancer therapy. Nine of them had an embryo cryopreservation, and one without partner an oocyte cryopreservation. Three patients had an embryo replacement without success, and in one case, a spontaneous full-term pregnancy was obtained after ovarian detransposition through coelioscopy. In the future, oocyte cryopreservation could appear a more suitable answer. Actually, oocyte donation with estrogen and progesterone replacement therapy gives good results (in our experience, 23.2 per cent of ongoing pregnancies per transfer). Nevertheless, after treatment against cancer, a study of the uterus with its arteries, and a particular adaptation of the treatment are necessary because of the risks of tissue damage impairing the embryo implantation. Indeed, in fifteen patients included in this group, eight women had fourteen transfers unfortunately without success. Consequently, the seven other women underwent complementary examinations. Two embryos were replaced in one patient with a more adjustable treatment allowing a full-term pregnancy.

This study concerns 63 oocyte donors who were investigated after a semi-directed interview. In our procedure all "personalized anonymity" donation took place on two levels: symbolic donation for close recipient, real donation for unknown recipient. All donors agree with anonymity without which some would not have preceded. Narcissic weakness often linked with recent trauma (death...) is often seen in patients who do not achieve the gift. Oblativity and happy motherhood are the most important reasons for oocyte gift.

In vitro fertilization has obtained a foreground position in therapeutics proposed to infertile couples. Technical developments could be improved in the obstetrical and pediatric field through a better understanding of events occurring in embryos implantation, and through a specific management of the subsequent pregnancies.

This study concerns fifty patients who were investigated after a semi-directed interview. Several factors came to light: the type of couples who use assisted reproductive techniques (diagnostic and psychological profiles); the stability of the couple when failure and when success occurred; the hope of having a child and their ideas concerning the child's future; secrecy, questions that were asked concerning the practice of anonymity and non-anonymous donation of oocytes; the relationships between the recipients and the donors as well as the specific relationships that develop between the couples and their physicians. The conclusion reached from the studies show that the diagnoses of the various causes for sterility give rise to different problems. Donor anonymity makes it possible for the recipient to stamp their own pattern of identity on the child about to be born and make him part of their family history. Bringing the technique into conception of the child does not seem to interfere with the relationship between the couple and with their desire to have a child. The upbringing of the child is the responsibility of the couple.

The purpose of this study is to determine the production of some factors in pregnant women (n = 18) after oocyte donation and replacement therapy, in the three following situations: ongoing pregnancies, abortions, and biochemical pregnancies. In serum samples taken at least once a week during 16 weeks of theoretical amenorrhoea (w.a.) and preserved at - 80C, the concentrations of 6 chorionic gonatrophin hormone (PhCG), oestradiol (Ez), progesterone (P4), inhibin (I), growth hormone (OH), epidermal growth factor (EGF) and insulinlike growth factor 1 (IGF1) were measured. In ongoing pregnancies, the hCG curve is similar in oocyte donation and in pregnancies with a corpus luteum (CL). In early pregnancies, E2 and P4 reflect the hormonal substitution. The trophoblast production of E2 is detectable between the 6th and 7th w.a., and that of P4 at the beginning of the 9th w.a. The inhibin is detectable 10 days after the transfer and increases distinctly on the 6th w.a. The GH curve is lower in women suffering from premature ovarian failure (POF) than in pregnant women possessing a CL; EGF and IGFl curves are uniform.

A new protocol was developed to provide participants of our oocyte donation program with oocytes donated by donors who were not financially rewarded, were anonymous, and fertile. Each participant provided an oocyte donor selected among fertile friends or family members. The retrieved oocytes were anonymously exchanged between phenotypically matched donor-recipient pairs. In the first 30 months of activity, we obtained 111 embryos suitable for transfer or cryopreservation from 52 retrievals, and 40 embryo transfers (ETs) were performed. Recipients received oral Estradiol-valerate and vaginal micronized progesterone. Fifteen embryos were transferred fresh in 8 ETs conducted after donor-recipient synchronization. This resulted in four pregnancies, all ongoing (ongoing pregnancy rate 50% per transfer). Of the 96 cryopreserved embryos, 82 were thawed for ET, and 45 surviving embryos were transferred in 32 ETs. This resulted in eight pregnancies, with six ongoing or delivered (ongoing pregnancy rate 19% per transfer). The overall ongoing pregnancy rate of 25% per transfer indicates that our approach is a viable method for obtaining donated oocytes while respecting the ethical guidelines that recommend that donation of human gametes should be free, and from anonymous and fertile donors. Furthermore, guaranteeing anonymous oocyte donation had practical importance because, for many volunteer donors, it played a crucial role in their decision to donate.