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Resume Objectifs de l’etude – Evaluer l’acceptabilite, l’interet personnel et economique de l’auto-injection de FSH recombinante dans le cadre d’une stimulation mono-ovulante avant Insemination Intra-Uterine (IIU). Patientes et methodes – Patientes âgees de moins de 42 ans pour qui etait prevue une serie de trois IIU apres induction de l’ovulation par FSH, en raison d’une sterilite datant de plus de deux ans. Toutes avaient au moins une trompe permeable, des taux de FSH et d’estradiol normaux au troisieme jour du cycle. Au moins 106 spermatozoides mobiles progressifs avec un taux de survie superieur a10 % a 24 h pouvaient etre recueillis par un test de migration sur le sperme du conjoint. Des leur inclusion dans l’etude, les patientes assistaient (seules ou avec leur conjoint) a une seance d’apprentissage de l’auto-injection. Un questionnaire, complete apres chaque cycle par les femmes ayant pratique l’auto-injection. permettait l’evaluation de l’enseignement et des difficultes rencontrees au cours des cycles de traitement. Resultats – Pour quarante patientes traitees, 103 cycles complets (40 premiers cycles, 35 deuxieme cycles et 28 troisiemes cycles) ont permis de realiser 99 IIU et d’obtenir dix grossesses. Quatre cycles ont ete annules, soit en raison d’une chute prematuree de l’estradiol (n = 2), d’un risque de grossesse multiple (n = 1) ou a cause d’une ovulation spontanee (n = 1). Trois grossesses sont survenues spontanement entre deux cycles de traitement. Toutes les patientes ont ete satisfaites de la pratique de l’auto-injection sous-cutanee (par elles-memes ou par le conjoint) sans qu’il y ait eu de repercussion negative sur les resultats des cycles de stimulation. Elles ont accepte de continuer lors du cycle de traitement suivant. Conclusion – En s’administrant elles-memes la FSH, apres une rapide seance d’initiation a la pratique des injections sous-cutanees, les femmes ont apprecie non seulement de se sentir activement impliquees dans leur traitement, mais aussi d’acquerir ainsi une meilleure autonomie. Une participation des equipes medicales a un programme d’education peut permettre d’ameliorer les contraintes vecues par les femmes et leurs conjoints.

The objective of this study was to compare the efficacy and safety of a recombinant follicle stimulating hormone (FSH) preparation (Org 32489, Puregon) with a urinary FSH preparation (Metrodin) in infertile women undergoing in-vitro fertilization (IVF and embryo transfer and who were pituitary-suppressed with triptorelin. In an assessor-blind, group-comparative, multicentre study, 60 women were randomized to Org 32489 and 39 to urinary FSH. An evaluation of the main parameter, the mean total number of oocytes recovered, indicated a similar efficacy for the two preparations: 9.7 with Org 32489 versus 8.9 with urinary FSH. In addition, there were no significant between-group differences with respect to other efficacy variables such as the total dose used, the duration of the treatment, the number of follicles > or = 17 mm in diameter and embryo quality. The ongoing pregnancy rates per attempt (30.2 versus 17.4%) and per transfer (34.0 versus 18.8%) were higher with Org 32489, but this difference was not statistically significant. No clinically relevant differences between Org 32489 and urinary FSH were seen with respect to safety variables. Serum antibodies were not detected in any of the subjects. It is concluded that Org 32489 compares favourably with urinary FSH in the treatment of infertile pituitary-suppressed women undergoing IVF and embryo transfer.

Serum antithrombin (AT) and AT 3 content in plasma and serum were measured in 204 women taking either 50 or 30 mg of estrogenprogestogen preparations, or a progestogen only pill, to determine the estrogen content on antithrombin levels. AT 3 determination was done with the Mancini technique, and serum AT activity was measured by the van Kaulla method. 140 controls were also observed before oral contraception. Results of the study showed a decrease in serum AT 3 and in serum AT activity with combined pills containing 50 mg of ethinyl estradiol, but the decrease was not time-dependent after the 3rd. month of treatment. A relevant decrease was also observed with pills with a 30 mg. of estrogen content, while progestin only pills did not induce a decrease in either AT 3 or AT activity.

This report concerns 20 patients with intrauterine fetal death. Blood samples for coagulation studies were obtained before, during and after delivery. No clinical defibrination or bleeding was noted. Coagulation defects were observed as follows: 2 biological defibrinations: The first case was a pregnancy of 32 wk with retention for more than 12 wk; hypofibrinogenemia was noted in all 6 samples, between 180 and 280 mg/100 ml. The second was a pregnancy of 32 wk with retention for more than 8 wk; fibrinogenemia was between 170 mg/100 ml and 140 mg/100 ml. 2 intravascular coagulations with normal fibrinogenemia, increase of fibrin degradation products and positive ethanol tests. 3 cases with slight coagulation defects that were difficult to explain. The coagulation defects appeared to be transient, and sometimes resolved themselves spontaneously. Induction of labour was made in 19 cases; quinine sulfate, used in 17 cases, was remarkably successful (1 intolerance, 1 failure). Study of the half-life of [125I]fibrinogen was made in 18 of the 20 cases. On average, it was reduced by half in comparison with the half-life of healthy men. The decrease was noted even in cases of fetal deaths without the coagulation defects detected by classical tests. The half-life of [125I]fibrinogen in 6 pregnant women before therapeutic abortion was also studied. The decrease of half-life was noted. Changes of metabolism of fibrinogen during pregnancy are discussed.

Antithrombin III (AT III) has been investigated in women before tatting the pill and after 3 months Or more, between the 22nd and the 26th day of the menstrual Cycle. The oral contraceptives consistedinacombination of a progestogen with 30 to 50 ug of oestrogen, or in a progestogen - only pill.AT III was measured by the Hancini method in plasma an serum and the antithrombin activity in serum by the von Kaulla method.The results were obtained from 120 women before taking the pill, 189 taking an oestro-progestagen : containing 50 μg oestrogenin 96 cases, 30 μg in 65 cases, 30 to 40 μg according to the day of the cycle in 28 cases, and 20 women taking a progestagen-only pill.The results show a statistically significant decrease in AT III in plasma and serum, and in antithrombin activity with all the oestroprogestagens. No difference is found between 50 and 30 fig oestrogen content. With the progestogen-only pills, no decrease in AT III is observed.

The effect of a progestagen-only contraceptive preparation (R 2010) on antithrombin III activity was studied in 19 women taking the .35-mg preparation daily throughout their entire cycles. 140 women matched for age and not taking an oral contraceptive and 185 women taking a estrogen-progestagen preparation with 50 mcg of estrogen (123 cases) or 30 mcg of estrogen (62 cases) were the controls. All women were studied at the end of the cycle between the 17th and 21st day of the combined preparation after more than 3 months of treatment. R 2010 affected neither plasma nor serum antithrombin III; also the serum antithrombin activity was not altered in contrast to the decreases observed with 50- and 30-mcg estrogen preparations (95.5 controls 92.4 progestagen-only 56.3 50 mcg and 54.2 with the 30-mcg preparation; P < .001). It is concluded that estrogen or estrogen activity resulting from the metabolism of some progestagens was responsible for the decrease in antithrombin III seen in women taking oral contraceptives.