Search

International audience; Study question: What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ? Summary answer: Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved.What is known already: Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermalcontraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2C increase in testicular temperature (Mieusset & Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018). Study design, size, duration: We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections. Participants/materials, setting, methods: Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test. Main results and the role of chance: Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple’s contraception method immediately before TC (N-1) was a female method (n ¼ 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n ¼ 31/36, 86%) and the willingness to take responsibility for contraception (n ¼ 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n ¼ 59/63, 94%) and using a method regarded as “natural” (n ¼ 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n ¼ 59 men), they described: i) significantly improved sexual satisfaction (3,49§0,29/4) compared to that experienced with previous contraceptive methods (3,27§0,58/4;p

No último Congresso Internacional de Educação Matemática, CIEM (ICME, International Congress on Mathematical Education), no verão de 2004, participei de um grupo de discussão (DG10) em um painel no qual os palestrantes foram convidados a apresentar, a partir de suas próprias experiências, exemplos de variantes teóricas que foram tendência ou que tiveram continuidade.

Study question Among health professionals involved in contraceptive prescribing, what are the knowledge, professional attitudes and training on male contraceptive methods? Summary answer The health professionals involved in prescribing contraception are not sufficiently trained in male contraception and almost all of them want more. What is known already The most recent large-scale studies show that 70% of couple contraception is provided by women and that the majority of men and women would be willing to adopt male contraception as couple contraception. The medicalization of contraception places the medical profession at the forefront of the acceptability of and information regarding a contraceptive method. However, only one study have evaluated health professionals’ knowledge of the various methods of male contraception (MC), including male hormonal contraception (MHC) and male thermal contraception (MTC). Study design, size, duration Between April 2020 and June 2020, we carried out a descriptive prospective multicentre study in a medical population of 2243 prescribers of couple contraception in France. Participants/materials, setting, methods The participants were obstetrician-gynaecologists, medical gynaecologists, general practitioners or midwives. They completed a three-part numerical questionnaire, including i) sociodemographic characteristics and personal experiences with contraception, ii) knowledge and professional attitudes about male contraception and iii) training on male contraception. Main results and the role of chance The overall participation rate was 19% (340/2243). Condoms and withdrawal were known by 98% and 89% of the population, respectively. Vasectomy was known by 75% of the population and significantly better known by obstetrician-gynaecologists than by medical gynaecologists and general practitioners (p = 0.026). Male hormonal contraception (MHC) and male thermal contraception (MTC) were known by 10% and 23% of the population, respectively, and were significantly better known by medical gynaecologists and general practitioners than by other specialties (p Limitations, reasons for caution The population was mainly representative of medical health practitioners of southeastern France. There was an over-representation of women in all medical specialties, except for midwives. Wider implications of the findings: Our study shows that health professionals involved in contraception have limited knowledge about MC and are eager to have more information about it. To advance the acceptability and dissemination of such contraceptive methods, it seems imperative to provide health professionals with an adapted training program on male contraception. Trial registration number 2020–01–23–03

Resume Objectifs Chez 15 a 30 % des couples infertiles, aucune cause n’est retrouvee conduisant au diagnostic « d’infertilite inexpliquee ». Le but de notre etude a ete de rechercher des facteurs pronostiques de naissances vivantes apres fecondation in vitro (FIV) chez ces couples. Methodes Etude de cohorte retrospective, monocentrique, des couples pris en charge par FIV pour une infertilite inexpliquee avec un âge de la femme ≤ a 40 ans. L’analyse principale a compare les couples ayant eu une naissance vivante apres FIV versus les couples restant sans enfant apres FIV. Resultats Entre janvier 2014 et decembre 2018, 104 couples ont ete inclus, 196 ponctions ovariennes ont ete effectuees, suivies de 234 transferts d’embryons (frais et congeles), ayant permis l’obtention de 43 accouchements. Le taux cumulatif de naissances vivantes par couple etait de 40,4 %. Aucun facteur pronostique clinique ou paraclinique entre les deux groupes n’a pu etre identifie prealablement a la tentative de FIV. Cependant, l’analyse multivariee a montre plusieurs facteurs biologiques de bon pronostic en cours de traitement, tels qu’un nombre plus eleve d’ovocytes fecondables et d’embryons de meilleure qualitedans le groupe « naissance vivante ». Conclusions En cas d’infertilite inexpliquee, les chances pour un couple d’avoir un enfant apres FIV sont de 40,4 %. Aucune caracteristique clinique ne nous a permis d’identifier des elements pronostiques favorables ou defavorables chez ces couples avant leur prise en charge en AMP. En revanche, les facteurs pronostiques identifies en cours de tentative sont interessants pour conseiller ou non la poursuite des FIV.

International audience; Background: In a previous study, we showed that the obstetric complication rate after in vitro fertilization (IVF) pregnancy was 40%. The main objective of our study was to determine maternal prognosis factors that influence the IVF pregnancy outcome.Methods: We conducted an observational retrospective monocentric study between January 2014 and January 2018. Pregnancy over 22 gestational weeks (GW) obtained after IVF in our infertility clinic was included. Maternal characteristics and pregnancy outcome were collected.Results: Data from 498 IVF pregnancies were analyzed. The most significant maternal prognosis factors for obstetric complications were maternal age above 40 years (OR 3,0 [95% IC 1,30-7,09], P = 0,010), twin pregnancies (3.8 [95% IC 1.49-9.99], P = .005), daily maternal smoking above 10 cigarettes (7.1 [95% IC 1.22-41.74], P = .029), maternal obesity (2.2 [95% IC 1.19-4.07], P = .012), endometriosis stages III and IV (6.4 [95% IC 1.52-27.04], P = .011), and history of ovarian hyperstimulation syndrome (OHSS) in early pregnancy (5.7 [95% IC 1.29-24.74], P = .021). Risk increase was independent of pregnancy type (singleton or twin) and allowed the elaboration of 2 nomograms.Conclusions: Our study showed a link between some maternal factors and increase in obstetric complications after IVF. Screening of these factors during preconceptional visit is essential to identify at high-risk pregnancies and adapt their monitoring.

Resume S’il existe un spectre de 11 methodes contraceptives differentes pour les femmes, il n’y en a que 3 couramment utilisees par les hommes : le preservatif et le retrait, avec leur taux d’echecs eleves, ainsi que la vasectomie, consideree comme une methode irreversible. Depuis 40 ans, de nombreuses etudes ont ete realisees pour developper des contraceptifs masculins hormonaux et non hormonaux surs et efficaces. Bien qu’elles aient fait la preuve de leur efficacite, les contraceptions masculines hormonale et thermique restent encore peu utilisees. Les principes, protocoles, efficacite, reversibilite et acceptabilite de ces deux methodes sont presentees, ainsi que les elements pratiques, pour leur prescription et leur suivi. Nous decrivons egalement de nouvelles methodes en cours de developpement (contraceptifs hormonaux masculins oraux ou transdermiques, methodes d’occlusion deferentielle). D’autres recherches sont necessaires pour l’amelioration et la diffusion de methodes contraceptives masculines efficaces, reversibles et sures qui permettront aux hommes autant qu’aux femmes de jouer un role actif dans la planification familiale.

Lead readily crosses the placenta and displays adverse effects on birth outcomes and neurodevelopment. Systematic identification of the risk of exposure during pregnancy is essential but rarely performed, probably due to hospital staff&rsquo, s workload and their lack of awareness. We aimed to evaluate the relevance of a questionnaire to screen pregnant women for lead exposure. A cross-sectional, multicentre study was carried out on a population of 792 pregnant women from February 2018 to May 2020. A total of 596 women had a blood lead test: 68.5% had blood lead levels below 10 &mu, g/L. The estimated prevalence above 25 &micro, g/L was 4% (95% confidence interval (CI) [2.6&ndash, 5.9]) and 1.3% had levels above 50 &micro, g/L (95% CI [0.6&ndash, 2.6]). Multivariate analysis showed that three risk factors significantly increased the probability of blood lead levels above 25 &micro, g/L: the use of traditional cosmetics (adjusted odds ratio [aOR]: 3.90, 95% CI [1.65&ndash, 9.21], p = 0.002), degraded old housing (aOR: 2.67, 95% CI [1.19&ndash, 6.038], p = 0.018), and (marginally) eating bread more than twice a day (aOR: 2.40, 95% CI [0.96&ndash, 6.11], p = 0.060). Our study reveals that a three-question tool can be used to quickly screen for the risk of lead exposure in our population and to trigger lead blood tests and special vigilance during pregnancy follow-up.

Cerium dioxide nanomaterials (CeO2 NMs) are widely used in nano-based diesel additives to decrease the emission of toxic compounds, but they have been shown to increase the emission of ultrafine particles as well as the amount of released Ce. The Organization for Economic Cooperation and Development included CeO2 NMs in the priority list of nanomaterials that require urgent evaluation, and the potential hazard of aged CeO2 NM exposure remains unexplored. Herein, human and rat sperm cells were exposed in vitro to a CeO2 NM-based diesel additive (called EnviroxTM), burned at 850 &deg, C to mimic its release after combustion in a diesel engine. We demonstrated significant DNA damage after in vitro exposure to the lowest tested concentration (1 &micro, g&middot, L&minus, 1) using the alkaline comet assay (ACA). We also showed a significant increase in oxidative stress in human sperm after in vitro exposure to 1 &micro, 1 aged CeO2 NMs evaluated by the H2DCF-DA probe. Electron microscopy showed no internalization of aged CeO2 NMs in human sperm but an affinity for the head plasma membrane. The results obtained in this study provide some insight on the complex cellular mechanisms by which aged CeO2 NMs could exert in vitro biological effects on human spermatozoa and generate ROS.

ObjectiveTo examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis.MethodsThis retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate.ResultsSeventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13-6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage.ConclusionsEST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women.

Research question Is polycyclic aromatic hydrocarbon (PAH) exposure associated with the reproductive outcomes of IVF treatment? Design A prospective, small-scale monocentric cohort study of couples who underwent IVF treatment between January 2018 and June 2019. Both members of each couple answered a questionnaire on PAH exposure and provided urine samples to measure urinary 1-hydroxypyrene (1-OHP) the day before oocyte retrieval and semen collection for fertilization. To assess the specific PAH exposure of gamete cells, immunostaining was conducted on both spermatozoa and granulosa cells obtained during IVF with an anti-benzo(a)pyrene diol epoxide (BPDE) monoclonal antibody that recognizes BDPE-DNA adducts. To assess DNA damage, a comet assay on spermatozoa was conducted. The PAH exposure was compared between couples who had positive HCG and couples who had negative HCG on day 14 after embryo transfer. Results Eighteen couples were included. The mean 1-OHP level in women whose HCG tests were positive (n = 6) was significantly lower than that in women with negative HCG tests (0.098 [0.042–0.170] versus 0.177 [0.067–0.812] μg/g creatinine; P = 0.048). The presence of BPDE-DNA adducts in granulosa cells of women with a negative (29.7 [16.2–57.5] arbitrary units) or positive HCG test (20.3 [9.3–23.3] arbitrary units) were not significantly different (P = 0.092). The urinary 1-OHP levels of men and BPDE-DNA adducts in spermatozoa showed no differences between groups. Conclusions This exploratory research should encourage further studies to determine the effect of women's exposure to PAHs on reproductive outcomes of IVF treatment.

International audience; SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) metamorphosed our medical practice. In early June 2020, more than 6,400,000 COVID-19 (coronavirus-19 disease) cases were diagnosed across the world and more than 380,000 deaths were linked to COVID-19. Many medical symptoms of COVID-19 were reported. We will focus, here, on potential impacts of COVID-19 on men's andrological health. Our society (French-speaking society of andrology, SALF) also emitted some recommendations in the andrological management of men infected by SARS-CoV-2. First, considering the fever and the potential presence of SARS-CoV2 in semen, SALF recommends waiting for 3 months (duration of one spermatogenesis cycle and epididymal transit) before re-starting ART in the case of men diagnosed COVID-19 positive. Whatever the nature of testosterone and COVID-19 relationships, we recommend an andrological examination, sperm parameters, and hormonal evaluation at the time of the COVID-19 is diagnosed, and several months later. Furthermore, we are concerned by the potential morbid-mortality of the COVID-19, which mainly affects men. This "andrological bias", if proven, must be reduced by specific andrological diagnosis, therapeutic and prophylactic measures. Research in this direction must be substantiated and financially supported over the next few months (years).; Le SRAS-CoV-2 (nouveau coronavirus ou coronavirus numéro 2 responsable du syndrome respiratoire aigu sévère) a métamorphosé notre pratique médicale. Début juin 2020, plus de 6,400,000 cas de COVID-19 (maladie à coronavirus 2019) ont été diagnostiqués dans le monde et plus de 380,000 décès ont été reliés à cette maladie. De nombreux symptômes médicaux de cette infection virale ont été signalés. Nous nous concentrerons, ici, sur les impacts potentiels de COVID-19 sur la santé andrologique des hommes. Notre société (Société d’andrologie de langue Française, SALF) émet ici quelques recommandations dans la prise en charge andrologique des hommes infectés par le SRAS-CoV-2. Tout d’abord, compte tenu de la fièvre et de la présence potentielle du SRAS-CoV2 dans le sperme, la SALF recommande d’attendre 3 mois (durée d’un cyclede spermatogenèse et transit épididymaire) avant de recommencer les techniques d’assistance médicale à la procréation pour les hommes diagnostiqués COVID-19 positifs. Quelle que soit la nature des relations entre la testostérone et l’infection à SARS-CoV-2, nous recommandons un examen andrologique, un examen des paramètres du sperme et une évaluation hormonale au moment du diagnostic de l’infection, ainsi qu’à distance (3–6 mois plus tard). De plus, nous sommes préoccupés par la morbidité et la mortalité potentielles de l’infection COVID-19, qui touche principalement les hommes. Ce “biais andrologique”, s’il est. prouvé, doit être réduit par un diagnostic andrologique spécifique et des mesures thérapeutiques et prophylactiques.La recherche dans ce sens doit être étayée et soutenue financièrement au cours des prochains mois (années).

ObjectiveWe sought to determine whether the early luteal serum progesterone (P4) level predicts the success of IVF treatment with oral dydrogesterone for luteal support.MethodThis retrospective monocentric cohort study included 242 women who underwent IVF treatment with fresh embryo transfer (ET) between July 2017 and June 2018. The population was unselected, and women were treated according to our unit's usual stimulation protocols. For the luteal phase support (LPS), all women were supplemented with a 10 mg three-times-daily dose of oral dydrogesterone beginning on the day of oocyte pick-up (OPU). Blood sampling was performed on the day of ET (Day 2-3 after OPU) to determine the early luteal serum progesterone level.ResultsROC curve analysis allowed us to determine two thresholds for the prediction of live birth using the early P4 level. Women who had early luteal P4 levels greater than 252 nmol/l had a significantly higher live birth rate (27.1%) than women with early luteal P4 between 115 and 252 nmol/l (17.2%) and women with early luteal P4 below 115 nmol/l (6.0%; p = 0.011). After a multiple regression analysis, an early luteal P4 level greater than 252 nmol/l was still associated with a higher chance of a live birth than a P4 between 115 and 252 nmol/l (OR = 0.40 [0.18-0.91]; p = 0.028) or a P4 below 115 nmol/l (OR = 0.10 [0.01-0.52]; p = 0.006).ConclusionsOur study suggests a positive association between early P4 levels and reproductive outcomes in IVF using oral dydrogesterone for luteal support. The inconsistencies between our results and those of other studies suggest that extrapolation is impractical. Further larger prospective cohort studies should be conducted to determine reliable thresholds that could be used to personalize luteal phase support.

International audience; Steroidogenic acute regulatory protein (StAR) mutations are the most frequent aetiologies of congenital lipoid adrenal hyperplasia (CLAH). Phenotypes may vary, and puberty may be absent in affected individuals. To date, only two pregnancies have been described in 46,XX CLAH patients with StAR mutations; these patients exhibited ovarian steroidogenesis along with spontaneous puberty and menarche and normal menses. The patient described here presented with CLAH caused by the homozygous (unreported, 1 bp) deletion c.719del in the StAR gene, which was diagnosed after acute adrenal insufficiency when the patient was 10 days old. The patient did not undergo spontaneous puberty, so puberty was induced by HRT when the patient was 13 years old. At the age of 25 years, the patient was referred to our reproductive unit because she desired to conceive. An initial cycle of clomiphene, stimulation produced follicular growth with two mature follicles measuring 18 and 15 mm, respectively, but the plasma oestradiol levels remained low (18 pg/ml) and the endometrium was thin (3 mm). Pregnancy was finally achieved after ovarian stimulation, IVF and transfer of frozen-thawed embryos after endometrial preparation with HRT. A normal female child was delivered following a 40 weeks' uneventful pregnancy. We therefore report the first IVF pregnancy achieved in a 46,XX CLAH patient homozygous for a StAR mutation, with inadequate ovarian steroidogenesis and no spontaneous puberty.

Resume Objectifs Etudier la dimension sociale de l’infertilite feminine liee a l’âge a travers l’analyse de trois points principaux : les parcours de vie des femmes infertiles âgees de plus de 40 ans ; leurs representations de leur âge et du fait de vouloir mener une grossesse apres 40 ans ; leurs opinions de la legislation francaise encadrant l’AMP concernant les limites d’âge, le don d’ovocyte et l’autoconservation ovocytaire pour raisons non medicales. Methodes Etude sociologique qualitative par entretiens semi-directifs aupres de femmes infertiles de plus de 40 ans en parcours d’AMP. Les entretiens etaient composes de 3 parties : l’histoire personnelle et conjugale, le vecu de l’âge, des questions d’opinions. Resultats Vingt-trois entretiens d’une duree allant de 1 h 30 a 2 h 30 ont ete effectues. Loin d’avoir un profil homogene, les femmes rencontrees ont eu des parcours de vie tres differents, expliquant leur desir de grossesse non abouti apres 40 ans. Des le debut du projet parental, elles entreprennent « une course contre la montre ». Un sentiment d’urgence accompagne leur parcours, lie a l’imperatif pour elles de ne pas etre trop âgees pour leur futur enfant. Elles sont majoritairement favorables a un assouplissement du cadre legal bioethique francais dans le sens ou cela leur permettrait d’eviter d’aller a l’etranger poursuivre leur parcours d’AMP. Conclusion Les profils etudies temoignent d’un decalage croissant entre les temporalites biologique et biographique, ainsi que d’une non-maitrise du recul du desir d’enfant. Face a ce decalage, le don d’ovocyte et l’autoconservation ovocytaire leur apparaissent comme des solutions envisageables.

Introduction Ovarian reserve is a major prognosic factor for Medical Assisted Procreation. Tubal surgery, realised close to mesosalpinx and ovarian vascularization, could impare ovarian function. However, salpingectomy is currently used to treat ectopic pregnancies or hydrosalpinx before IVF attempt. Disponible studies on this subject are unclear. The aim of this study is to evaluate the impact of salpingectomy for ectopic pregnancy on the ovarian response during IVF attempt. Material and methods It was a single center comparative study. Included patients were the one receiving oocyte puncture for IVF attempt, with a history of unilateral tubal surgery: salpingectomy for ectopic pregnancy. We conducted a case-control study, comparing the sonographic parameters of the surgery ovary (case) to those of the safe ovary (control) during the first IVF attempt after salpingectomy. The ovarian sonographic response was evaluated according to the follicular antral count on day 3 and the sonographic follicular count on trigger day. Results 55 patients were included. There was no significant difference in the number of recruited follicles on the operated side versus control side (p = 0.85 for >14 mm follicles, p = 0,46 for 10 to 14 mm, p = 0,52 for total amount of recruited follicles). There was no significant difference for the follicular antral count neither (p = 0.79). Discussion In our population, there was no significant difference in the sonographic ovarian response to IVF stimulation between the ovary on the operated side and the control ovary among patients treated by unilateral salpingectomy for ectopic pregnancy.

International audience; Objectives: Pregnancy rate in in vitro fertilization (IVF) depends on many factors, such as the characteristics of the couple and the clinicobiological parameters. Interest in alternative and complementary medicine (ACM) for IVF is discussed because of the lack of scientific evidence. Energy resonance by cutaneous stimulation (ERCS), an acupuncture-like technique, consists of skin stimulation to transmit vibratory messages. The aim of this study was to evaluate the effect of ERCS on live birth rates (LBRs) in IVF. Design: A prospective observation study was performed in the Unit of Assisted Reproductive Technologies of a University Teaching Hospital. Every woman who agreed to participate in this study and received a fresh embryo transfer (ET) after IVF or Intracytoplasmic Sperm Injection (ICSI) was included. Patients randomly underwent an ERCS session on the day of ET according to the schedule of the midwife performing this technique. The control group consisted of women undergoing ET under usual conditions. The main outcome measure was the LBR per transfer. Results: Three-hundred-eighteen women were included, 120 in the ERCS + ET group and 198 in the ET without ERCS group. None of the women dropped out. The clinical characteristics in both groups were comparable. There was a significant difference in the clinical pregnancy rates, 31.7% in the ERCS group versus 21.7% in the No ERCS group (p = 0.037). The LBR in the ERCS group was nearly significantly higher, 29.2% versus 20.7% in the No ERCS group (p = 0,059). Conclusions: Women undergoing ERCS on the day of ET had a significantly higher IVF pregnancy rate. However, this methodology made not possible to draw conclusions about the mechanisms that induced the increase of IVF LBRs: placebo effect, ''cocooning,'' or ERCS self-effect? Further well-conducted studies are strongly needed to assess ERCS efficacy.

Alteration of sperm parameters related to occupational exposures is the subject of several studies, often on a case-control approach. The study populations usually comprise men consulting in infertility clinics for couple infertility. The objective of this review is to identify, from these case-control studies, the main occupational factors that may be associated with altered sperm parameters. We selected 13 articles in the PubMed database. Participation in these studies varied from 61 to 2619 subjects, with great methodological heterogeneity, particularly in the characterization of exposure. The main occupations that appear significantly associated with a risk of altered sperm parameters are workmen, painters, farriers, welders, plumbers and technicians. When analysis focuses on occupational exposures, a significant result is reported for solvents, heavy metals, heat, vibrations and non-ionizing radiation. None of the selected studies has found a link with exposure to pesticides. (C) 2015 Elsevier Masson SAS. All rights reserved.

International audience

International audience; Cerium dioxide nanoparticles (CeO 2 NP) are widely used for industrial purposes, as in diesel, paint, wood stain and as potential therapeutic applications. The Organization for Economic Cooperation and Development included CeO 2 NP in the priority list of nanomaterials requiring urgent evaluation. As metal nanoparticles can cross the blood-testis barrier, CeO 2 NP could interact with spermatozoa. The genotoxicity of CeO 2 NP was demonstrated in vitro on human cell lines and mouse gametes. However, the effects of CeO 2 NP on human spermatozoa DNA remain unknown. We showed significant DNA damage induced in vitro by CeO 2 NP on human spermatozoa using Comet assay. The genotoxicity was inversely proportional to the concentration (0.01 to 10 mg·L −1). TEM showed no internalization of CeO 2 NP into the spermatozoa. This study shows for the first time that in vitro exposure to very low concentrations of cerium dioxide nanoparticles can induce significant DNA damage in human spermatozoa. These results add new and important insights regarding the reproductive toxicity of priority nanomaterials, which require urgent evaluation.

International audience; Objectives: Solvent exposure is among the most common occupational exposures to chemical toxicants; data about the impact of such exposure on semen parameters are contradictory. We conducted the first meta-analysis to evaluate the risk of alteration in semen parameters related to occupational exposure to solvents. Methods: From the PubMed database, we selected studies analyzing the semen of subjects occupationally exposed to solvents, compared with unexposed controls. The meta-analysis was performed on the various semen parameters analyzed in both populations. Results: Seven studies were included in the study. The meta-analysis revealed a significant decrease in ejaculate volume [standardized mean difference (SMD) ¼ À0.35 (À0.63 to À0.07)] and sperm concentration [SMD ¼ À0.36 (À0.64 to À0.08)] in workers exposed to solvents compared with unexposed controls. Conclusion: Our results highlight the importance of preventing reprotoxic risks to male fertility in the workplace.

Nanoparticles (NPs) are sized between 1 and 100 nm. Their size allows new nanoscale properties of particular interest for industrial and scientific purpose. Over the past twenty years, nanotechnology conquered many areas of use (electronic, cosmetic, textile...). While, human is exposed to an increasing number of nanoparticles sources, health impacts and, particularly on reproductive function, remains poorly evaluated. Indeed, traceability of nanoparticles use is lacking and nanotoxicology follows different rules than classical toxicology. This review focuses on the impact of NPs on health and particularly on fertility and addresses potential risks of chronic exposure to NPs on human fertility. (C) 2014 Elsevier Masson SAS. All rights reserved.

International audience; Le secteur de la cosmétique, employant très majoritaire-ment des femmes, expose a ` de nombreux risques professionnels. La prévention des risques potentiels pour la reproduction est donc un enjeu important. Nous avons conduit une enquête auprès des médecins du travail, en charge de salons de coiffure ou d'esthétique, afin de mieux connaıˆtreconnaıˆtre leurs pratiques, leurs ressources et leurs difficultés dans la démarche de prévention visa `-vis des femmes en a ˆge de procréer ou enceintes. Méthode. Un questionnaire spécifique a e ´té construit et les méde-cins du travail de la région PACA ont e ´té invités a ` y répondre en ligne, via la liste de diffusion de la société régionale de médecine et santé au travail comptant 257 médecins. Résultats. Parmi les 92 médecins ayant répondu, 46 ont déclaré e ˆtre en charge du suivi de coiffeuses, esthéticiennes et/ou prothé-sistes ongulaires. Parmi ceux-ci, huit seulement ont déclaré avoir e ´té confrontés a ` des questions en rapport avec la grossesse chez les salariées de ce secteur. Cependant, l'ensemble des médecins ont mis en avant les difficulte´s rencontre´es dans l’identification des composants des produits cosmétiques et l’évaluation du risque reprotoxique. Ils ont également identifie´ les contraintes posturales comme risque professionnel majeur chez ces salarie´es.Discussion et conclusion. Il apparaıˆt que la pre´vention des risques professionnels (information, formation, équipements de protection. , notamment en lien avec la grossesse, pourrait être améliorée. Les dispositions relatives a` la protection des femmes enceintes au travail (ame´nagement de poste, changement temporaired’affectation, suspension du contrat de travail avec garantie de rénumération. . .) semblent ne pas être fréquemment mises en oeuvre dans le secteur de la cosmétique. Par ailleurs, les connaissances sur les risques des expositions professionnelles pour la reproduction dans ces métiers sont encore insuffisantes. De nouvelles étudessemblent donc nécessaires afin de compléter les données actuelles

BACKGROUND: The purpose of this retrospective observational study was to identify prognostic factors that lead to a live birth (LB) in couples with unexplained infertility in order to define the best assisted-reproductive technique (ART) strategy. METHODS: Prognostic factors of couples with unexplained infertility managed initially with gonadotropin intrauterine inseminations (IUI) at a single university fertility center were analyzed. Infertility was not considered “unexplained” in case of mild male infertility and suspicion of diminished ovarian reserve (FSH>10 IU/L). ART management consisted to start with IUI cycles and then, if failure, to propose in vitro fertilization (IVF). Couples were compared according to the results of IUI cycles in terms of LB. RESULTS: Between January 2011 and July 2015, 133 couples with unexplained infertility were included (320 IUI cycles). The average age of women was 31.6±4.6 years and the average number of IUI per couple was 2.4±1.2. The IUI live birth rate (LBR) was 37.6%, with an average of 2 cycles to obtain a pregnancy. For 63 couples, no pregnancy occurred after IUI cycles. The prognostic factors of the two groups “LB after IUI” vs. “no LB after IUI” were not statistically different. The remaining 20 couples had a spontaneous pregnancy with a LB. Cumulative LBR, including spontaneous and ART pregnancies, was 65.7 %. Of the 63 couples with no LB after IUI, 33.3% dropped-out from infertility treatments before starting IVF. CONCLUSIONS: To avoid couple’s drop-out, we advise to start infertility treatment for unexplained infertility with two IUI before undergoing IVF if IUI failure.

En France, environ 24 % des couples sont concernes par une infertilite au bout de 12 mois sans contraception ; les causes etant autant d’origine feminine que masculine. Plusieurs facteurs environnementaux sont connus comme pouvant alterer les parametres spermatiques. Depuis 10 ans au CHU de Marseille, la realisation du spermogramme pour bilan d’infertilite de couple est precedee d’une enquete environnementale en vue d’identifier d’eventuels facteurs de risque. Cette communication decrit les expositions reprotoxiques d’une population de 2444 patients recrutes dans ce centre. Materiels et methodes Les expositions sont recueillies a l’aide d’un questionnaire lors de l’entretien medical precedant le recueil de sperme. Le spermogramme est realise et interprete selon les recommandations de l’OMS. Les professions sont codees selon la CITP-08. Sont exclus de la base de donnees les patients presentant des causes medicales connues d’infertilite. Resultats Parmi les 2444 patients, 80 % presentent un spermogramme anormal. L’âge moyen est de 35,8 ans ± 7,3. La proportion de fumeurs est de 48 % et 12 % declarent consommer du cannabis. Les professions les plus representees sont les metiers qualifies de l’industrie et de l’artisanat (24 %), principalement dans le BTP, puis les personnels des services directs aux particuliers et commercants (14 %), les professions intermediaires (14 %), les professions intellectuelles (13 %) et les professions elementaires (11 %). Au total, 33 % des patients declarent une exposition professionnelle a au moins un produit chimique, avec, par ordre de frequence, les solvants (15 %), le ciment (12 %), puis les colorants, gaz/fumees, hydrocarbures aromatiques polycycliques, pesticides et metaux. Concernant les facteurs physiques, 31 % des patients sont exposes a des vibrations, 27 % a la chaleur et 27 % ont des postures assises prolongees. Discussion et conclusion La recherche systematique d’expositions environnementales, notamment professionnelles, chez les hommes infertiles permet de reperer certains facteurs susceptibles d’etre reprotoxiques. La proportion de sujets exposes aux agents chimiques dans cette population est en coherence avec les chiffres de SUMER 2010. La prevention vis-a-vis de ces facteurs peut ameliorer la prise en charge en pratique clinique. Cette approche, developpee au CHU de Marseille par la mise en place d’une plateforme pluridisciplinaire CREER (Couple Reproduction Enfant : Environnement & Risque), s’appuie egalement a present sur la constitution d’un reseau au niveau national. Il importe en effet de developper des outils mutualises pour optimiser la caracterisation des expositions et renforcer la collaboration entre medecins du travail et de la reproduction.

Introduction Parmi les expositions professionnelles a des toxiques chimiques, l’exposition aux solvants est parmi les plus frequentes. Plusieurs etudes mettent en evidence l’impact des solvants sur la spermatogenese mais les donnees sont souvent contradictoires. Nous avons conduit une meta-analyse pour evaluer le risque d’alteration des parametres spermatiques en rapport avec l’exposition professionnelle a differents types de solvants. Materiels et methodes A partir de la base de donnees PubMed, nous avons selectionne les etudes analysant les spermogrammes de sujets exposes professionnellement aux solvants, comparativement a des temoins non exposes. La meta-analyse a ete realisee a l’aide du logiciel STATA statistical software, a partir des effectifs des populations (exposees et non exposees) et de la distribution (moyenne et ecart-type) des differents parametres spermatiques analyses. Les resultats sont exprimes en difference moyenne standardisee (DMS), associee a son intervalle de confiance a 95 % [IC 95 %]. Resultats Sept etudes ont ete incluses dans la meta-analyse (272 exposes et 247 non exposes). Pour 4 d’entre elles, les resultats montrent une alteration significative d’au moins un parametre spermatique. La meta-analyse revele, chez les travailleurs exposes aux solvants comparativement aux temoins non exposes, une diminution significative du volume de l’ejaculat (DMS = −0,35 [−0,63 ; −0,07]) et de la concentration en spermatozoides (DMS = −0,36 [−0,64 ; −0,08]). La morphologie, la mobilite et la vitalite des spermatozoides apparaissent egalement diminuees mais de facon non statistiquement significative. Discussion et conclusion Il s’agit de la premiere meta-analyse sur cette question. Elle porte sur un faible nombre d’etudes disponibles. Ces dernieres concernent differents types de solvants : ethers de glycol, perchlorethylene, hydrocarbures aromatiques, N,N-dimethylformamide, disulfure de carbone. Cette meta-analyse demontre un effet deletere de l’exposition professionnelle aux solvants sur les parametres spermatiques, avec une diminution significative du volume et de la concentration. Ces resultats soulignent l’importance de la prise en compte et de la prevention des risques reprotoxiques sur la fertilite masculine en milieu de travail.

Objectifs L’objectif de cette etude etait de presenter la prise en charge globale des blesses medullaires dans notre centre, depuis le recueil de sperme pour preservation de la fertilite jusqu’au resultats de l’utilisation des paillettes en aide medicale a la procreation (AMP). Methodes Il s’agissait d’une etude descriptive retrospective monocentrique incluant tous les hommes blesses medullaires adresses dans notre Centre d’etude et de conservation des œufs et du sperme humains (CECOS) entre 2002 et 2018 pour preservation de la fertilite et/ou desir de paternite immediat. Les caracteristiques generales de la population etaient analysees ainsi que le detail des lesions medullaires. Le sperme etait recueilli par voie anterograde et/ou retrograde par technique de Hotchkiss modifiee soit apres masturbation, soit apres stimulation vibratoire penienne (SVP) soit enfin apres prelevement chirurgical. Les tentatives d’AMP etaient ensuite realisees en fonction du projet parental, des parametres spermatiques et des facteurs feminins. Resultats Cent vingt-deux patients ont ete inclus dans l’etude avec un âge median de 31 ans au moment de la prise en charge. Le delai median entre la lesion medullaire et le debut de la prise en charge etait de 3,09 ans. Vingt-sept couples (22 %) avaient des antecedents de fertilite avec 29 grossesses et 19 parites. Soixante-six (54 %) patients consultaient pour preservation de leur fertilite alors que 52 d’entre eux (43 %) avaient deja un desir d’enfant. Au total, 346 tentatives de recueil de sperme ont ete realisees conduisant a 183 (53 %) essais fructueux (18/26 par masturbation, 143/297 par SVP et 22/23 par chirurgie). Au total, 1028 paillettes ont pu etre congelees. Trente-huit couples ont pu beneficier de tentatives d’AMP ayant conduit a 25 grossesses et 18 naissances vivantes. Conclusion La prise en charge des blesses medullaires a permis de preserver la fertilite de 122 patients et d’obtenir un taux de naissance cumule de pres de 50 %. Une collaboration formalisee entre centres de reeducation, urologues et biologistes de la reproduction permettrait de proposer une information systematique et une prise en charge en AMP adaptee au niveau lesionnel.

L’incidence des cancers augmente et concerne des sujets de plus en plus jeunes. En parallele, les taux de survie augmentent mais souvent au prix d’une sterilite induite par la gonadotoxicite de nombreux traitements et un risque de mutagenicite. Les techniques de preservation sont simples et les resultats obtenus apres reutilisation en Assistance medicale a la procreation (AMP) sont satisfaisants. L’information du patient sur les possibilites de preservation de la fertilite est une obligation legale pour tout medecin avant le demarrage d’un traitement potentiellement sterilisant. L’amelioration de la qualite de vie apres la guerison doit egalement inciter les oncologues a proposer a leurs patients une telle preservation afin de leur offrir des chances suffisantes de paternite ulterieure.

International audience; Our objective was to optimize the CA technique on mammal embryos. Materials and methods: 1000 frozen 2-cell embryos from B6CBA mice were used. Based on a literature review, and after checking post-thaw embryo viability, the main outcome measures included: 1) comparison of the embryo recovery rate between 2 CA protocols (2 agarose layers and 3 agarose layers); 2) comparison of DNA damage by the CA on embryos with (ZP +) and without (ZP−) zona pellucida; and 3) comparison of DNA damage in embryos exposed to 2 genotoxic agents (H 2 O 2 and simulated sunlight irradiation (SSI)). DNA damage was quantified by the % tail DNA. Results: 1) The recovery rate was 3,3% (n = 5/150) with the 2 agarose layers protocol and 71,3% (n = 266/ 371) with the 3 agarose layers protocol. 2) DNA damage did not differ statistically significantly between ZP − and ZP+ embryos (12.60 ± 2.53% Tail DNA vs 11.04 ± 1.50 (p = 0.583) for the control group and 49.23 ± 4.16 vs 41.13 ± 4.31 (p = 0.182) for the H 2 O 2 group); 3) H 2 O 2 and SSI induced a statistically significant increase in DNA damage compared with the control group (41.13 ± 4.31% Tail DNA, 36.33 ± 3.02 and 11.04 ± 1.50 (p < 0.0001)). The CA on mammal embryos was optimized by using thawed embryos, by avoiding ZP removal and by the adjunction of a third agarose layer.

International audience; Purpose Does the type of anesthesia (paracervical block (PCB) or general anesthesia (GA)) impact live birth rate, pain, and patient satisfaction? Methods A non-randomized prospective cohort study was conducted in women treated for IVF. Two groups of patients were prospectively included: the PCB group (n = 234) and the GA group (n = 247). The type of anesthesia was determined by the patients. The primary endpoint was cumulative live birth rate by OR. Secondary endpoints were self-assessment of the patients' peri-operative abdominal and vaginal pain vs the doctors' evaluations during PCB, post-operative abdominal and vaginal pain level, and patient satisfaction in both groups. Pain levels were assessed with a numerical rating scale (NRS). Results The live birth rate was similar in both groups (19.8% in the GA group vs 20.9% in the PCB group, P = 0.764). During oocyte retrieval in the PCB group, the physicians significantly under-estimated the vaginal pain experienced by the patients (3.04 +/- 0.173 for patients vs 2.59 +/- 0.113 for surgeons, P = 0.014). Post-operative vaginal and abdominal pain were significantly greater in the PCB group compared to the GA group (2.26 +/- 0.159 vs 1.66 +/- 0.123, respectively, P = 0.005, and 3.80 +/- 0.165 vs 3.00 +/- 0.148, respectively, P < 0.001). Patients were more significantly satisfied with GA than with PBC (P < 0.001). Conclusion Because the LBR was similar in both groups and patient satisfaction was high, the choice of anesthesia should be decided by the patients.

International audience; Studies suggest a relationship between semen quality and the concentration of trace elements in serum or seminal plasma. However, trace elements may be linked to DNA and capable of altering the gene expression patterns. Thus, trace element interactions with DNA may contribute to the mechanisms for a trans-generational reproductive effect. We developed an analytical method to determine the amount of trace elements bound to the sperm DNA, and to estimate their affinity for the sperm DNA by the ratio: R = Log [metal concentration in the sperm DNA/metal concentration in seminal plasma]. We then analyzed the concentrations of 15 trace elements (Al, Cd, Cr, Cu, Hg, Mn, Mo, Ni, Pb, Ti, V, Zn, As, Sb, and Se) in the seminal plasma and the sperm DNA in 64 normal and 30 abnormal semen specimens with Inductively Coupled Plasma/Mass Spectrometry (ICP-MS). This study showed all trace elements were detected in the seminal plasma and only metals were detected in the sperm DNA. There was no correlation between the metals’ concentrations in the seminal plasma and the sperm DNA. Al had the highest affinity for DNA followed by Pb and Cd. This strong affinity is consistent with the known mutagenic effects of these metals. The lowest affinity was observed for Zn and Ti. We observed a significant increase of Al linked to the sperm DNA of patients with oligozoospermia and teratozoospermia. Al’s reproductive toxicity might be due to Al linked to DNA, by altering spermatogenesis and expression patterns of genes involved in the function of reproduction.

International audience; Objective: To evaluate the percentage of parents in one French center for the study and preservation of eggs and sperm who disclose their use of donated spermatozoa to their children.Design: A questionnaire survey of couples who had a child using donated spermatozoa.Setting: University hospital laboratory.Patient(s): One hundred five couples.Intervention(s): Questionnaire sent by mail.Main Outcome Measure(s): The percentage of parents who disclose their use of donated spermatozoa to their child.Result(s): Among the 157 questionnaires sent, 105 couples answered, which corresponded to 138 children. There were 40 (38%) couples who had already disclosed the donor origin to their child and 65 (62%) who had not. Of the 40 couples who disclosed the donor origin, 37 (93%) had intended to do so before making use of assisted reproductive techniques (ART), but two (5%) had not wanted to do so before ART. Among the 65 couples who did not inform their child, 42 (65%) planned to inform their child soon, but 20 (31%) wanted to keep the sperm origin secret. Of the 20 couples who wanted to keep the origin secret, nine couples had told other persons about the gamete donation but had not informed their child and do not intend to inform their child in the future.Conclusion(s): This first report about disclosure attitude in a large cohort of parents of donor-conceived offspring in France showed that most parents had already disclosed their use of donated spermatozoa to their children or intended to disclose it soon and had an attitude after birth consistent with their intentions prior to ART.

International audience; Objective: The aim of this study was to evaluate the information pregnant women received regarding possible exposures to five recognized reprotoxic agents during their pregnancy. Study design: A cohort study was conducted using two postnatal units in France. Women hospitalized in postnatal units were requested to complete a self-administered two part questionnaire. The first part gathered information about the patient's socio-professional level and the type of pregnancy follow-up. The second part examined the information the patient received regarding daily products containing the following known reprotoxic agents: bisphenol A, toluene, n-hexane, cis-chloroallyl-triaza-azonia-adamantane-chloride and O-phenyl-phenol. The women cited the sources of information. We combined the employment status and educational level to separate the women into two groups. The groups were then compared using the Chi Square test or Fisher's exact test. Result(s): There were 390 women in this study. Our results showed the women received information regarding the following: 21.6% (n=84) regarding tin cans, 21.9% (n =85) concerning plastic meal boxes when heated in microwave ovens, 8.8% (n=32) about water in gas-bottles, 27.4% (n=106) about non organic foods, 39.3% (n= 152) about hair dyes, 17% (n = 66) about nail polishes, 23.4% (n =103) about insect repellents, 34.4% (n=133) about “do-it-yourself” products, 2.1% (n=8) about gardening products, 26.7% (n=103) about electric plug-in repellents, 21.1% (n= 81) about housekeeping products, and 6.8% (n= 26) about register receipts. Women with a higher level of education and a qualified occupation were better informed about these daily products. These women were more likely to learn the information on their own (internet, media). Conclusion(s): Our study showed French women did not receive sufficient information regarding potential exposures to reprotoxic agents during pregnancy. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

International audience; Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.