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Objective: Unexplained infertility is defined by the absence of identifiable causes of infertility. The results of randomized studies and meta-analysis regarding the treatment of unexplained infertility are discordant due to methodological problems., Design: The aim of this study is to compare the clinical pregnancy rate per cycle (CPR/c) in IUI and IVF/ICSI in cases of unexplained infertility, according to the woman's age group and to identify the factors which predict success., Interventions: We performed a retrospective study in two ART centers, comparing overall clinical pregnancy, ongoing pregnancy and live birth rates in IVF/ICSI and IUI. We also compared pregnancy and birth rates according to different female age groups., Results: 855 IVF/ICSI and 804 IUI cycles were compared. We found a significant difference (p < 0.001) in the pregnancy and live birth rates per cycle between IUI and IVF/ICSI, overall and in the different female age groups, except in women aged 40 and over. The greatest chances of pregnancy with IUI are found in women with secondary unexplained infertility, during the first two cycles and with a bi-follicular response to stimulation. In IVF/ICSI, pregnancy rates are higher in women with secondary unexplained infertility, in the first two cycles, in IVF and in women receiving a transfer of two embryos regardless of the embryonic stage., Conclusion: We recommend IVF/ICSI treatment rather than IUI for unexplained infertility (OR CPR/c 4.20 with 95% CI [3.72-4.68]). This is in accordance with NICE, which advises the use of IVF after 2 years., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist-FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models' calibration was excellent (coefficients: 0.943-0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy.

Objective To investigate the effect of anticoagulant treatment on pregnancy outcomes in patients with previous recurrent miscarriages (RM) who carry a methylenetetrahydrofolate reductase ( MTHFR) gene mutation. Methods In this longitudinal retrospective study, patients with RM were treated during pregnancy with either: (i) 100 mg/day aspirin and 5 mg/day folic acid (group 1); or the same protocol plus 0.4 mg/day enoxaparin (group 2). An age-matched group of triparous women without RM or thrombophilia was used as the control group (group 3). Results This study enrolled 246 women with RM (123 per treatment group) and age-matched controls ( n = 117). The delivery rate was significantly lower in group 1 than group 2 (46.3% versus 79.7%, respectively). The miscarriage rate was significantly lower in group 2 compared with group 1 (20.3% versus 51.2%, respectively). In the control group 3, the delivery rate was 86.3% and the miscarriage rate was 12.8%. Conclusion Treatment with low-dose aspirin, enoxaparin and folic acid was the most effective therapy in women with RM who carried a C677T MTHFR mutation.

Objective: To evaluate the IUI success factors relative to controlled ovarian stimulation (COS) and infertility type, this retrospective cohort study included 1251 couples undergoing homologous IUI., Results: We achieved 13% clinical pregnancies and 11% live births. COS and infertility type do not have significant effect on IUI clinical outcomes with unstable intervention of various couples' parameters, including the female age, the IUI attempt rank, and the sperm quality., Conclusion: Further, the COS used seemed a weak predictor for IUI success; therefore, the indications need more discussion, especially in unexplained infertility cases involving various factors. Indeed, the fourth IUI attempt, the female age over 40 years, and the total motile sperm count <5 × 10 6 were critical in decreasing the positive clinical outcomes of IUI. Those parameter cut-offs necessitate a larger analysis to give infertile couples more chances through IUI before carrying out other ART techniques.

Background: In patients treated with IVF, the incidence of poor ovarian response (POR) after ovarian stimulation varies from 9 to 25 %. However, at present, there are no clear guidelines for treating these poor responders. This study was designed to compare two different ovarian stimulation protocols and addresses future perspectives in the management of these unfortunate patients., Method: Four hundred and forty poor responders were studied during their second IVF cycle. They had all failed to become pregnant during their first IVF cycle where the long GnRH-agonist stimulation protocol (P1) was used. Patients were prospectively randomly assigned to 2 protocol groups (P2 or P3, 220 patients in each arm) at the start of ovarian stimulation according to the order of entry into the study including one patient per each stimulation protocols: The P2 group was treated with a contraceptive pill + flare-up GnRH-agonist protocol and the P3 group with the GnRH-antagonist protocol. The ovarian stimulation characteristics as well as the clinical and ongoing pregnancy rates were compared., Result(s): Although the numbers of embryos obtained and transferred were significantly higher with the P2 protocol, the implantation and ongoing pregnancy rates per transfer were the same in the two studied groups (8.9 % versus 14.6 % and 8.4 % versus 14.2 % for the P2 and P3 protocols, respectively). Good prognostic factors for ongoing pregnancy with both protocols were: a maternal age <36, no tobacco consumption, a total dose of gonadotropins injection <5000 IU and an endometrial thickness >10 mm., Conclusion(s): In poorly responding patients treated with IVF, the implantation and ongoing pregnancy rates per transfer were not significantly different between the two protocols studied: contraceptive pill + flare-up GnRH-agonist protocol and the GnRH-antagonist protocol. It is suggested that current strategies for the management of poor responders be reconsidered in the light of the potential contribution of age and the effect of life style changes on fertility potential. A customised policy of ovarian stimulation in these patients including mild stimulation protocols, sequential IVF cycles, oocytes-embryos freeze all protocols and blastocyst transfers after screening may improve the clinical outcome.

Objectives: In France, oocyte donation program is still underdeveloped because of lack of donors and this situation entails an important wave of cross border medical tourism to different European countries mainly Spain and Greece. In 2011, the General inspection of social affairs report recommended to the biomedicine agency to promote spontaneous oocyte donation via different channels of information to develop this national program. The main objective of this study is to assess the knowledge of women after baby delivery about oocyte donation. The second objective is the identification of ways to assure better information and to promote oocyte donation., Patients and Methods: We conducted a prospective study with anonymous questionnaire distribution to women after delivery at obstetrics/gynecology department of the Regional University Hospital and Maternity-Children Unit "Victor-Pauchet" of Amiens, from December 2012 to January 2013., Results: Two hundred and fifty-five questionnaires were distributed and 242 of them were analyzed (94.9%). About oocyte donation knowledge: 28% did not know it was possible, 45% did not know it was legal in France, 54% did not know who was concerned and 36% know that a treatment is necessary, 9% think that oocyte donation is paid and 10% it is non-anonymous. If 67% seems to be favorable to this initiative, only 35% could accept to realize it. About information efficiency, 88% think not to receive enough information, 64% would like to have more information. The health care professional wanted to give this information is an obstetrician (51%), a midwife (37%) and a nurse (12%)., Discussion and Conclusion: Oocyte donation program is misoriented due to a lack of information. Obstetricians and midwives have an important educational and informative role to support oocyte donation. Specific strategy of communication and valuable targeted information are needed to motivate potential donor and achieve the objectives of the program., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The intrauterine insemination with husband's sperm is an assisted reproductive technologie, as proposed in the case of cervical infertility, moderate male infertility, dysovulation, mild or moderate endometriosis or unexplained infertility. In the last three indications the ovarian stimulation is necessary. The couple demographic criteria (age of both partners, lifestyle, duration of infertility) and the results of the infertility evaluation (ovarian reserve, uterus, spermogram-spermocytogram) increase the chances of pregnancy by intrauterine insemination with husband's sperm and reduce the risk of multiple pregnancies. Pregnancy rates observed ranged from 8 to 20% per cycle according to indications.

In France, there is a decline in first-time motherhood influenced by many sociocultural factors thus leading to a reproductive age where fertility decreases and which increase the risks associated with late pregnancy. The oocyte donation in France is subject to The Bioethic law granting no support in infertility beyond past 43 years. Thus, to satisfy their need for maternity, the French use a gift abroad. Then we will report the case of a pregnancy obtained by an oocyte donation, after 42 years, which was complicated. We will discuss the importance of taking into account the risk factors before a support to ART, and the ethical issues raised by this case. After a brief review of French legislative framework governing the practice of oocyte donation, we will evoke ways to improve the coverage needs of it in France., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

The SPRM (selective progesterone receptor modulators) are agonists and/or antagonists of progesterone receptor. They are responsible for anovulation, amenorrhea and a lower prostaglandin levels, which leads to an improvement in pain and regression of lesions in endometriosis. On the endometrium, a particular aspect, the progesterone receptor modulator-associated endometrial changes (PAEC), raises additional studies to verify its harmlessness. However, due to the lack of hypoestrogenism and metabolic effects with these drugs, it is very likely that the SPRM will in the near future an important place in the treatment of endometriosis., (Copyright © 2013. Published by Elsevier SAS.)

Objectives: To identify IVF±ICSI pregnancy predictive factors during "Top Quality" attempts in case of double embryo transfer., Patients and Methods: Three years retrospective study (2007, 2008 and 2009) on parameters and results obtained during IVF±ICSI defined as "Top Quality" attempts: first or second attempts on less than 35years old women (age inferior or equal to) with one or two "Top Quality" embryo transfer., Results: In case of double embryo transfer, pregnancy predictive factors are (OR [IC 95%], P): average endometrial thickness on start (4.6 [2.9-5.5], P<0.01), women smoking (4.2 [3.5-4.9], P<0.01), average stimulation duration (3.4 [2.7-3.9], P<0.01), average men age (2.2 [1.7-2.5], P<0.05), gonadotrophins total dose (2.1 [1.1-3.2], P<0.05) and first rank's attempts (1.6 [1.2-2.5], P<0.05)., Discussion and Conclusion: Age patient, rank attempts and quality embryo are criteria, which used to guide to a single embryo transfer. Our results incite us to consider other parameters, in particular men age and women smoking status., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Aim: To determine the pronostic factors of pregnancy in intra-uterine insemination using sperm of donor (IIU-D) by analysing female factors, data from the ovarian stimulation and even the characteristics of the donor selected for the recipient couple., Material and Methods: Retrospective study between January 2002 and December 2009. It took place at the University and Hospital of Amiens over 149 couples performing a total of 535 IIU-D cycles. Factors related to the pregnancy were defined thanks to uni and multivariate analysis., Results: Female age was 30.6 ± 4.3 years old (6% of the cycles with women>38). The initiated pregnancy rate per cycle was 27.9%; the birth rate per cycle was 20.4% and the cumulative live birth rate over 63.4% for six cycles. In multivariate analysis prognostic factors of success were: day 3 of estradiol level less than 80 pg/mL (P<0.05), no tube defects (P=0.022), cured and benign womb pathology (P=0.005), a higher number of follicles greater than 16 mm the day of the ovulation triggering (P=0.0018) and a higher number of pregnancies already obtained by the donor in ART in the CECOS (P<0.001). Neither the female age nor the donor age was associated with a probability of success., Discussion and Conclusion: Classical pronostic factors concerning the female profile and the ovarian stimulation quality have been found. But the most interesting and original part is that the most significant factor concerns the donor and his history of pregnancy in Assisted Reproductive Technology (ART) in the center. This may be very useful to guide the choice of the donor for the recipients., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Mild stimulation is the administration of low doses (150 IU/day) of FSH, continuously, from the fifth day of the cycle, associated with the administration of GnRH antagonists. Despite the lower number of oocytes collected during mild stimulation, they are better for pregnancy rates on with an endometrium nearest closer to the natural cycle, and reducing the risk of ovarian hyperstimulation. Although the number of IVF ± ICSI attempts is limited to 4 in France, the Mild stimulation may be proposed in young women, those with a polycystic ovary syndrome or "low responder" women., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objectives: ART transparency of results and ways to submit are in centre of present biologists and clinical cares. This work aims at identifying ART results' presentation pertinent tests., Patients and Methods: At first time, we propose a questions' list to French ART professionals. Next, we apply results on Amiens' ART center 2006, 2007 and 2008 IVF parameters., Results: One hundred and twenty questions' lists were analysed. Ninety percent of interrogated people were in favour of the results' center public communication. Most quoting criterions hold to define a reference population are (percentage of favourable opinions): IVF/ICSI treatment (96%), first of second rank's attempts (71%), women age less than 35 years old (68%), one or two top embryos quality transfer (60%). In 2007, 2008 and 2009, we made 1123 tentative IVF±ICSI in Amiens' ART center. Pregnancy rates were analysed for these years with criterions next quoting as most pertinent (women's age and rank's attempt), and in function of puncture retrieval oocytes number and indications., Discussion and Conclusion: Most of professionals are in favour of ART transparency of results. All would like that results presentation holds to special criterions to allow a fair comparison. Pregnancy predictive factors, which are women age, rank attempt, puncture retrieval oocytes number, seem to be main criterions for evaluation. These criterions pertinence has been shown thanks to Amiens ART center results., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

The aetiological assessment of an infertile couple includes several complementary biological and morphological examinations. Initial exploration of the female genital tract requires the performance of pelvic ultrasound and hysterosalpingography. The value of systematic laparoscopy in infertility assessment is still subject to debate. The aim of the present review is to evaluate arguments against the systematic use of laparoscopy and to define the place of the other tests as Chlamydia Trachomatis serology, hysterosalpingosonography and MR-IRM. In our opinion, laparoscopy is of course indicated in infertility assessments not only when anomalies are revealed by hysterosalpingography but also in the following circumstances: past history of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant risk of adhesions), unexplained secondary infertility, unexplained infertility after the age of 38 (when choosing between artificial insemination and direct enrolment in an IVF programme) and failure of 3 cycles of good-quality intra-uterine inseminations (with ovarian stimulation and a sufficient number of spermatozoids)., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Since 1999, French legislation has stipulated that embryo donation is one of the possibilities afforded to couples who have a surplus of cryopreserved embryos. Donation of embryos with no foreseeable future use by the genetic couple can therefore be given to infertile couples. In practice however, since the authorization of this novel Medically Assisted Reproduction technique, embryo donation is not widely performed in France even though it is not technically difficult. Why then is there reluctance towards the implementation of embryo donation in France? The aim of this article is to analyze the grounds for the delay in the realization of embryo donation in France. Our findings propose that a myriad of factors including organizational, ethical and psychological determinants have deterred the implementation of embryo donation in France., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objectives: The Professional Practice Evaluation (PPE) is at the heart of quality management in procreation centers. Hereby, we report 3 years of EPP in Cytogenetics and Reproduction laboratory in Amiens University Hospital., Patients and Methods: This PPE is based upon prospective analysis of in vitro fertilization techniques regarding two major parameters: clinically in improving embryo transfer and biologically by determining fecundation levels. Clinical pregnancies in "Top Quality" trial is chosen as a major indicator of our results., Results: Per transfer, there is an increase of 8% for clinical pregnancies and 31% in "Top quality" trials., Discussion and Conclusion: The improvement in our results allowed us to propose, in favourable conditions, single embryo transfer., (Copyright © 2010. Published by Elsevier SAS.)