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Development of the in vitro cultured and fertilized ovocyte appears to be improved when progesterone and estrogen concentrations in the follicular fluid are above 2 000 and 1 000 ng/ml respectively, with a A/E ratio under 1 and a PGE/PGF ratio above 0.8. Such criteria are only infrequently fulfilled: once in seven cases. They were found in one of the two patients who had a pregnancy after in vitro fertilization during induced ovulation. Division of ovocytes from spontaneous ovulation was recorded in several instances in spite of a less propitious composition of the follicular fluid.

In vitro fertilization was attempted during a spontaneous cycle in 17 out of 97 patients. Preovulatory urinary estrogen and LH maximas were assayed in order to time celioscopy 24 hours after the onset of the triggering urinary LH maxima. In 8 patients, comparison with plasmatic LH shows that the timing of spontaneous ovulation can be precisely predicted from urine assays. However, when the triggering LH release is weak, LH must be above or equal to 25 IU/g of creatinine with a creatininuria above or equal to 0.4 g/l in two urine samples at a three-hour interval.

Autotransplantation of the ovary by microvascular anastomoses was performed in 42 rabbits by three different procedures: orthotopic replantation with selective end-to-end anastomoses of the ovarian vessels; heterotopic transplantation in the groin area, with anastomosis of the ovarian vessels on the inferior epigastric vessels; heterotopic transplantation in the groin with the ovary included in a peritoneal sac to prevent adhesions. Three weeks later, at day 3 of a pseudo-pregnancy, the grafts were examined and morphology, presence of adhesions and ovulation were compared with those of a control group. The long-term vascular patency rate was 78%. The ovulation rate was 71.5% in the orthotopic group, 50% in the heterotopic group and 83.5% in the heterotopic group with the ovary in a peritoneal sac. Subcutaneous transplantation of the ovary within a peritoneal sac provides a new and useful experimental model for the study of tubo-ovarian function and for recovery of postovulatory oocytes.

Vascular microsurgery was applied late to gynaecology. The authors evaluate its use in transplantations of the uterus, the ovaries and the tubes and the experimental as well as the clinical angles. The vascular pedicles that can be used in women are studied from the anatomical point of view as well as the functional and technical angles in order that surgical protocols can be worked out logically for transplantation of the tubes and ovaries.

In this review paper the respective places of microsurgery and in vitro fertilization in the treatment of tubal infertility are evaluated. The best and current results of the two methods are compared and their future is considered. Most of the indications for microsurgery remain, while some (e.g. poor prognosis salpingostomy, repeated tuboplasty, tubal transplantation) require discussion and new ones are appearing. The advent of in vitro fertilization has introduced some technical changes in surgery of the ovaries and surrounding tissues and has given rise to new techniques. It has also modified the initial investigations in infertile women and the use of pre-operative and second-look laparoscopy. It has exerted little influence on microsurgeons specialized in problems of reproduction but has obliged their teams to be reorganized on a multidisciplinary basis in order to cope with new techniques.

The reasons for 50 requests for reversal of tubal sterilisation were studied prospectively. Our results agree with those in the rest of the literature and show that within a population of women who have been sterilised there is a group who have "a strong likelihood to ask for reversal of sterilisation". These results make one think of the role of the doctor and can help by using scores that have been worked out previously to improve the indications for sterilisation in case legislation will be forthcoming.

Two hundred and twenty-three cases notes of patients with toxaemia of pregnancy were analysed in order to try to establish the ability to predict through clinical and biological assessments of the mother the prognosis for the fetus. Statistical analysis methods were chosen to work out the classification of the parameters and to lead to an index of severity that could be established by a multifactorial discriminating analysis. This study confirms that there is an inversion in the circadian rhythm of arterial blood pressure, with an increase in the evening and at night. It shows how bad prognostically blood pressure instability is. On the other hand oedema of the legs is of no significance. Contrary to the view that has been held for a long time, an increase in weight is directly proportional to fetal parameters. As far as parameters are concerned as a whole (both clinical and biological) a rise in blood urea is more discriminating at every stage of the illness and precedes an increase in the platelet count, the changes in creatinine clearance and night blood pressure. Maternal changes are better correlated with fetal variability before the 35th week of the pregnancy whereas after that date the prognostic value of these readings is of little importance.

The preovulatory LH surge induces final maturation of the ovocyte which makes it suitable for in vitro fertilization. The spontaneous LH peak can be detected in blood or in the urine. Whatever the method of determination, the diagnosis of the triggering LH surge can be done only on strict criteria. This work defines these criteria when urinary Higonavis is used: a rise in the plus signs in two successive samples or a positive result in urine diluted fourfold.