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Objective to assess the evidence from multidisciplinary simulation team training in obstetrics that integrates human’s factors components on patient outcome. Introduction It has been stated that simulation-based education has the potential to improve technical and nontechnical skills. Reports from enquiries into maternal and newborn adverse outcomes, highlight that the majority of incidents are due to a breakdown of communication and a lack of crisis resource management skills (CRM). It is therefore reasonable to think that a better training on teamwork based on simulation will ultimately improve obstetrics care. In order to explore further that idea, we conducted a literature review on patient outcome after a multidisciplinary simulation training in obstetrics. Method Pubmed, Advances in health sciences education, BMC in medical education, BMC in pregnancy and Childbirth, BMJ open, BMJ Simulation and technology enhanced learning were searched from inception to May 2020 for full-text publications in English on interprofessional, multidisciplinary, obstetrics, simulation training, non-technical skills, CRM. Searches were limited to studies with a report on patient outcome after a multidisciplinary simulation program that included elements of CRM. Result Out of the ten studies selected in our review, five were single site before and after prospective studies and five were cluster before and after randomized trials. All the single site studies reported a positive outcome in low and high resource countries. Three single site studies reported a reduction between 41 and 50 % of blood transfusion after simulation team training. Two single studies reported a reduction of maternal mortality by 34 % and a decrease in an adverse obstetrics index outcome from 0.052 to 0.048 with a p-value of 0.05. Cluster studies showed either no change or some improvement in patient outcomes such as a 37 % improvement on weighted obstetrics adverse outcome, a 17 % reduction in the incidence of PPH and a 47 % reduction in the incidence of retained placenta. Stillbirths rate was reduced by 34 % while newborn deaths was down by 62 %. There was also a 15 % reduction of maternal mortality in favor of the trained team after adjustment to the secular mortality trend. Neonatal death from 24 weeks during the first 24 h was also reduced by 83 % in the intervention site compare with an increase by 18 % in the control site. Conclusion There is evidence that simulation team training that includes CRM is associated with better patient outcome. In order to consolidate this finding, appropriate methodology should be used in future studies with the support of health authorities.

Resume Objectifs La theorie interpersonnelle du suicide (Interpersonal Psychological Theory of Suicide, IPTS) a ete proposee en 2005 par Joiner afin de promouvoir un modele theorique global du comportement suicidaire. Selon cet auteur, trois facteurs de risque provoqueraient le comportement suicidaire : la perception d’etre un fardeau, l’appartenance contrariee et la capacite acquise a se donner la mort. L’objet de l’article est de presenter la theorie et une synthese des travaux. Sa pertinence sur le risque suicidaire des medecins et des etudiants en medecine est ensuite abordee et une etude originale dans un groupe de 178 etudiants en medecine est presentee. Methodes Les etudiants en medecine se repartissaient de la maniere suivante selon le risque suicidaire : 95 n’ont aucun risque suicidaire (absence d’idees suicidaires, de plans suicidaires ou d’antecedents de tentative de suicide), 24 ont des idees suicidaires life-time, 28 presentent des idees suicidaires recentes, 26 des plans suicidaires actuels. Resultats et Conclusion Utilisant des questionnaires valides mesurant les trois dimensions et controlant la depression par l’echelle de Beck ainsi que le sexe et l’âge, les resultats ont montre un niveau significativement plus eleve, d’une part, d’appartenance contrariee chez les sujets avec des plans ou des idees suicidaires recentes comparativement aux autres groupes d’etudiants et, d’autre part, du sentiment d’etre un fardeau chez les sujets avec des plans suicidaires comparativement aux trois autres groupes.

The incidence of breech presentation in single pregnancies at term is between three to 5 %. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced., info:eu-repo/semantics/published

Approximately 22.9 million Caesarean Sections (CS) are performed worldwide each year, mainly to save the life of the mother and/or new-born infant.

Objectives: Our aim was to compare maternal and neonatal outcomes of women with a low-risk pregnancy attending the “Cocoon,” an alongside midwifery-led birth center and care pathway, with women with a low-risk pregnancy attending the traditional care pathway in a tertiary care hospital in Belgium. Methods: We performed a retrospective cohort study of maternal and neonatal outcomes of women with a low-risk pregnancy who chose to adhere to the Cocoon pathway of care (n = 590) and women with a low-risk pregnancy who chose the traditional pathway of care (n = 394) from March 1, 2014, to February 29, 2016. We performed all analyses using an intention-to-treat approach. Results: In this setting, the cesarean birth rate was 10.3% compared with 16.0% in the traditional care pathway (adjusted odds ratios [aOR] 0.42 [95% CI 0.25-0.69]), the induction rate was 16.3% compared with 30.5% (0.46 [0.30-0.69]), the epidural analgesia rate was 24.9% compared with 59.1% (0.15 [0.09-0.22]), and the episiotomy rate was 6.8% compared with 14.5% (0.31 [0.17-0.56]). There was no increase in adverse neonatal outcomes. Intrapartum and postpartum transfer rates to the traditional pathway of care were 21.1% and 7.1%, respectively. Conclusions: Women planning their births in the midwifery-led unit, the Cocoon, experienced fewer interventions with no increase in adverse neonatal outcomes. Our study gives initial support for the introduction of similar midwifery-led care pathways in other hospitals in Belgium., SCOPUS: ar.j, info:eu-repo/semantics/published

To assess the birthweight of neonates conceived after fresh and frozen embryo transfers (FET) and, if different, to investigate whether estradiol levels during the late follicular phase were associated with the observed difference.Singleton pregnancies from fresh and FET transfers between January 1990 and December 2013 were compared retrospectively. A total of 2885 singleton pregnancies after fresh embryo transfer and 746 after FET were analyzed. Obstetric and neonatal outcomes were compared between fresh and FET cycles.The singletons born after FET were found to have a significantly higher birth weight (3313 g), compared to those born after fresh embryo transfer (3143 g); p .001. The main predictor of this difference was found to be estradiol levels at the end of the follicular phase. The difference in birthweight was inversely correlated to estradiol levels considering all cycles together but also considering fresh and frozen cycles separately.Our study demonstrates a link between high estradiol levels and low birth weight of singletons after IVF both in fresh and frozen-thawed embryo transfer cycles. It provides additional support to the involvement of hyperestrogenemia in the process of implantation and on the subsequent fetal development.

Résumé L’association entre les caractéristiques individuelles des mères et la prématurité ou le faible poids à la naissance, tout comme l’effet de l’environnement de vie sur la santé périnatale ont fait l’objet de nombreux travaux. Plus rares sont les études qui se sont penchées sur l’effet que l’environnement de vie pouvait avoir sur l’association entre ces caractéristiques individuelles et la santé périnatale. Dans cet article, nous adoptons une perspective multi-niveaux pour prendre en compte conjointement l’effet de l’environnement de vie et les déterminants individuels des mères sur deux indicateurs de santé périnatale, la prématurité et le faible poids à la naissance en Wallonie. Les analyses portent sur 147 718 naissances vivantes uniques issues de mères qui résidaient en Wallonie de 2010 à 2013. Les variables indépendantes principales sont le niveau d’instruction, le statut professionnel et l’état de cohabitation des mères. Les variables dépendantes sont la prématurité et le faible poids à la naissance. Un indice synthétique des conditions de bien-être (ICBE) est utilisé pour décrire l’environnement de vie et mis en relation avec la prématurité et le faible poids à la naissance grâce à des modèles de régression logistique multivariables à un et plusieurs niveaux. La fréquence de la prématurité et du faible poids s’avère plus élevée dans les communes avec un environnement de vie défavorisé. Les mères ayant un faible niveau d’instruction, n’ayant pas d’activité professionnelle ou déclarant vivre seule courent par ailleurs un risque plus élevé d’accoucher prématurément ou d’avoir un enfant de faible poids à la naissance. Dans les analyses multi-niveaux, les mesures d’association entre les variables socio-économiques de la mère et les deux variables dépendantes restent identiques aux mesures d’association observées dans les régressions classiques. Les conditions de bien-être dans une commune, mesurées par l’ICBE, n’ont pas d’effet additionnel sur les associations entre les caractéristiques socio-économiques de la mère et la prématurité ou le faible poids à la naissance. Abstract The association between the individual characteristics of mothers, preterm birth or low birth weight and the impact of the living environment on perinatal health have been widely studied. Far fewer studies have examined the way the living environment can influence the association between characteristics and perinatal health. In this paper, we adopt a multi-level analysis to simultaneously study the effects of the living environment and the individual characteristics of the mothers on preterm birth and low-birth weight in Wallonia. The study population consists of 147’718 single live births to mothers who resided in Wallonia and delivered between 2010 and 2013. The main independent variables are the mothers’s level of education, their occupational and cohabitation status. The dependent variables are preterm birth and low birth weight. A synthetic index of Well-being condition (ICBE) is used to describe living conditions. The association between these conditions, preterm birth and low birth weight is quantified through multilevel logistic regression models adjusted for mothers’ characteristics. Preterm birth and low birth weight rates are higher in municipalities with a poor living environment. Non-working, single mothers or with low levels of education are at higher risk of delivering a preterm or low birth weight baby. In the multilevel analyses, the association between the socio-economic variables and the two dependent variables is similar to the one observed in the classical regressions (one level-analysis). Well-Being conditions, measured through ICBE, have no additional effect on the association between individual socio-economic characteristics of the mother, preterm birth or low birth weight.

L’objectif est de developper des courbes de croissance ajustees sur des facteurs maternels et fœtaux dans deux regions belges (Wallonie et Bruxelles) afin de creer un indicateur « petit poids pour âge gestationnel » (PAG). Trois indicateurs PAG ont ete crees sur la base de modeles de croissance in utero, developpes par Gardosi: non ajuste (modele 1), tenant compte du sexe (modele 2) et ajuste sur les facteurs maternels (taille et poids de la mere, parite) et fœtaux (modele 3). Parmi les naissances, la proportion d’enfants avec un petit poids pour leur âge gestationnel (AG) est de 8,1 % avec le modele 1, 7,9 % avec le modele 2 et 6,8 % avec le modele 3. Le modele 3 reclasse 2,6 % des naissances. L’indicateur PAG, prenant en consideration les facteurs maternels et fœtaux, est une premiere en Belgique. La proportion d’enfants avec un petit poids pour leur AG diminue lorsque les facteurs maternels et fœtaux sont pris en compte.

The aim of this study was to evaluate whether pregnancies resulting from oocyte donation have a higher risk of preeclampsia compared with pregnancies after IVF using autologous oocytes. Propensity score matching on maternal age and parity was carried out on a one to one basis, and a total of 144 singleton pregnancies resulting in delivery beyond 22 gestational weeks, achieved by oocyte donation, were compared with 144 pregnancies achieved through IVF and intracytoplasmic sperm injection with the use of autologous oocytes. All pregnancies were achieved after fresh embryo transfer. Obstetric and neonatal outcomes were compared for each pregnancy. Singleton pregnancies after oocyte donation were associated with a significantly higher risk for preeclampsia (OR 2.4, CI 1.02 to 5.8; P = 0.046), as well as for pregnancy-induced hypertension (OR 5.3, CI 1.1 to 25.2; P = 0.036), and caesarean delivery (OR 2.3, CI 1.4 to 3.7; P = 0.001) compared with pregnancies using autologous oocytes.

Introduction: Ensuring access to quality caesarean sections (CS) is a challenge for the next millennium and a sustainable development goal to reduce maternal and infant mortality. A CS involves risks and complications and should therefore be performed in an approved way and not used excessively.

Introduction: Ensuring access to quality caesarean section (CS) care is a key millenium development strategy and the next sustainable development goal to reduce maternal and infant mortality. The WHO recommends that the caesarean section rate should not exceed 10-15%. The objective of our analysis is to document the variability of caesarean section rates in Sub- Saharan Africa.

Background The relationships between hedonic deficits, type D personality and suicidal ideation were explored in a group of medical students. Methods In a cross-sectional study, 382 medical students filled out several questionnaires measuring suicide risk, depression (using the Beck Depression Inventory, i.e. BDI), type D personality (using the type D personality scale-14, i.e. DS-14) and anhedonia (using the anhedonia subscale of the BDI, the Snaith Hamilton Pleasure Scale, the Anticipatory and Consummatory subscales of the Physical Anhedonia Scale). Results State anhedonia and, in particular, recent change of state anhedonia and not trait anhedonia was significantly associated with suicidal ideation, specifically when depression was controlled for. Negative affectivity component of type D personality and anhedonia were independent predictors of suicidal ideation even when depression was controlled for. Loss of pleasure and not loss of interest was a significant predictor of suicidal ideation. Conclusions Change of state anhedonia and its component of loss of pleasure measuring dissatisfaction in life could be a risk factor of suicidal ideation in medical students. Dissatisfaction, particularly in the medical course, could be a strong predictor of suicidal ideation in medical students., SCOPUS: ar.j, info:eu-repo/semantics/published

We have reported previously that after 1-year follow up, gonadotropin-releasing hormone agonist (GnRHa) did not prevent chemotherapy-induced premature ovarian failure (POF) in patients with lymphoma, but may provide protection of the ovarian reserve. Here, we report the final analysis of the cohort after 5 years of follow up., SCOPUS: ar.j, info:eu-repo/semantics/published

To investigate the effect of maternal origin on the association between maternal height and the risk of preterm birth (PTB)., SCOPUS: ar.j, info:eu-repo/semantics/published

The purpose of the present study is to study what is the best predictor of severe ovarian hyperstimulation syndrome (OHSS) in IVF. This is a retrospective analysis of all consecutive IVF/intracytoplasmic injection cycles performed during a 5-year period (2009–2014) in a single university fertility centre. All fresh IVF cycles where ovarian stimulation was performed with gonadotrophins and GnRH agonists or antagonists and triggering of final oocyte maturation was induced with the administration of urinary or recombinant hCG were analyzed (2982 patients undergoing 5493 cycles). Because some patients contributed more than one cycle, the analysis of the data was performed with the use of generalized estimating equation (GEE). Severe OHSS was diagnosed in 20 cycles (0.36%, 95% CI 0.20–0.52). The number of follicles ≥10 mm on the day of triggering final oocyte maturation represents the best predictor of severe OHSS in IVF cycles. The cutoff in the number of follicles ≥10 mm with the best capacity to discriminate between women that will and will not develop severe OHSS was ≥15. The presence of more than 15 follicles ≥10 mm on the day of triggering final oocyte maturation represents the best predictor of severe OHSS in IVF cycles.

STUDY QUESTION Do the benefits of ovarian tissue cryopreservation outweigh the risks for patients seeking to preserve fertility before gonadotoxic treatment in various indications? SUMMARY ANSWER In >90% of the patients undergoing cryopreservation of ovarian tissue, oncological treatment was associated with a reduced ovarian reserve and in 30% of patients, premature ovarian failure (POF) occurred within 5 years. WHAT IS KNOWN ALREADY Ovarian tissue cryopreservation is an effective fertility preservation option, especially for pre-pubertal patients and patients who have a short time between diagnosis of a disease and gonadotoxic treatment. STUDY DESIGN, SETTING, DURATION This study retrospectively analysed ovarian function and fertility recovery rates, as well as ovarian tissue characteristics, of patients who underwent ovarian tissue cryopreservation at Erasme Hospital between 1999 and 2011. PARTICIPANTS/MATERIALS, SETTINGS, METHODS A total of 225 patients referred from 15 Belgian oncological units underwent cryopreservation of ovarian tissue before gonadotoxic therapy for malignant or benign diseases. There were 28 patients (12.4%) who died during follow-up due to recurrence of disease. One severe adverse event occurred during anaesthesia for ovarian tissue collection, leading to the death of the patient. Ovarian function and fertility outcomes were available for 114 patients including 13 girls who were pre-pubertal at the time of the procedure. Eight patients had undergone ovarian tissue transplantation in order to restore their fertility after remission of the disease. MAIN RESULTS AND THE ROLE OF CHANCE Breast cancer and haematological disease were the most frequent indications for ovarian tissue cryopreservation. Overall, 90% of post-pubertal patients were diagnosed with poor ovarian reserve (AMH 40 IU/ml). Breast cancer patients had a lower rate of POF than did post-pubertal patients with haematological diseases (11 versus 34.5%, respectively), despite the older age (mean 31 versus 23.5 years old, respectively) of the breast cancer patients. Ovarian function returned in 71 post-pubertal patients without the need for grafts of cryopreserved tissue. Spontaneous pregnancies were reported for 33 of them, leading to 34 live births. Among the 13 pre-pubertal patients who reached pubertal age during the follow-up, 10 had POF. Eight patients received cryopreserved ovarian grafts to reverse POF and three of them have already become pregnant. LIMITATIONS, REASONS FOR CAUTION This study is a retrospective analysis. The cohort was not compared with a control group of patients who did not undergo the procedure. WIDER IMPLICATIONS OF THE FINDINGS After careful evaluation of the surgical risks, ovarian tissue cryopreservation can be proposed as an efficient option to preserve the fertility of children and young adults facing gonadotoxic therapies. However, alternative procedures such as oocyte or embryo cryopreservation should be considered as first options especially for older patients or if there is high risk of neoplastic cells within the ovaries. STUDY FUNDING/COMPETING INTEREST This study was supported by the Tele vie, FNRS-FRSM and Fondation Belge contre le cancer. There are no competing interests to report. © 2014 The Author.

To compare two different vitrification methods to slow freezing method for cryopreservation of human cleavage stage embryos. Design: Prospective randomised trial. Setting: University assisted reproduction centre. Patient(s): 568 patients (mean age 33.4 ± 5.2) from April 2009 to April 2011., JOURNAL ARTICLE, SCOPUS: ar.j, info:eu-repo/semantics/published

Study question: What is the effect of a legal limitation of the number of embryos that can be transferred in an assisted reproductive technology (ART) cycle on the multiple delivery rate? Summary answer: The Belgian national register shows that the introduction of reimbursement of ART laboratory costs in July 2003, and the imposition of a legal limitation of the number of embryos transferred in the same year, were associated with a >50% reduction of the multiple pregnancy rate from 27 to 11% between 2003 and the last assessment in 2010, without any reduction of the pregnancy rate per cycle. What is known already: Individual Belgian IVF centres have published their results since the implementation of the law, and these show a decrease in the multiple pregnancy rate on a centre by centre basis. However, the overall national picture remains unpublished. Study design, size, duration: Cohort study from 1990 to 2010 of all ART cycles in Belgium (2685 cycles in 1990 evolving to 19 110 cycles in 2010), with a retrospective analysis from 1990 to 2000 and prospective online data collection since 2001. Participants/materials, setting, methods: Registration evolved from paper written reports per centre to a compulsory online registration of all ART cycles. From 2001 up to mid-2009, data were collected from Excel spread sheets or MS Access files into an MS Access database. Since mid-2009, data collection is done via a remote and secured web-based system (www.belrap.be) where centres can upload their data and get immediate feedback about missing data, errors and inconsistencies. Main results and the role of chance: National Belgian registration data show that reimbursement of IVF laboratory costs in July 2003, coupled to a legal limitation in the number of embryos transferred in utero,were associated with a 50% reduction of the multiple pregnancy rate from 27 to 11% without reduction of the pregnancy rate per cycle, and with an increase in the number of fresh and frozen ART cycles due to improved access to treatment. Limitations, reasons for caution: There is potential underreporting of complications of ART treatment, pregnancy outcome and neonatal health. Wider implications of the findings: Over the 20 years of registration, the pregnancy rate has remained constant, despite the reduction in the number of embryos transferred, optimization of laboratory procedures and stimulation protocols, introduction of quality systems and implementation of the EU Tissue Directive over the period 2004–2010.

Objective. To provide insight into the differential effect of immigration on cesarean section (CS) rates, using the Robson classification. Design. A population-based study using birth certificates from the birth registry of 2009. Setting. All births in two of the three Belgian regions excluding Flanders. Population. 37 628 deliveries from Belgian and immigrant mothers from sub-Saharan Africa, Maghreb and Eastern Europe. Methods. Multivariate analyses using CS as the dependent variable and immigration status as the primary independent variable. Several multivariate logistic regression models were built including medical, anthropometric, socio-economic characteristics, and medical interventions. The impact of analyzing all delivery sites together was tested using mixed-effect analyses. Main outcome measures. CSs of immigrant subgroups compared with Belgian women. Results. CS rates varied according to immigrant subgroups. Mothers from sub-Saharan Africa had an adjusted odds ratio of 2.06 (1.62-2.63) for CS compared with Belgian natives. Increased risk for mothers from sub-Saharan Africa compared with Belgian natives was found among nulliparous and multiparous women without previous CS, and a term, singleton fetus in cephalic position. In comparison, nulliparous East European mothers with a term singleton fetus in cephalic position in spontaneous labor had an adjusted odds ratio of 0.29 (0.08-0.99) for CS. Conclusions. CS rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from sub-Saharan Africa with a term, singleton infant in cephalic position, without previous CS, appear to carry the highest burden.

Objectives: We aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child. Design: Nationwide population-based prospective cohort study. Setting: Emergency obstetric care. Participation of 97% of maternity units covering 98.6% of the deliveries in Belgium. Participants: All women with uterine rupture in Belgium between January 2012 and December 2013. 8 women were excluded because data collection forms were not returned. Results: Data on 90 cases of confirmed uterine rupture were obtained, of which 73 had a previous Caesarean section (CS), representing an estimated prevalence of 3.6 (95% CI 2.9 to 4.4) per 10 000 deliveries overall and of 27 (95% CI 21 to 33) and 0.7 (95% CI 0.4 to 1.2) per 10 000 deliveries in women with and without previous CS, respectively. Rupture occurred during trial of labour after caesarean section (TOLAC) in 57 women (81.4%, 95% CI 68% to 88%), with a high rate of augmented (38.5%) and induced (29.8%) labour. All patients who underwent induction of labour had an unfavourable cervix at start of induction (Bishop Score ≤7 in 100%). Other uterine surgery was reported in the history of 22 cases (24%, 95% CI 17% to 34%), including 1 case of myomectomy, 3 cases of salpingectomy and 2 cases of hysteroscopic resection of a uterine septum. 14 cases ruptured in the absence of labour (15.6%, 95% CI 9.5% to 24.7%). No mothers died; 8 required hysterectomy (8.9%, 95% CI 4.6% to 16.6%). There were 10 perinatal deaths (perinatal mortality rate 117/1000 births, 95% CI 60 to 203) and perinatal asphyxia was observed in 29 infants (34.5%, 95% CI 25.2% to 45.1%). Conclusions: The prevalence of uterine rupture in Belgium is similar to that in other Western countries. There is scope for improvement through the implementation of nationally adopted guidelines on TOLAC, to prevent use of unsafe procedures, and thereby reduce avoidable morbidity and mortality., SCOPUS: ar.j, info:eu-repo/semantics/published

Background: Maternal mortality measurement remains a critical challenge, particularly in low and middle income countries (LMICs) where little or no data are available and maternal mortality and morbidity are often the highest in the world. Despite the progress made in data collection, underreporting and translating the results into action are two major challenges that maternal death surveillance systems (MDSSs) face in LMICs. Objective: This paper presents a protocol for a scoping review aimed at synthesizing the existing models of MDSSs and factors that influence their completeness and usefulness. Methods: The methodology for scoping reviews from the Joanna Briggs Institute was used as a guide for developing this protocol. A comprehensive literature search will be conducted across relevant electronic databases. We will include all articles that describe MDSSs or assess their completeness or usefulness. At least two reviewers will independently screen all articles, and discrepancies will be resolved through discussion. The same process will be used to extract data from studies fulfilling the eligibility criteria. Data analysis will involve quantitative and qualitative methods. Results: Currently, the abstracts screening is under way and the first results are expected to be publicly available by mid-2017. The synthesis of the reviewed materials will be presented in tabular form completed by a narrative description. The results will be classified in main conceptual categories that will be obtained during the results extraction. Conclusions: We anticipate that the results will provide a broad overview of MDSSs and describe factors related to their completeness and usefulness. The results will allow us to identify research gaps concerning the barriers and facilitating factors facing MDSSs. Results will be disseminated through publication in a peer-reviewed journal and conferences as well as domestic and international agencies in charge of implementing MDSS. [JMIR Res Protoc 2016;5(4):e197]

This study aims to determine if in-vitro maturation (IVM) of human immature oocytes should be performed before or after vitrification.A total of 184 immature oocytes were randomly divided into two different groups: 100 were vitrified at metaphase II (MII) stage 24 h-48 h after IVM (group 1) and 84 were immediately vitrified at germinal vesicle (GV) or metaphase I (MI) stages and in vitro matured after warming (group 2).Survival rate after warming was similar in both groups (86.9% versus 84.5%). However, oocyte maturation rate per collected oocyte was significantly higher for oocytes matured before vitrification (group 1, 46%) than for oocytes vitrified before IVM (group 2, 23.8%) (p0.01). Consequently, the number of MII oocytes inseminated per oocyte collected was significantly higher for group 1 (40%) than for group 2 (23.8%) (p0.05).IVM procedure is more efficient when it is performed before oocyte vitrification.

To analyse treatment outcomes after SET law enforcement and to evaluate the contribution of cryopreservation in a SET policy.Embryo transfer cycles performed after the law enforcement (SET period) was retrospectively compared to the cycles performed before the law enforcement (DET period).Pregnancy and delivery rates after fresh transfer of SET and DET periods were comparable (31.7% versus 33.3% and 24.5% versus 26.2%, respectively, NS). Overall twin delivery rate is significantly decreased after the law enforcement (11.3% versus 22.4%, p 0.001) but not in patients aged 36 to 39 years (20.3% versus 24%, NS). Frozen-thawed embryo cycles allowed similar cumulative pregnancy rate (30.6%, NS). Taking into account all frozen embryos still to be transferred, SET period offers a better overall pregnancy rate than the DET period (36.1% versus 32.3%, p 0.01).The Belgian law allowed a dramatic reduction of twin deliveries especially for patients under 39 years. Cryopreservation maintains a similar cumulative pregnancy rate.

Background Fertility expectations for patients with Turner's syndrome (TS) have clearly changed in the last three decades. However, medical risks during pregnancy are supposed to be highly increased. The aim of the study was to assess clinical outcome and obstetrical complications in a series of patients with TS in an oocyte donor programme. Methods A retrospective study was carried out on 24 women with TS seeking a pregnancy in the Fertility Clinic of the Erasme Hospital from 1992 up until March 2011. Results Twenty-three patients with TS were included in an oocyte donation cycle. Forty-nine oocyte donation cycles were performed, which led to 45 fresh and 10 frozen-thawed embryo transfers. Altogether, 18 pregnancies were obtained, 10 deliveries (9 singletons and 1 pair of twins), 3 miscarriages and 5 biochemical pregnancies. The clinical pregnancy rate per transfer was 24.4% in fresh cycles and 20% in frozen replacement cycles. Complications of pregnancy occurred in 5 of 10 pregnancies (50%), which led to three premature deliveries because of pregnancy-induced hypertensive disorders. The mean birthweight (g) (±SD) for singletons and twins was 2728 ± 577 and 2335 ± 318, respectively. Four babies were below the 10th percentile. No cardiac complications were observed in any of the pregnant women. Conclusions Pregnancy rates after oocyte donation in patients with TS are comparable with those previously published but a high risk of pregnancy hypertensive disorders and a high risk of low birthweight can be highlighted from our study. Strict inclusion criteria and single embryo transfer are necessary to minimize complications during pregnancy in this high-risk group.

Aggressive chemotherapy generally results in the loss of both endocrine and reproductive functions. If the patient has not undergone previous oocyte, embryo or ovarian tissue cryopreservation, orthotopic allotransplantation of fresh ovarian tissue from a genetically non-identical sister may be considered. Here, we describe a case report. The patient, aged 15 years and presenting with homozygous sickle cell anemia, underwent chemotherapy (busulfan, cyclophosphamide) and total body irradiation before bone marrow transplantation, the donor being her HLA-compatible sister. HLA group analysis later revealed complete chimerism. When the patient was 32 years old, ovarian allografting was performed, with the ovarian tissue donor being the same sister who had already donated bone marrow. The goal was to restore ovarian activity and natural fertility. No immunosuppressive therapy was administered. No sign of rejection was observed. Restoration of ovarian function was achieved 3.5 months after transplantation, as proved by the first estradiol peak and follicular development detected by ultrasound. After 9 months of regular ovulatory cycles, IVF was attempted because proximal tubal stenosis (unknown at the time of grafting) could not be repaired by tubal reanastomosis. After stimulation, three oocytes were retrieved. Two embryos were obtained. One embryo was frozen and the other was transferred, resulting in an ongoing pregnancy. The patient delivered a healthy baby girl weighing 3.150 g at 37 2/7 weeks of gestation.

We compared the outcome of different cellular and viral factors on the regulation of the HPV-16 early viral gene expression in trophoblastic and cervical cancer cells. A high variability of the long control (LCR) activity was observed, prompting us to evaluate the role of secreted factors in the control of the early gene expression in trophoblastic cell lines. Endogenous progesterone and exogenous dexamethasone were found to activate LCR driven transcriptional activity. Since host cells express HPV early proteins to regulate LCR activity, we investigated the effect of the combined HPV-16 early proteins on the LCR driven transcription and the possible involvement of E2. A physiological level of HPV-16 early proteins expression strongly induced the LCR driven reporter activity. According to mutational analysis, E1 and E2 proteins, indispensable for viral replication, were not involved in LCR extrachromosomal transcriptional regulation. This suggests that E5 and/or E6 and/or E7, consequently, activated viral transcription.

background: This study compares recipient couples’ and donors’ motivations towards the type of donation and attitudes concerning secrecy or disclosure of the mode of conception in three oocyte donation groups: couples and their donor for a known donation, couples and their donor for a permuted anonymous donation (known-anonymous) and couples without a donor, on a waiting list for a donation (anonymous). methods: Data collected by two psychologists through semi-structured interviews of 135 recipient couples and 90 donors before oocyte donation were analysed retrospectively. results: In known donation (42 couples), donors were preferentially family members with a blood tie (54.7%). Choosing their donor seemed mainly for the couple’s reassurance rather than to access the child’s origins as 50% wanted secrecy. On the other hand, in knownanonymous donation (48 couples), donors were more frequently chosen among friends (41.6%; P ¼ 0.038). These couples were either open to disclosure (45.8%; P ¼ 0.002) or remained hesitant (39.6%). In anonymous donation (45 couples), 49% chose not to seek a donor mostly in order to maintain secrecy towards the child (77.3%). Among the 51% who sought but could not find a donor, only 30.4% wanted secrecy. Recipients from North Africa and from Europe preferred anonymous or known-anonymous donation (83.3 and 75.6%), whereas subSaharan Africans opted more often for known donation (63%; P , 0.001). Among Europeans (90 couples), 50% were in favour of disclosure compared with only 8.9% of recipients from North or sub-Saharan Africa (45 couples; P , 0.001). conclusions: A diversity of attitudes and cultural differences exist among recipient couples and donors regarding oocyte donation; this pleads for maintaining access to different types of oocyte donation as well as for psychological counselling prior to treatment.

This study investigated whether failed maturation oocytes could be used to evaluate different cryopreservation procedures. A total of 289 failed maturation oocytes (GV and MI stages), obtained from 169 patients undergoing IVF treatment (mean age 33.84±5.0) were divided into two different slow-cooling groups (1.5 mol/l 1,2-propanediol+0.2 mol/l sucrose in either NaCl (group A) or choline chloride (ChCl) (group B) based cryopreservation solutions) and one vitrification group (15% ethylene glycol+15% dimethyl sulphoxide). Survival rate, in vitro maturation (IVM) rate, fertilization and developmental rate of cryopreserved oocytes were assessed. Regardless of the stage at which cryopreservation was performed (GV+MI), the slow cooling with ChCl based medium always gave significantly lower survival rate than the slow cooling in NaCl based medium (p=0.01) and vitrification (p0.001). An extended study also showed statistically reduced survival rate between slow-cooling NaCl based medium and vitrification (p0.05). Global results of in vitro maturation and fertilization showed worse results between both slow-cooling NaCl and ChCl based media versus vitrification. In conclusion, for oocytes that had failed to mature, vitrification gave better survival, maturation, fertilization and also cleavage rates than the slow-cooling protocols. Four cells embryos were obtained only from vitrified in vitro matured MI oocytes.

BACKGROUND: Bone morphogenetic protein 15 (BMP15) is an oocyte-derived growth factor acting as a major player in follicle differentiation in mammals. Mutations in the BMP15 gene, some of which lead to defective secretion of bioactive dimers, have been associated with premature ovarian failure (POF) in humans. METHODS: Fifty patients diagnosed with POF with a normal karyotype were included in the study. After DNA extraction and amplification by PCR, the entire coding sequence and intron-exon junctions of BMP15 gene were analysed in the cohort of POF patients and in a control group of 214 patients. RESULTS: Nine variants of the BMP15 gene including six missense substitutions and one insertion of three nucleotides were identified in the POF group. Three of them were previously described as single nucleotide polymorphisms and were also found in the control group. Two variants (H81R and G199R) have not been previously described and were not identified among controls but were not predicted to be deleterious. One variant (A180T) was identified among two POF cases, and also in two controls. One variant (F194S), predicted as potentially deleterious, was identified for the first time in a POF patient but also identified in one control. One variant (L148P), potentially deleterious, previously reported in POF patients, was identified for the first time among controls. The variant 788insTCT, previously identified among POF patients, probably has a low biological impact as it was also found in control patients and is a common polymorphism in sub-Saharan African populations. CONCLUSIONS: Various missense variants of the BMP15 gene were identified among patients with POF. For most variants, the impact of the amino-acid substitution on the protein structure and function was predicted to be low. The two variants predicted as potentially deleterious were also identified among controls and could be considered as rare polymorphisms. Although some of these variants could contribute to the development of POF in a complex manner, the demonstration of their role in the pathogenesis of POF requires additional functional studies.

The relationships between anhedonia and suicidal ideation or suicide attempts were explored in a large sample of physicians using the interpersonal psychological theory of suicide. We tested two hypotheses: firstly, that there is a significant relationship between anhedonia and suicidality and, secondly, that anhedonia could mediate the relationships between suicidal ideation or suicide attempts and thwarted belongingness or perceived burdensomeness., SCOPUS: ar.j, info:eu-repo/semantics/published

To assess the prevalence of major obstetric haemorrhage managed with peripartum hysterectomy and/or interventional radiology (IR) in Belgium. To describe women characteristics, the circumstances in which the interventions took place, the management of the obstetric haemorrhage, the outcome and additional morbidity of these women., SCOPUS: ar.j, info:eu-repo/semantics/published

Among high-risk human papillomaviruses (HPV), HPV-16 infection is the most prevalent causative factor for cervical cancer. Beside other mucosal targets, HPV-16 was reported to infect the placenta and to replicate in trophoblastic cells. Since these cells share invasive properties of tumoral cells, they represent an ideal model to investigate several oncogenic processes. In the present work, we analyzed the impacts of HPV-16 E5, E6 and E7 oncoproteins on the trophoblastic model. Our results showed that E5 impaired the viability of trophoblastic and cervical cell lines but E6 and E7, favoring cell growth, neutralized the E5 cytotoxic effect. In addition, E5 decreased the adhesiveness of trophoblastic cells to the tissue culture plastic and to endometrial cells similarly as described previously for E6 and E7. E5 and E6 plus E7 increased also their migration and their invasive properties. Cells expressing HPV-16 early proteins under the control of the long control region endogenous promoter displayed growth advantage and were also more motile and invasive compared with control cells. Interestingly, the E-cadherin was downregulated in trophoblastic cells expressing E5, E6 and E7. Nuclear factor-kappaB and activator protein-1 activities were also enhanced. In conclusion, HPV-16 early proteins enhanced trophoblastic growth and intensify the malignant phenotype by impairing cell adhesion leading to increased cellular motile and invasive properties. HPV-16 E5 participated, with E6 and E7, in these changes by impairing E-cadherin expression, a hallmark of malignant progression.

To retrospectively evaluate factors influencing human cytomegalovirus serologic status of couples consulting our fertility clinic.Human cytomegalovirus individual serologic status of 3,227 women and 2,565 men was studied according to age, serologic status of the sexual partner, and presence of children in the family at entry in the clinic. Among 1,906 initially seronegative individuals, human cytomegalovirus seroconversions during follow-up were recorded and correlated to age, serologic status of the sexual partner, and presence of children aged younger than 3 years in the family.Human cytomegalovirus status at entry in the fertility clinic depended on age, but women were more frequently seropositive (54%) than men (43%), although they were younger (mean age 33 years for women and 37 years for men). The probability of seroconversion of women and men was significantly associated with the presence of children aged younger than 3 years; 35 of 217 women (16%) and 17 of 130 men (13%) living with children aged younger than 3 years seroconverted compared with 37 of 1,066 women (3.4%) and 16 of 493 men (3.2%) without children. Moreover, women's seroconversion was significantly associated with the seropositivity of the sex partner; 13 of 96 (13.5%) women with a cytomegalovirus seropositive partner seroconverted compared with 33 of 452 (7.3%) of those without such a partner.Our results suggest that human cytomegalovirus is sexually transmitted among couples in our fertility clinic. Safe sex practices should be included in hygiene precaution advice given to pregnant women to avoid human cytomegalovirus contamination.II.

Background Transplantation of ovarian tissue is, at present, the only clinical option available to restore fertility using cryopreserved ovarian tissue. More than 30 transplantations of cryopreserved tissue have been reported, and six babies have been born, worldwide, following this procedure. Despite these encouraging results, it is essential to optimize the procedure by improving the follicular survival, confirming safety and developing alternatives. Here, we review the different factors affecting follicular survival and growth after grafting. Methods Relevant studies were identified by searching Pubmed up to January 2009 with English language limitation. The following key words were used: (ovarian tissue or whole ovary) AND (transplantation) AND (cryopreservation or pregnancy). Using the literature and personal experience, we examined relevant data on the different exogenous and clinical factors affecting follicular development after grafting. Results Clinical factors such as the patient's age and the transplantation sites influenced the lifespan of the graft. A heterotopic transplantation site is not optimal but offers some advantages and it may also promote the hormonal environment after a combined heterotopic and orthotopic transplantation. Exogenous factors such as antioxidants, growth factors or hormones were tested to improve follicular survival; however, their efficiency regarding further follicular development and fertility potential remains to be established. Conclusion Additional evidence is required to define optimal conditions for ovarian tissue transplantation. Alternatives such as whole ovary or isolated follicles transplantations require further investigation but are likely to be successful in humans in the future.