OBJECTIVE:The French Law relating to Bioethics allows access to medically assisted reproduction for lesbian couples and single women and has expanded the possibilities for self-preservation of gametes. The question now arises of new uses of gametes of the couple, within couples of two cis women, one cis woman and one transgender woman, or two transgender individuals. The acronym EUGIC (Extension of the Use of Gametes in IntraCouple) allows these new situations to be grouped together, particularly if gametes have already been previously cryopreserved, thus avoiding the need for gamete donation. METHODS:Analysis of the different situations of sperm use from a trans woman using gametes available within the couple rather than gamete donation. RESULTS:The inconsistency in the use of sperm from a trans woman, the situations already encountered by professionals, the prospects for filiation for a trans woman as well as the issues related to the interest of the unborn child are discussed. CONCLUSION:French law does not fully address the use of a trans woman's spermatozoa to meet the new EUGIC requirements and leads to complex situations for healthcare professionals.

- Objectif : : La Loi du 2 août 2021 relative à la Bioéthique (LBE) permet désormais l'accès à l’assistance médicale à la procréation (AMP) aux couples de femmes et aux femmes seules non mariées. Avec ces nouvelles situations se présentent de nouvelles demandes d’usage intraconjugal de gamètes, au sein de couples composés de deux femmes cis, d’une femme cis et d’une femme trans, ou de deux personnes trans. Ces nouvelles situations peuvent être regroupées sous l’acronyme EUGIC (Extension de l’Utilisation de Gamètes en IntraConjugal), en particulier si des gamètes ont déjà préalablement été autoconservés, évitant ainsi le recours à un don de gamètes.- Méthode : Sont analysées les différentes situations d’usages intra conjugaux des spermatozoïdes d’une femme trans permettant de privilégier les gamètes disponibles au sein du couple (frais ou autoconservés) plutôt que de recourir à un don.- Résultats : Les questions qui entourent l’usage des spermatozoïdes d’une femme trans, les situations déjà rencontrées par les professionnels, les perspectives en matière de filiation pour une femme trans ainsi que les enjeux liés à l’intérêt de l’enfant à naître sont discutés.- Conclusion- : Le droit français n’appréhende pas pleinement les situations d’usage des spermatozoïdes d’une femme trans pour répondre aux nouvelles demandes d’EUGIC et place les professionnels de santé dans une situation délicate.

Abstract Study question What is the outcome of testicular sperm extraction (TESE) after microinjection of frozen–thawed sperm and the correlation with histological analysis in azoospermic patients? Summary answer In our cohort of 240 azoospermic patients, sperm could be retrieved in 167 patients (69.6%). What is known already Testicular biopsy is a crucial assessment in reproductive practice with diagnostic and prognostic importance for ICSI. Divers histological procedures are used throughout the centres. There is increasing need to accurately analyse histological biopsies in order to characterise different type of spermatogenic failure and allows data storage of value in clinical practice and research. Compared with Bouin’s and formalin, glutaraldehyde fixed and semithin section of testicular biopsies have the advantage of yielding not only good cellular morphology but also it allows the possibility of performing electron microscopy. Study design, size, duration This is a monocentric retrospective study of TESE practice in azoospermic patients in Strasbourg University Hospital from February 2011 to December 2019. Participants/materials, setting, methods A total of 240 azoospermic patients underwent TESE followed by sperm cryopreservation when sperm were present and data of histological analysis and clinical outcome of ICSI were analysed. The analysis include initial hormonal status, type of azoospermia, body max index, classification of histological findings, freezing rate and outcome of ICSI-IVF procedure. Main results and the role of chance The mean age of 240 patients was 34.5 years. Out of all patients, 42% were diagnosed with obstructive azoospermia (OA) and 58% patients with non-obstructive azoospermia (NOA). There was no correlation of sperm retrieval with the body mass index. Overall, sperm could be retrieved in 69.6% patients. Spermatozoa were always successfully recovered in patients with normal testicular histological findings, 41.7% patients (n 100). Histological analysis revealed a Sertoli cell-only (SCO) syndrome in 27.5% cases (n 66), hypospermatogenesis in 14.2% (n 34), germ cell arrest in 7.9 (n 19) and mixed pattern in 8.3% (n 20). In patients with serum FSH concentrations >12 IU/l, 46% of patients (n 42) sperm were present at TESE. In patients with no sperm retrieval, 31.5% had normal FSH levels. Out of all men with elevated FSH, 63% had SCO pattern, 4% germ cell arrest, 21% hypospermatogenesis and 12% mixt patterns. In the group of patients with no sperm retrieved at TESE, histological analysis showed SCO in 69.9% cases, germ cell arrest in 15% and hypospermatogenesis in 9.6% of cases. Out of 167 patients with TESE and sperm cryopreservation, 126 patients undergone ICSI-IVF procedure and 80 babies were born. Limitations, reasons for caution This study is a retrospective analysis in a single centre. The cohort was not compared with groups of patients with different histological and fixation techniques. Wider implications of the findings: Accurate histological diagnosis is a prerequisite for research and clinical data collection and open the possibilities to include patients with NOA in subsequent detailed genetic screen. Trial registration number NA

La difficulté à mener à bien une grossesse (G) en cas de projet parental (PP) est une complication majeure du syndrome de Turner, liée à une dysgénésie gonadique et/ou à des contre -indications (CI) cardio-vasculaires à la G. L’objectif de ce travail était d’analyser rétrospectivement le taux et les causes d’échec du PP dans la cohorte monocentrique strasbourgeoise de patientes suivies selon les recommandations du PNDS 2008. Sur 93 patientes, 44 (47,3 %) avaient un PP, 19 (43,1 %) l’ont concrétisé par 2 (4 %) G spontanées, 13 (30 %) dons d’ovocytes (DO), 1 (2 %) FIV, 3 (7 %) adoptions. Il a été observé 36 G (47,7 %), 20 naissances (55,5 %), 4 patientes avec complications obstétricales mineures (1 cas de préeclampsie non sévère), 4 complications néonatales dont 2 sévères (1 hypotonie, et 1 hypotrophie sévères idiopathiques), 0 malformation congénitale. Vingt-cinq (57 %) patientes ont échoué du fait de 6 CI à la G, 12 échecs du DO, 1 FCS à répétition sur GS. Neuf (20 %) patientes ont abandonné leur PP ; 4 pour CI à la G et refus d’adoption, 1 pour refus du DO, 3 pour raisons personnelles. Trois patientes sont en attente de DO, 2 en démarche d’adoption. L’absence de contraception a entraîné 3 IVG. À notre connaissance, il s’agit des premières données sur le PP chez les patientes turnériennes ; données utiles pour l’accompagnement des patientes : 43 % de réussite du PP ; efficacité du DO identique aux autres indications, bon pronostic des G avec ovocyte maternel, penser à l’adoption.

The aim of this prospective study was to evaluate outcome benefits expected in repeated implantation failure (RIF) patients (n = 217) after customized embryo transfer based upon identification of the receptivity window by transcriptomic approach using the Win-Test. In this test, the expression of 11 endometrial genes known to be predictive of endometrial receptivity is assessed by RT-PCR in biopsies collected during the implantation window (6–9 days after the spontaneous luteinizing hormone surge during natural cycles, 5–9 days after progesterone administration during hormone replacement therapy cycles). Then, patients underwent either customized embryo transfer (cET, n = 157 patients) according to the Win-Test results or embryo transfer according to the classical procedure (control group, n = 60). Pregnancy and live birth rates were compared in the two groups. The Win-Test showed that in 78.5% of women, the receptivity window lasted less than 48 h, although it could be shorter (< 24 h, 9.5%) or longer (> 48 h, 12%). This highlighted that only in 20% of patients with RIF the endometrium would have been receptive if the classical embryo transfer protocol was followed. In the other 80% of patients, the receptivity window was delayed by 1–3 days relative to the classical timing. This suggests that implantation failure could be linked to inadequate timing of embryo transfer. In agreement, both implantation (22.7% vs. 7.2%) and live birth rates per patient (31.8% vs. 8.3%) were significantly higher in the cET group than in the control group. cET on the basis of the Win-Test results could be proposed to improve pregnancy and live birth rates. ClinicalTrials.gov ID: NCT04192396; December 5, 2019, retrospectively registered.

Objective: This study aimed to assess the application of the French guidelines for pregnancies in Turner syndrome (TS) and their impact on perinatal prognosis. Study design: We performed a French multi-center retrospective study (14 centers), including TS pregnant patients (spontaneously or by Assisted Reproductive Technology (ART)) between January 2006 and July 2017. Only clinical pregnancies were analyzed. The adjustment of medical follow-up modalities to French guidelines was evaluated for all pregnancies after 2009. Pregnancies from oocyte donation (0D)after 2009 were compared to those of a cohort of TS pregnancies obtained by OD before 2009, which were reported by the French Study Group for Oocyte Donation. Results: One hundred seventy pregnancies in 103 patients were included: 35 spontaneous, 5 by means of intra-conjugal ART, and 130 with OD. No serious maternal complications were observed. We reported two stillbirths and one intra uterine fetal death. The French guidelines were partially respected. The preconceptional assessment was carried out in 74% of cases. Cardiology follow-up during pregnancy was performed in accordance with guidelines in 74% of patients. Postpartum cardiac ultrasonography was performed in 45% of pregnancies but only in 11% within 8 days post-partum. When compared to the 2009 historical cohort, the rates of high blood pressure (19% vs. 38%; p < 0.005) preeclampsia (8% vs. 21%; p < 0.005) and prematurity <35 weeks (15% vs 38%; p < 0.0001) were lower. Conclusions: The implementation of guidelines has allowed the standardization of TS pregnancy care and improved perinatal indicators for both mothers and children. However, an effort must be done, in a postpartum survey. (C) 2018 Elsevier B.V. All rights reserved.

INTRODUCTION:The objective of this study was to assess the impact on the clinical pregnancy rate of luteal phase progesterone treatment in patients being prepared for natural cycle frozen embryo transfer (FET) with induced ovulation. MATERIAL AND METHODS:This retrospective cohort study collect all the FET protocols over a 6-month period at Strasbourg University Hospital fertility unit between December 2016 and May 2017. In total 293 consecutive patients with regular menstrual cycles were prepared for natural cycle FET during this period. All patients had an embryo cryopreservation secondary to in vitro fertilisation (IVF) or by intracytoplasmic sperm injection (ICSI). There were 2 protocols during this period and patients either received or did not received progesterone. Ovulation was routinely triggered in all patients by injection of choriogonadotrophin alfa. Patients in the treated group received vaginal natural micronized progesterone treatment of 400mg daily, starting on the day of ovulation. The principal assessment criterion was the occurrence of pregnancy. RESULTS:In total, 231 patients were analysed: 108 in the group not receiving progesterone and 123 in the group receiving progesterone. Patient characteristics were comparable between groups. A higher clinical pregnancy rate (39% vs. 24.1%, p=0.02; 95CI [1.10; 3.74]) was recorded in the treated group. CONCLUSIONS:Our results suggest that luteal phase support with vaginal progesterone statistically increases the clinical pregnancy rate following hCG-triggered natural cycle FET and that it should be used more widely.

Objective. - Comparing rates of pregnancy and childbirth between IUI at either 24 or 48 hours after injection of HCG.Methods. - This is a single-center retrospective study of couples who underwent intrauterine insemination between January 2013 and December 2014 at Medical-Surgical Obstetrical Centre of Schiltigheim. Stimulation of ovulation was done by FSH or HMG, and ovulation induction by 250 mu g of recombinant HCG. The insemination was performed after 2 days (group D2) or the day after (group D1).Results. - Among the 1092 intrauterine insemination cycles included in our study, 62 were done the day after ovulation induction by HCG (Dl), and 1030 the day after (D2). Our study showed no significant difference in the rate of biological pregnancy, defined by a rate of BHCG > 15 IU/L, between the group D1 (1935%) and the group D2 (18.12%), P = 0.94, and no difference in live birth rate: respectively 14,50% and 11.75%, P = 0.18.Conclusion. - Our study reported similar rates of pregnancy and childbirth in the group who underwent IUI at D1 and D2 of ovulation induction, suggesting the possibility of IUI on day 1 when the organization of the service needs it, without loss of opportunity for pregnancy. (C) 2017 Elsevier Masson SAS. All rights reserved.

A recent adverse effect of a paracervical block (cardiac arrest) occurred during an oocyte retrieval (OR), forcing us to reconsider our pain management during OR. Since then, we decided to use intravaginal lidocaine gel as analgesia during OR.Objectives. -To evaluate the pain during OR after intravaginal lidocaine gel analgesia and to evaluate the motivations of women choosing this technique.Methods. -A monocentric observational study was performed on 200 patients. Pain was measured using a numeric pain scale during and after oocyte retrieval. The tolerance of the procedure was evaluated through a patient questionnaire.Results. -Median maximal pain was 5 +/- 2.3 (0-10) per-retrieval and 3 +/- 2.2 (0-10) post retrieval. The procedure was considered bearable by 85.5% of the patients and 81.5% of them would choose this method in case of new oocyte retrieval. No adverse effect occurred during the study.Conclusion. -The use of intravaginal lidocaine gel seems an acceptable analgesia alternative during oocyte retrieval. (C) 2016 Elsevier Masson SAS. All rights reserved.

Objective: To determine whether egg donation (ED) pregnancies are at higher risk of pregnancy-induced hypertension (PIH) than those achieved by autologous assisted reproductive technology (ART; controls).Design: Anonymous comparative observational matched cohort study.Setting: Assisted reproductive technology centers.Patient(s): Two hundred seventeen ED and 363 control singleton pregnancies matched at 7-8 weeks (pregnancy date, parity, cycle type [fresh/frozen] and women's age). According to French practice, all women were under 45.Intervention(s): None.Main Outcome Measure(s): Percentage of PIH for ED versus controls.Result(s): The groups were comparable (mean age, 34.5). PIH was more frequent during ED pregnancies (17.8% vs. 5.3%), as was preeclampsia (11.2% vs. 2.8%) and eclampsia (1.8% vs. 0.0%). In multivariate analyses, PIH risk increased with ED (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.93-7.97) and women's age (OR, 1.08; 95% CI, 1.00-1.16). No significant effect of previous pregnancies or cycle rank/type was observed.Conclusion(s): This study had sufficient power to detect doubling of the PIH rate. It was demonstrated that the risk of PIH was tripled for ED versus controls. Even in young women, ED is a risk factor for PIH. An immunological explanation seems most likely, that is, the fetus is fully allogeneic to its mother. This risk must be acknowledged to inform couples and provide careful pregnancy monitoring. (C) 2016 by American Society for Reproductive Medicine.

Despite excellent published results, the lack of well-designed, multicentre, randomized clinical trials results in an absence of general consensus on the efficacy of autologous endometrial cells coculture (AECC) in Assisted Reproductive Technology (ART). An open, multicentre, prospective, randomized controlled trial was designed to compare the pregnancy rate (PR) after the transfer of one blastocyst on day 5 after AECC to the transfer of one embryo on day 3 (control group). Patients were women aged 18 to 36, undergoing an ART cycle with no more than 1 embryo transfer failure. Sample size was calculated at 720 for a superiority trial involving an intermediate analysis at 300 patients. We present the results of the intermediate analysis that resulted in the study ending considering the observed difference. Three hundred thirty nine patients were randomized: 170 in the AECC group and 169 in the control group. The clinical PR per transfer was 53.4% with AECC and 37.3% in the control group (p=0.025). The quality of embryos was improved with AECC. These results suggest that implementation of the AECC technique to a large number of In-Vitro Fertilization (IVF) centres could lead to a substantial improvement in the proportion of successful assisted reproduction. The study was supported by the Laboratoires Genévrier, France.

The onset of menarche and age of first sexual experience have both lowered over the past century. Does the age of puberty influence the sexuality of the girl/young occidental woman? If so, to what degree? Besides, is the acquisition of reproductive function, regardless of age, a sign of sufficient maturity to engage in sexual activity? Studies show that early puberty, early sex, unprotected sexual intercourse in adolescence and number of sexual partners in early adulthood are closely related. These early sexual experiences could be stimulated by early drug use as well as by depressive disorders. The age of puberty has a real influence on sexuality but this link will be modulated by a number of social behavioral factors and it is not sustainable. The age of puberty is not a good indicator of maturity for teenage sexuality; early maturation and early sexual activity are usually associated with risky behaviors. However, other studies on the subject are required, including a consideration of the issues associated with delayed puberty, a subject virtually absent from the literature.

Chez la femme vivant avec le VIH, la procreation naturelle trouve une place grandissante. En cas de desir d’enfant, la consultation preconceptionnelle revet une importance capitale pour guider au mieux les couples. La recommandation actuelle est de proposer systematiquement a toute personne infectee un traitement au long cours ayant pour objectif une charge virale indetectable. Dans ces conditions, le risque de transmission virale de la mere a l’enfant est nul. Plusieurs traitements sont utilisables en cours de grossesse, c’est la fin de la predominance de l’AZT. Cependant, la prudence est de mise avec les medicaments plus recents. La perfusion d’AZT et la cesarienne ne sont pratiquees que si la charge virale est superieure a 400 copies/mL. Pour la contraception, il est necessaire de maintenir le preservatif jusqu’a autorisation contraire de l’infectiologue. Le choix d’une contraception doit etre personnalise et decide en discussion pluridisciplinaire. Si on opte pour une contraception orale, on peut utiliser preferentiellement un progestatif derive de la 17-0H-progesterone associe a l’œstradiol naturel. L’utilisation du dispositif intra-uterin doit etre encouragee. Ainsi, bien qu’au prix d’une surveillance pluridisciplinaire rapprochee, la sante reproductive de la femme VIH+, de la contraception au desir de devenir parents, de la grossesse au suivi du bebe, se rapproche de plus en plus de celle de la femme non infectee.