A 5-day free interval after OCP or progestogen offers the advantages of gonadotrophin recovery and homogeneous follicular cohort, whereas early FSH rebound occurring after estrogen pre-treatment argues for a short free period.

A total of 96 women undergoing in-vitro fertilization (IVF) treatment were examined by transvaginal ultrasonography with colour and pulsed Doppler ultrasound on the 22nd day of the menstrual cycle preceding IVF. We assessed endometrial thickness, endometrial morphology, myometrial echogenicity, subendometrial vascularization, the uterine artery pulsatility index, protodiastolic notch and end diastolic blood flow in order to define a uterine score which could be correlated with the pregnancy rate. The overall pregnancy rate was 30.2%, and there was no difference between the pregnant and non-pregnant groups with regard to any of the ultrasonographic and Doppler parameters when examined separately. However, the uterine score was significantly higher in the pregnant group (15.9 +/- 2.81 versus 12.7 +/- 5.3, P = 0.002; t-test). No pregnancy occurred if the score was between 0 and 10. With a score of 11-15 there was a 34.7% chance of pregnancy, and scores >16 had a 42% chance of pregnancy. In conclusion, individual ultrasonographic and Doppler parameters are not of sufficient accuracy to predict uterine receptivity. The uterine score calculated prior to IVF cycles appears to be a useful predictor of implantation.

The aim of this prospective study was to establish complementary data of uteri exposed to diethylstilbestrol (DES) in utero for transvaginal analysis and vascularity changes during the menstrual cycle. A total of 28 women with DES-exposed uteri were compared with 60 non-exposed women. Transvaginal ultrasound and colour Doppler imaging were performed on days 5 and 22 of the menstrual cycle. Uteri were measured on sagittal and transverse scans. Uterine length, width, thickness and uterine cavity length and width were measured. Uterine volume and uterine cavity area were calculated. DES-exposed uterine volume was equal to 31.84 +/- 3.37 cm3. The cavity area of DES-exposed uterus was equal to 35.85 +/- 3.93 cm2. Cervix length of DES-exposed uterus was significantly smaller than that of non-exposed uterus. The uterine artery pulsatility index (PI) of DES-exposed uterus was significantly higher than that of normal uterus. Blood flow remained stable throughout the menstrual cycle. The PI of DES-exposed uterus remained stable during the menstrual cycle, as in non-exposed uterus, and it decreased during the luteal phase. This lack of modification in vascularity of DES-exposed uterus may explain miscarriages and obstetric complications such as intrauterine growth retardation or pre-eclampsia. The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation in DES-exposed uterus.

Objectives

RESUMELe pronostic des infertilitds masculines s~v~res, dont les azoospermies sdcr~toires, s'est consid~rablement am~lior~ ces dernitres ann~es avec la microinjection (ICSI). Le biologiste de la Reproduction participe activement, en collaboration avec le chirurgien /~ la recherche et rextraction des spermatozoides /l partir du tissu testiculaire (TESE).La presence du biologiste au bloc op~ratoire est imperative pour guider le chirurgien et dviter des biopsies trop nombreuses. L'extraction des spermatozoides au laboratoire se fait le plus souvent par extraction m~ca-nique en dilac~rant le tissu en fins l~mbeaux l'aide de pinces fines. L'extraction enzymatique fi l'aide de collagdnase de type IV pourrait ~tre employee dans le cas des azoospermies s~cr~toires afin de mieux dissocier les cellules et d'augmenter les chances de rdcup~ration de formes matures. La purification des spermatozoides sur fraction 50 % de PureSpe~'m permet de limiter la perte en spermatozoides sur des pr~l~vements qui sont souvent moins cellulaires que dans les cas d'azoospermie excrfitoire. L'addition de stimulant de la mobilit~ (telle que la Pentoxifylline) ou la culture in vitro pendant 3 jours dans le cas d'akin~sie, permet d'amdliorer les r~sultats en AMP.La cryopr~servation des spermatozoides est obligatoire dans la prise en charge de ces cas d'azoospermie, permettant de programmer la TESE de manibre asynchrone par rapport ~ la FIV-ICSI. Les r~sultats de cryoconservation des spermatozoides testiculaires obtenus ces derni~res ann~es sont satisfaisants. La cong~-lation de plusieurs fractions spermatiques de petit volume serait /l privil~gier. II apparait important de diminuer les interventions chirurgicales sur le testicule.Nous pr~sentons bribvement notre experience sur 36 cas d'azoospermie s~cr~toire, dans 13 cas la recherche de spermatozoides a ~t~ n~gative soit 36 % ; c'est le taux qui est retrouv~ dans la litt~rature.