A semi-quantitative and non-invasive method for scoring embryos obtained after in-vitro fertilization (IVF) has been defined, aiming at selection of embryos before transfer and at prognostic evaluation of IVF trials. Grading of embryos observed on the inverted microscope was essentially based on the amount of anucleate fragments expelled during early cleavage and on developmental speed. Embryos endowed with a high score were more often associated with pregnancy and in particular with the occurrence of multiple pregnancy. No difference was observed between scores attributed to embryos related to ongoing, aborted or chemical pregnancies. Average embryonic scores corresponding to double and triple transfers differed significantly in failures as well as pregnancies. The better quality of embryos replaced in triple transfers was also apparent from the significantly higher implantation rate per embryo observed in this group. From our results, five criteria including clinical data and embryonic scores can be derived for defining a high risk of multiple pregnancy prior to transfer. It might be warranted to replace only two embryos when these conditions are fulfilled.

The multicentric study regroups 128 cases of the ovarian hyperstimulation syndrome (OHSS) in in-vitro fertilization (IVF) and 256 selected controls. Values of serum oestradiol obtained from different laboratories were found to be normally distributed after logarithmic transformation. Comparative study of clinical and biological characteristics indicates that among OHSS patients (i) mean age was lower; (ii) tubal indications for IVF were less frequent; (iii) polycystic ovary-like conditions (i.e. hyperandrogenism, anovulation, luteinizing hormone/follicle stimulating hormone ratio > 2) were more frequent. OHSS patients displayed ovarian hypersensitivity reflected by higher oestradiol peak concentrations in response to lower dosage of human menopausal gonadotrophin and by a steeper slope of oestradiol increment during stimulation. In these patients, the collection of greater numbers of fertilizable oocytes allowed replacement of more embryos with a good vitality score. Ongoing pregnancy rate was found to be higher among the OHSS patients. The following complications were recorded among OHSS cases: abdominal fluid at echographic examination or clinical ascites (86.7 and 71.1%, respectively); pleural and pericardial effusion (21 and 3%, respectively); haemoconcentration (71.1%); electrolytic disorders (6.2%). Although significantly different between groups, clinical and biological parameters under study showed considerable overlap of their distributions in control and OHSS cases. Therefore, these data must be submitted to discriminant analysis in order to derive a formula predictive of the risk of OHSS.

The aim of this study was to determine whether the presence of a hydrosalpinx influences in-vitro fertilization (IVF) prognosis. Comparisons were made between 69 IVF cycles in 37 patients carrying hydrosalpinges (hydrosalpinx group) and 67 IVF cycles in 41 patients without tubes or surgically sterilized (control group). Twenty-two patients carrying hydrosalpinges underwent salpingectomy or salpingoplasty (operated group); they then underwent 42 IVF trials which were compared with the two former groups. In the hydrosalpinx group, pregnancy rates by oocyte retrieval were 10.1% for clinical and ongoing pregnancies. In the control group, the corresponding pregnancy rates were 23.0 and 21.3% respectively. The implantation rate per embryo was 4.2% for clinical and ongoing pregnancies in the hydrosalpinx group and 11.0 and 10.4% respectively in the control group. The operated group had pregnancy rates of 38.1% for clinical pregnancies and 31.0% for ongoing pregnancies, with implantation rates of 17.4 (clinical) and 14.8% (ongoing) respectively. Pregnancy and implantation rates were statistically lower in the hydrosalpinx group as compared with controls and with the operated group. The differences between control and operated groups were not significant. In conclusion, the presence of a hydrosalpinx is thus associated with poor prognosis in IVF treatment. Surgical correction of such lesions appears to restore high success rates.

The aim of this work was to evaluate the relationship between follicular size at the time of oocyte retrieval, and the subsequent oocyte competence to be fertilized and to develop in vitro. All the obtained oocytes were classified according to the corresponding volume of aspirated follicular fluid. Aspirated volume of follicular fluid <2 ml corresponded to a follicular diameter <16 mm and constituted the small size group. Volume of follicular fluid from 2 to 6 ml corresponded to a diameter from 16 to 23 mm and constituted the medium size group. The large size group contained follicles with diameter >23 mm and corresponded to an aspirated volume of follicular fluid of >6 ml. A progressive and significant increase in the rates of oocytes with a first polar body was observed from the small size group to the other groups and from the medium to the large size group: 75.3, 85.9 and 95.3% respectively. After classical in-vitro fertilization (IVF), significantly better rates of fertilization and development were obtained in the medium size group compared to the two other groups. Moreover, a positive relationship was observed between follicular diameter and rates of embryos scored as 'good' when oocytes were fertilized by intracytoplasmic sperm injection (ICSI). These results demonstrated that follicular size is positively related to the oocyte ability to be fertilized and to develop. Although oocytes from small follicles gave lower percentages of development probably due to partial oocyte incompetence, they allowed an increase in the total number of embryos scored as 'good'.

SUMMARY The duration of the phase of DNA synthesis (S-phase) and turnover times were measured by autoradiography in the vaginal and endo-uterine epithelium of spayed mice at different times after a single oestradiol injection. With three doses of oestradiol (0·3, 1·2 and 10·0 μg), changes of turnover time followed similar patterns in uterine epithelium, but maximal activation and subsequent levelling off of proliferation rates were reached sooner with higher doses. In the vagina, no significant dose-dependence was apparent with the same doses of oestradiol; maximal activation of cell proliferation was observed in every case 12 h after hormone injection. Transient shortening of S-phase was observed in both tissues under oestrogen stimulation. The morphological changes in uterine epithelium appeared to be independent of mitotic stimulation. For vaginal epithelium, the results may be interpreted to indicate that oestrogen-induced keratinization starts by a differentiating action on pre-existing G1 cells.