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Infertility: HELP
Articles by Hervé Fernandez
Based on 26 articles published since 2008
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Between 2008 and 2019, H. Fernandez wrote the following 26 articles about Infertility.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline [Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. 2018

Collinet, P / Fritel, X / Revel-Delhom, C / Ballester, M / Bolze, P A / Borghese, B / Bornsztein, N / Boujenah, J / Bourdel, N / Brillac, T / Chabbert-Buffet, N / Chauffour, C / Clary, N / Cohen, J / Decanter, C / Denouël, A / Dubernard, G / Fauconnier, A / Fernandez, H / Gauthier, T / Golfier, F / Huchon, C / Legendre, G / Loriau, J / Mathieu-d'Argent, E / Merlot, B / Niro, J / Panel, P / Paparel, P / Philip, C A / Ploteau, S / Poncelet, C / Rabischong, B / Roman, H / Rubod, C / Santulli, P / Sauvan, M / Thomassin-Naggara, I / Torre, A / Wattier, J M / Yazbeck, C / Canis, M. ·Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. Electronic address: pierre.collinet@chru-lille.fr. · Service de gynécologie-obstétrique et médecine de la reproduction, Inserm CIC 1402, 2, rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 86000 Poitiers, France; Inserm CIC 1402, 86000 Poitiers, France. · Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 La Plaine-Saint-Denis cedex, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard-Lyon 1, 69000 Lyon, France. · Service de chirurgie gynécologie-obstétrique 2 et médecine de la reproduction, CHU Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, Inserm U1016, université Paris Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France. · 29, rue de l'Essonne, 91000 Evry, France. · Service de gynécologie-obstétrique, CHU Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France; Faculté de médecine, Encov-ISIT, UMR6284 CNRS, université d'Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France. · 98, route de Blagnac, 31200 Toulouse, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC-6 centre expert en endométriose (C3E), Sorbonne université, Paris, France; UMR-S938 Inserm Sorbonne université, Paris, France. · Service de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France. · 3, rue Pablo-Picasso, 92160 Antony, France. · Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; EA 4308 gamétogenèse et qualité du gamète, CHRU de Lille, 59037 Lille cedex, France. · EndoFrance, BP 50053, 01124 Montluel cedex, France. · Université Claude-Bernard-Lyon 1, 69000 Lyon, France; Clinique gynécologique et obstétricale, hôpital de la Croix-Rousse, groupe hospitalier Nord, CHU de Lyon-HCL, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France; EA 7285 risques cliniques et sécurité en santé des femmes, université Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, équipe épidémiologie et évaluation des stratégies de prise en charge, VIH, reproduction, pédiatrie, université Paris-Sud, Paris, France. · Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 8, avenue Dominique-Larrey, 87042 Limoges, France; UMR-1248, faculté de médecine, 87042 Limoges, France. · Service de chirurgie gynécologique oncologique, obstétrique, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. · Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78303 Poissy, France. · Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris-Sud, 94276 Le Kremlin-Bicêtre cedex, France. · Service de chirurgie digestive, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75001 Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, CHU Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie Paris 6, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), hôpital Tenon, Paris, France. · Service de chirurgie gynécologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France. · Service de gynécologie-obstétrique, centre hospitalier de Versailles, 177, route de Versailles, 78157 Le Chesnay cedex, France. · Service d'urologie, CHU Lyon-Sud, 165, chemin du Grand-Revoyet, 60495 Pierre-Bénite, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Mère-Enfant, CHU de Nantes, 8, boulevard Jean-Monnet, 44093 Nantes, France. · Service de gynécologie-obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 93022 Bobigny, France. · Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. · Clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59000 Lille, France; Université Lille-Nord-de-France, 59000 Lille, France. · Service de gynécologie-obstétrique, CHU Bicêtre, AP-HP, 78, avenue du Général-de-Gaulle, 94275 Le Kremlin-Bicêtre, France. · Service d'imagerie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, Paris, France; Institut universitaire de cancérologie, Assistance publique, Paris, France. · Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France. · Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France. · Service de gynécologie-obstétrique, hôpital Foch, AP-HP, 40, rue Worth, 92151 Suresnes, France; Centre d'assistance médicale à la procréation, clinique Pierre-Cherest, 5, rue Pierre-Cherest, 92200 Neuilly-Sur-Seine, France. ·Gynecol Obstet Fertil Senol · Pubmed #29550339.

ABSTRACT: First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

2 Review [Comparison of fertiloscopy versus laparoscopy in the exploration of the infertility: analysis of the literature]. 2014

Braidy, C / Nazac, A / Legendre, G / Capmas, P / Fernandez, H. ·Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. · Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm U1018, 82, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud 11, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. Electronic address: herve.fernandez@bct.aphp.fr. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #24767305.

ABSTRACT: BACKGROUND: Fertiloscopy is a recent technique designed to explore the tubo-ovarian axis in unexplained infertility. It is a simple outpatient technique, allowing to perform operative procedures, but its position relative to laparoscopy is yet to be defined. MATERIAL AND METHODS: A thorough and extensive bibliographical search was undertaken to fully embrace the question, challenging Medline at the National Library of Medicine, Cochrane Library, National Guideline Clearinghouse, Health Technology Assessment Database. All the retrieved articles were classified as either descriptive or comparative studies and evaluated on a set of criteria. RESULTS: Most of the papers described case series coming from a few teams, focusing mainly on the technical aspect of the procedure, like the access rate to the posterior cul-de-sac, the success rate in visualizing the pelvis, the complications rate (mainly rectal perforation), and its operative performance in drilling ovaries for resistant polycystic ovarian syndrome. Comparative studies numbered six trials. They all followed the same design, fertiloscopy preceding conventional laparoscopy in patients taken as their own control. The concordance rate between the two modalities reaches 80% in terms of tubal pathology, adherences and endometriosis, with an estimated reduction of laparoscopies varying from 40% to 93%. CONCLUSION: The current literature shows a concordance between fertiloscopy and conventional laparoscopic findings for certain parameters in cases of tubal pathology, adherences and endometriosis. The relative positions of these two modalities in unexplained infertility still remain elusive.

3 Review Impact of obesity on reproductive outcomes after ovarian ablative therapy in PCOS: a collaborative meta-analysis. 2012

Baghdadi, Leena R / Abu Hashim, Hatem / Amer, Saad A K / Palomba, Stefano / Falbo, Angela / Al-Ojaimi, Eftekhar / Ott, Johannes / Zhu, Wenjie / Fernandez, Hervé / Nasr, Ahmed / Ramzy, Abdel Maguid / Clark, Justin / Doi, Suhail A R. ·School of Population Health, University of Queensland, Brisbane, Australia. ·Reprod Biomed Online · Pubmed #22809865.

ABSTRACT: Obesity is known to interfere with reproductive outcomes in polycystic ovary syndrome. There is no consensus regarding the impact of obesity on reproductive outcomes after ovarian ablative therapy (OAT) and there is no level I evidence to answer this question. This systematic review and meta-analysis assessed the strength of the association between obesity and ovulation or pregnancy rates after OAT. MEDLINE and several other databases were searched from 2000 to September 2011 for studies reporting on OAT and reproductive outcomes. Data were synthesized to determine the relative risk of reproductive outcomes (ovulation and pregnancy) in lean (body mass index <25 kg/m(2)) compared with overweight or obese women. The study obtained 15 data sets (14 articles) for analysis, which included 905 subjects in the obese group and 879 subjects in the lean group. Lean women had increased ovulation rates (RR 1.43, 95% CI 1.22-1.66) compared with obese women. Pregnancy rates also showed a similar trend (RR 1.73, 95% CI 1.39-2.17). Reproductive outcomes were generally better in younger women, more recent studies and randomized controlled trials. It is concluded that lean women respond better to OAT than their obese counterparts. These epidemiological observations indicate that obesity alters reproductive outcomes after OAT negatively. Obesity is known to interfere with reproductive outcomes in polycystic ovary syndrome. There is no consensus regarding the impact of obesity on ovarian ablative therapy (OAT) and there is no level I evidence to answer this question. We therefore undertook a systematic review and meta-analysis to assess the strength of the association between obesity and ovulation or pregnancy rates after OAT. We searched MEDLINE and several other databases from 2000 to September 2011 for studies reporting on OAT and reproductive outcomes. Data were synthesized to determine the risk ratio of reproductive outcomes (ovulation and pregnancy) in lean (BMI <25 kg/m(2)) as opposed to overweight or obese women. We obtained 15 datasets (14 articles) for analysis, which included 905 subjects in the obese group and 879 subjects in the lean group. Lean women had increased ovulation rates (RR 1.43, 95% CI 1.22-1.66) as compared to obese women. Pregnancy rates also showed a similar trend (RR 1.73, 95% CI 1.39-2.17). Reproductive outcomes were generally better in younger women, more recent studies and randomized controlled trials. We conclude that lean women respond better to OAT than their obese counterparts. These epidemiological observations indicate that obesity alters reproductive outcomes after OAT negatively.

4 Review [Myomectomy for infertile women: the role of surgery]. 2011

Bendifallah, S / Brun, J-L / Fernandez, H. ·Département de gynécologie-obstétrique, centre hospitalier universitaire de Bicêtre, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. sofiane.bendifallah@yahoo.fr ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #22056193.

ABSTRACT: At present, it is estimated that fibroids may be associated with infertility in 5 to 10% and are possibly the sole cause of infertility in 1 to 3%. Their effects on fertility remain debated. The aim of this review of published studies between January 1990 and November 2010 was to clarify the relation between myoma and fertility, and to assess the role of myomectomy in infertile patients. In assisted reproduction technology and spontaneous conception, hysteroscopic sub-mucous myoma resection increased pregnancy rates. Intramural fibroids appear to decrease fertility, but the myomectomy does not improve assisted reproduction technology and spontaneous fertility. More high-quality studies are needed to conclude toward the value of myomectomy for intramural fibroids. Subserosal fibroids do not affect fertility outcomes, and removal does not confer benefit.

5 Review [The place of myomectomy in woman of reproductive age]. 2011

Legendre, G / Brun, J-L / Fernandez, H. ·Département de gynécologie-obstétrique, hôpital universitaire du Kremlin-Bicêtre, 78, avenue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. g_legendre@hotmail.com ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #22056179.

ABSTRACT: OBJECTIVE: To define the involvement of myomas and myomectomy in all stages from conception to post-partum in women of reproductive age. MATERIALS AND METHODS: A literature review was conducted using the Medline and Cochrane databases to March 2011 by matching the keywords "fertility, infertility, miscarriage, pregnancy, delivery" with "myomas, fibroids, myomectomy". RESULTS: An association between myomas and fertility has been observed but the responsibility fibroids in infertility remains unclear. Myomas are associated with an increased rate of obstetric complications. Adhesions are the main complication of myomectomy. Endoscopic procedures and the use of anti-adhesive barriers prevent adhesion formation. Pregnancy rate in cases of myomectomy by laparotomy and laparoscopy is similar. Myomectomy during pregnancy is exceptionally indicated. CONCLUSION: The discovery of a uterine myoma needs to consider the responsibility of myomas in infertility, but also its impact on a future pregnancy. The therapeutic management is based on myomectomy but expected benefits must be weighed with potential risks.

6 Review Ovarian drilling for surgical treatment of polycystic ovarian syndrome: a comprehensive review. 2011

Fernandez, Hervé / Morin-Surruca, Michèle / Torre, Antoine / Faivre, Erika / Deffieux, Xavier / Gervaise, Amélie. ·Univ Paris-Sud, Bicêtre, France. herve.fernandez@bct.aphp.fr ·Reprod Biomed Online · Pubmed #21511534.

ABSTRACT: This systematic literature review is intended to clarify and evaluate the results obtained by ovarian drilling as surgical treatment for polycystic ovarian syndrome (PCOS). Four databases were consulted (Medline at the National Library of Medicine, USA; Cochrane Library, UK; National Guideline Clearinghouse, USA; and the Health Technology Assessment Database, Sweden) and searched for 'polycystic ovary syndrome' plus 'drilling' in the title or abstract. The assessment criteria used to define the efficacy of the procedure were the rates of ovulation, clinical pregnancy and early miscarriage. Alternatives to surgical ovarian drilling were evaluated. This search produced 147 references, 81 of which met the selection criteria. This review of infertility management in women with PCOS indicates that ovarian drilling is a second-line treatment when treatment with clomiphene citrate fails to lead to conception. The benefits of ovarian drilling are that it does not induce either hyperstimulation syndrome or multiple pregnancies. It is concluded that ovarian drilling is an option in the management of female infertility associated with PCOS, especially as a second-line treatment after the failure of clomiphene citrate treatment.

7 Review [Which is the method of choice for evaluating uterine cavity in infertility workup?]. 2010

Ait Benkaddour, Y / Gervaise, A / Fernandez, H. ·Service de gynécologie-obstétrique A, pôle Mère-Enfant, CHU de Marrakech, faculté de médecine, université Cadi Ayyad, Marrakech, Maroc. yaitbenkaddour@gmail.com ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #20870363.

ABSTRACT: Uterine factors represent only 2 to 3 % of infertility, but intra-uterine lesions are much more common in infertile women (40-50 %). These lesions can interfere with spontaneous fertility and can compromise pregnancy rates in assisted reproduction. Exploration of the uterine cavity is actually one of the basic explorations in infertility workup. Classically, hysterosalpingography and transvaginal sonography are most communally used for this purpose. Hysteroscopy, with the development and miniaturization of equipment, is currently simple, outpatient cost-effective exploration and it is considered the gold standard for diagnosis of intrauterine lesions. However, the benefit of the systematic use of hysteroscopy in the initial assessment of infertility remains unclear and the exploration of the uterine cavity in the initial assessment of infertility should be based on hysterosalpingography or hysterosonography. Systematic hysteroscopy before IVF is widely accepted practice that is supposed to improve pregnancy rates but still lacks scientific evidence. After repeated implantation failure in IVF cycles, uterine cavity should be reevaluated by hysteroscopy and this practice has been demonstrated to improve pregnancy rates.

8 Article Hysteroscopic resection of type 3 myoma: a new challenge? 2016

Capmas, Perrine / Voulgaropoulos, Audrey / Legendre, Guillaume / Pourcelot, Anne-Gaelle / Fernandez, Hervé. ·Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, F-94276 Le Kremlin Bicêtre, France. Electronic address: perrine.capmas@aphp.fr. · Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France. · Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France; Faculty of Medicine, Univ Paris Sud, F-94276 Le Kremlin Bicêtre, France. · Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, F-94276 Le Kremlin Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, F-94276 Le Kremlin Bicêtre, France; Faculty of Medicine, Univ Paris Sud, F-94276 Le Kremlin Bicêtre, France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #27607740.

ABSTRACT: OBJECTIVE: Type 3 myomas are intramural within contact with the endometrium but lack any cavity deformation. There is no guideline for management of symptomatic type 3 myoma. The aim of this study was to evaluate the feasibility of symptomatic type 3 myoma hysteroscopic resection. METHOD: This retrospective study included symptomatic women (mainly pain, infertility or bleeding) who obtained an operative hysteroscopy for type 3 symptomatic myoma from June 2010 to December 2014 in the gynaecological unit of a teaching hospital. RESULT: Thirteen women with an operative resection using bipolar electrosurgery of type 3 myoma during the study period (June 2010 to December 2014) were included in the study. Two women had a hysterectomy 6 and 12 months after the procedure and one woman had an open myomectomy 30 months after the procedure for the recurrence of abnormal bleeding. Postoperative office hysteroscopy show a postoperative synechiae in 3 women out of 8. Incomplete resection was also obtained in 3 women out of 8. CONCLUSION: Hysteroscopic resection is a potential alternative to traditional surgery for type 3 myoma. This procedure must be confined to skilled surgeons because it is a difficult procedure. A postoperative office hysteroscopy is recommended in women of reproductive age.

9 Article [Fertility after hysteroscopic resection of submucosal myoma in infertile women]. 2016

Ahdad-Yata, N / Fernandez, H / Nazac, A / Lesavre, M / Pourcelot, A-G / Capmas, P. ·Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. · Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; U1018 CESP-Inserm, Centre de recherché en épidémiologie et santé des populations, 82, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France. · Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Laboratoire de physique des interfaces et des couches minces, école polytechnique, 91128 Palaiseau, France. · Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France. · Service de gynécologie obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; U1018 CESP-Inserm, Centre de recherché en épidémiologie et santé des populations, 82, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France. Electronic address: perrine.capmas@bct.aphp.fr. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #26321611.

ABSTRACT: OBJECTIVES: Myoma is the most frequent benign uterine tumor and might have a negative impact on fertility. In 5 to 10% of cases, infertility is associated with myoma and in 1 to 3% myoma is the only infertility factor. Even if effect of myomectomy on fertility is controversial, benefit of hysteroscopic myomectomy for submucosal myoma on fertility has already been shown. The aim of this study is to evaluate fertility of infertile women less than 46years old after hysteroscopic resection of submucosal myoma. MATERIAL AND METHODS: This retrospective unicentric study took place in the gynecologic unit of a teaching hospital. All infertile women with a hysteroscopic myomectomy for submucosal myoma between March 2009 and May 2013 were included. A phone questionnaire was conducted to evaluate pregnancy rate, eventual medical assistance, time between submucisal resection and pregnancy and issue of pregnancies. RESULTS: Seventy-one infertile women with a hysteroscopic resection of submucosal myoma were included. Pregnancy rate was 33.8% with 50% of live births, 41.6% of miscarriages and 8.4% of late fetal losses with a mean follow-up of 28.7months. Mean time between hysteroscopic resection and pregnancy was 9.9months. A medical assistance was necessary for 6 women (25% of pregnancy). CONCLUSION: This study reports hysteroscopic resection of submucosal myoma for infertile women. The rate of pregnancy after treatment is 33.8%.

10 Article [Day care surgery for laparoscopic gynecologic surgery: What can be done?]. 2016

Houllier, M / Capmas, P / Fernandez, H. ·Service de gynécologie obstétrique, CHU de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France. · Service de gynécologie obstétrique, CHU de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France; Inserm U1018, CESP « Reproduction et développement de l'enfant », 82, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France; Université Paris Sud, Bicêtre, 63, rue Gabriel-Péri, 94270 Le-Kremlin-Bicêtre, France. Electronic address: perrine.capmas@bct.aphp.fr. · Service de gynécologie obstétrique, CHU de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France; Inserm U1018, CESP « Reproduction et développement de l'enfant », 82, rue du Général-Leclerc, 94270 Le-Kremlin-Bicêtre, France; Université Paris Sud, Bicêtre, 63, rue Gabriel-Péri, 94270 Le-Kremlin-Bicêtre, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #25979452.

ABSTRACT: OBJECTIVES: To study feasibility of day care surgery for laparoscopy for adnexial pathology, infertility treatment or exploration and to research influencing factors. MATERIAL AND METHOD: Women who beneficiate of laparoscopy for adnexial pathology, infertility treatment or exploration and to research influencing factors were included between 1st January 2010 and 30th June 2012 in this monocentric retrospective study. RESULTS: Four hundred women were included. Day care surgery was possible in 63% of cases. A switch to conventional hospitalization was required for 17% of the women planned for day care surgery. The rate of a second hospitalization in the month following day care procedure was 1% with 0.4% of second surgery for complications. Influencing factors for day care surgery are age, surgeon and time of the surgery. The global satisfaction rate of women was 98%. CONCLUSION: Day care surgery is feasible for women who beneficiate of laparoscopy for adnexial pathology, infertility treatment or exploration. Second hospitalization or surgery for complications is very rare.

11 Article [Using an ovarian drilling by hydrolaparoscopy or recombinant follicle stimulating hormone plus metformin to treat polycystic ovary syndrome: Why a randomized controlled trial fail?]. 2015

Fernandez, H / Cedrin-Durnerin, I / Gallot, V / Rongieres, C / Watrelot, A / Mayenga-Mankezi, J-M / Arnoux, A. ·Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; CESP-Inserm U1018, 82, rue du Général-Leclerc, 94276 Le Kremlin-Bicêtre, France; Université Paris-Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France. Electronic address: herve.fernandez@bct.aphp.fr. · Service de médecine de la reproduction, hôpital Jean-Verdier, AP-HP, avenue du 14-Juillet, 93140 Bondy, France. · Service de gynécologie obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France. · Service de gynécologie obstétrique, CMCO hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France. · Service de gynécologie obstétrique, centre de chirurgie gynécologique, 22, avenue Rockfeller, 69008 Lyon, France. · Service de gynécologie obstétrique, hôpital de Sèvres, 141, Grande-Rue, 92310 Sèvres, France. · Unité recherche clinique (URC) Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #25618178.

ABSTRACT: OBJECTIVES: To evaluate pregnancy rates after randomized controlled trial (RCT) between ovarian drilling by fertiloscopy or ovarian hyperstimulation+insemination+metformine after clomifène citrate (cc) treatment fails. PATIENTS AND METHODS: Randomized controlled trial with 126 patients in each arm in 9 university centers. After 6-9 months of stimulation by cc, 2 groups were randomized: group 1, ovarian drilling with bipolar energy versus group 2: 3 months treatment by metformine followed by 3 hyperstimulation by FSH+insemination. The success rate was pregnancy rate above 12 weeks. RESULTS: RCT was stopped after the screening of 40 patients. In spite of the low number of patients, the pregnancy rate is significantly higher in medical group 8/16 versus 3/18 (p=0.04). CONCLUSION: The causes of fail of RCT were in relationship with difficulties of inclusion, with absence of final agreement by team included. Moreover, RCT between medical and surgical management is often root of difficulties for patients who decline surgical strategy. However, medical treatment appeared better than drilling in this RCT.

12 Article [Uterine fibroids]. 2014

Fernandez, Hervé. · ·Rev Prat · Pubmed #24855792.

ABSTRACT: The uterine fibroid is a benign tumour. The prevalence, in all the population, is 50% for european women and 80% for black women. 30% of fibroids are symptomatic. The new FIGO classification gives 7 positions (0 to 7), submuccus (0, 1, 2), interstitial (3, 4, 5), subserous (6, 7). Diagnosis is performed by 2D and 3D ultrasound which could be associated by hysterosonography. Hysteroscopy and MRI could be proposed. Hysterectomy is the main treatment, if possible by vaginal or laparoscopic way. Conservative treatment (myomectomy) could be realized by hysteroscopic, laparoscopic way or laparotomy for patients who desire to preserve fertility. Arteries embolisation is an alternative to hysterectomy or myomectomy for patients without desire of pregnancy. Preoperative treatments by GnRH agonist or SPRM like ulipristal acetate treat anaemia, decrease the myoma volume and could modify the therapeutic strategy.

13 Article [Adiana(®) hysteroscopic tubal occlusion device for the treatment of hydrosalpinx prior to in vitro fertilization: a case report]. 2013

Legendre, G / Gallot, V / Levaillant, J-M / Capmas, P / Fernandez, H. ·Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, 78, rue Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. guillaume.legendre@bct.aphp.fr ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #23597488.

ABSTRACT: This case report outlines a successful pregnancy after proximal occlusion of a fallopian tube with Adiana(®) micro-insert in a patient with hydrosalpinx. A 32-year-old nulligravid patient with pelvic adhesive disease and unilateral hydrosalpinx underwent a successful occlusion of the hydrosalpinx by Adiana(®) matrix with a pregnancy after IVF cycle. Adiana(®) hysteroscopic tubal occlusion device can be used prior to IVF and seems to be an alternative to Essure(®) procedure. The theoretical advantage of Adiana(®) is the ability to maintain a uterine cavity free of all foreign matter.

14 Article [Myomectomy]. 2013

Brun, Jean-Luc / Legendre, Guillaume / Bendifallah, Sofiane / Fernandez, Hervé. ·Hôpital Pellegrin, centre Aliénor d'Aquitaine, pôle d'obstétrique reproduction gynécologie, 33076 Bordeaux, France. jean-luc.brun@chu-bordeaux.fr ·Presse Med · Pubmed #23582900.

ABSTRACT: Myomas induce menorrhagia and pelvic pain, and increase the risk of infertility and obstetrical complications. Symptomatic sub-mucosal myomas are classically treated by hysteroscopic resection. Symptomatic interstitial and sub-serosal myomas may be treated by myomectomy, either by laparotomy or laparoscopy according to their number and size. Prophylactic myomectomy is not recommended to prevent from obstetrical complications or the risk of leiomyosarcoma. Although all myomas have a negative effect on fertility, the removal of sub-mucosal myomas is the sole recommendation to improve spontaneous fertility or assisted reproduction technology.

15 Article Fertility after ectopic pregnancy: the DEMETER randomized trial. 2013

Fernandez, Hervé / Capmas, Perrine / Lucot, Jean Philippe / Resch, Benoit / Panel, Pierre / Bouyer, Jean / Anonymous3930752. ·Epidemiology of Reproduction and Child Development Team, Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, F94276 Le Kremlin Bicêtre, France. ·Hum Reprod · Pubmed #23482340.

ABSTRACT: STUDY QUESTION: Does treatment for the resolution of ectopic pregnancy (EP) affect subsequent spontaneous fertility [occurrence of an intrauterine pregnancy (IUP)]? SUMMARY ANSWER: There is no significant difference in 2 years subsequent fertility neither between methotrexate and conservative surgery for less active EP nor between conservative and radical surgery for the most active EP. WHAT IS KNOWN ALREADY: No randomized trial has compared radical and conservative surgery treatments. A recent review of the Cochrane database did not conclude about fertility due to insufficient data. Prospective studies from EP registries in two regions of France (Auvergne and Greater Lille) have suggested that fertility is similar after medical treatment and conservative surgery and lower after radical surgery. STUDY DESIGN, SIZE, DURATION: This randomized controlled trial included all women with an ultrasound-confirmed EP. Women were divided into two arms according to the activity of the EP (defined by Fernandez's score). In arm 1 (less active ectopic pregnancies, i.e. Fernandez's score <13 and no haemodynamic failure), medical treatment was considered practicable, and women were randomly allocated to conservative surgery with a systematic post-operative i.m. methotrexate injection within 24 h or to an i.m. methotrexate injection alone. In arm 2 (active ectopic pregnancies), medical treatment was considered impracticable, and, thus, all women had to undergo surgery; they were randomly allocated to either a radical or conservative procedure, the latter including a post-operative methotrexate injection. Sample sizes (n = 210 in arm 1 and n = 230 in arm 2) were computed to provide a statistical power of 80% to detect a 20% difference in subsequent cumulative fertility rates between treatments in each arm. The total duration of the trial was 5 years. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: The trial took place in 17 centres in France from 2005 to 2009. Two hundred and seven women were included in arm 1 and 199 in arm 2. Cumulative fertility curves were drawn with the Kaplan-Meier method and compared with the log-rank test. Hazard ratios (HRs) were computed with the Cox model. Analysis was performed according to the intention-to-treat principle. MAIN RESULTS: Arm 1: cumulative fertility curves were not significantly different between medical treatment and conservative surgery. HR was 0.85 (0.59-1.22) P = 0.37. The 2-year rates of IUP were 67% after medical treatment and 71% after conservative surgery. Arm 2: cumulative fertility curves were not significantly different between conservative and radical surgery. HR was 1.06 (0.69-1.63) P = 0.78. The 2-year rates of IUP were 70% after conservative surgery and 64% after radical surgery. LIMITATIONS, REASONS FOR CAUTION: Inclusion in this trial was more difficult than expected, especially in arm 2 in which women were reluctant to radical surgery. In consequence, the sample size was slightly lower than planned. However, due to a lower proportion of lost to follow-up than expected (10% instead of 15%), the statistical power remained very close to 80%. WIDER IMPLICATIONS OF THE FINDINGS: As it is a multicentre randomized trial, the results may be generalized with satisfactory confidence. The results of this trial invite gynaecologists to reconsider the management of EP and to modify balance between considerations of initial recovery and preservation of fertility. TRIAL REGISTRATION NUMBER: NCT00137982 on the WHO International Clinical Trials Registry Platform.

16 Article Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: reproductive outcomes study. 2013

Bendifallah, Sofiane / Faivre, Erika / Legendre, Guillaume / Deffieux, Xavier / Fernandez, Hervé. ·Assistance Publique Hôpitaux de Paris, Department of Obstetrics and Gynaecology, Hôpital Bicêtre, Le Kremlin Bicêtre, France. ·J Minim Invasive Gynecol · Pubmed #23317507.

ABSTRACT: STUDY OBJECTIVE: To assess reproductive outcomes in patients after surgical correction of septate uterus. DESIGN: Observational retrospective study (Canadian Task Force classification II-2). SETTING: Two university hospitals. PATIENTS: One hundred twenty-eight patients with primary infertility or recurrent miscarriage with partial (American Fertility Society [AFS] class Va), complete (AFS class Vb), or fundic (AFS class VI) septate uterus. Metroplasty is the current method of choice for surgically correcting septate uterus. The procedure and its indications are a matter of debate. INTERVENTIONS: Metroplasty via hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Outcomes including the numbers of pregnancies, first live births (FLBs), and miscarriages were determined. After metroplasty, 78 women (60.9%) became pregnant, and 70 live neonates were delivered. The FLB rate in infertile women was 53.1%. Of the 25 pregnancies, 13 (52%) resulted from assisted reproductive technology. In women who experienced recurrent miscarriage, the miscarriage rate was significantly improved. Outcomes (miscarriages and FLBs) differed significantly according to anatomical type of septum after surgery. CONCLUSION: Hysteroscopic septum resection is accompanied by safe improvement in reproductive performance in patients with symptoms of AFS class V/VI septate uterus.

17 Article [Post-curettage and aspiration synechiae: is there value in an anti-adhesion agent?]. 2012

Fernandez, H / Benifla, J-L / Fritel, X / Fallet, C. ·CHU du Kremlin Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre cedex, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #22445169.

ABSTRACT: -- No abstract --

18 Article [Risk factors for recurrence of ectopic pregnancy]. 2012

De Bennetot, M / Rabischong, B / Aublet-Cuvelier, B / Belard, F / Fernandez, H / Bouyer, J / Mage, G / Pouly, J-L. ·Service de gynécologie-obstétrique et reproduction humaine, CHU de Clermont-Ferrand, CHU Estaing, 1, place Lucie-Aubrac, 63100 Clermont-Ferrand, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #22018441.

ABSTRACT: OBJECTIVES: Investigate and identify the risk factors influencing the recurrence of ectopic pregnancies. PATIENTS AND METHODS: The Auvergne ectopic pregnancy registry data were analyzed from 1992 to 2008. The appearance of a recurrence was studied among 1108 women from 18 to 44 years old, who attempted to conceive again. RESULTS: One hundred and sixteen repeated ectopic pregnancies occurred (10.5 %) during the period under study. The rate of recurrence was significantly higher among women who had a history of voluntary termination of pregnancy (P=0.01). Conversely, fewer recurrences (P=0.01 and 0.0478) occurred among women having a history of infertility or previous live birth. The treatment for ectopic pregnancy, whether it is conservative or radical laparoscopic, or medical with methotrexate did not significantly influence the recurrence rate (P=0.86). CONCLUSION: Reproductive history appears to involve the risk of repeated ectopic pregnancy and must be taken into account in their secondary prevention. As for the choice of treatment, the risk of recurrence does not seem to constitute a decisive argument.

19 Article Surgical management of infertility due to polycystic ovarian syndrome after failure of medical management. 2011

Poujade, Olivier / Gervaise, Amélie / Faivre, Erika / Deffieux, Xavier / Fernandez, Hervé. ·Univ Paris-Sud, Clamart, F-92140, France. ·Eur J Obstet Gynecol Reprod Biol · Pubmed #21641713.

ABSTRACT: OBJECTIVES: To evaluate surgical management and fertility and pregnancy outcome in women with polycystic ovarian syndrome (PCOS). STUDY DESIGN: Retrospective file review and follow-up of 74 consecutive women with PCOS resistant to citrate clomiphene (CC) who underwent ovarian drilling by fertiloscopy with bipolar energy, together with hysteroscopic surgery when indicated (Canadian TASK FORCE II-2). RESULTS: Of 77 files, only 3 women were lost to follow-up. Mean age was 30.2 years (SD 5.3) [29.0-31.4 CI 95%], and mean BMI 25.6kg/m(2) (SD 6.2) [24.2-27.0 CI 95%]. Pregnancy occurred after drilling in 47 cases (63%), spontaneously in 20 (27%), after ovarian stimulation in 5 (6.7%) and after in vitro fertilization in 22 (29.7%). Laparoscopic conversion was required in 5 cases (6.7%), due to failure to visualize the adnexa (n=3), or pelvic adhesions (n=1), or uterine hemorrhage (n=1). Hysteroscopy detected and simultaneously treated a uterine anomaly in 18 of 74 patients: uterine septum (n=10, 13%), T-shaped uterine cavity (n=3, 4%), endometrial polyp (n=2, 2.7%), endometrial hypertrophy (n=2, 2.7%), and synechiae (n=1, 1.3%). The mean overall delay to pregnancy was 11.1 months (SD 8.5) [8.7-13.5 CI 95%] and to spontaneous pregnancy, 7 months (SD 7.6) [3.7-10.3 CI 95%]. The mean follow-up was 23.4 months (SD 16.5) [18.1-28.7 CI 95%]. After multivariate analysis, the likelihood of pregnancy was significantly associated with previous ovarian stimulation by FSH (OR=2.28, 95% CI=1.08-4.83) and initial FSH level (OR=0.52, 95% CI=0.29-0.93). CONCLUSION: Ovarian drilling by hydrolaparoscopy is an effective treatment for CC-resistant PCOS. The high rate of associated uterine anomalies justifies simultaneous hysteroscopic surgery.

20 Article Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus. 2011

Fernandez, Hervé / Garbin, Olivier / Castaigne, Vanina / Gervaise, Amélie / Levaillant, Jean-Marc. ·Service Gynécologie Obstétrique, Hôpital Bicêtre, Kremlin Bicêtre, France. herve.fernandez@bct.aphp.fr ·Hum Reprod · Pubmed #21398337.

ABSTRACT: BACKGROUND: The aim of this study was to describe the surgical approach to, and evaluate the reproductive outcome of, a T-shaped uterus. METHODS: The study included 97 women who were eligible for hysteroscopic surgery, by either monopolar or bipolar electrosurgical instruments. All had diagnostic hysteroscopy 2 months afterwards to assess the success of the procedure and determine whether any synechiae were present. RESULTS: Forty-eight women (49.5%) became pregnant after metroplasty. The overall live birth rate per pregnancy before surgery was 0%; for these patients, it increased to 73%, and their miscarriage rate fell from 78 to 27% (P < 0.05). For all 57 pregnancies in 48 women, the ectopic pregnancy rate was 9% (n = 5), the miscarriage rate 28% (n = 16), the preterm delivery rate 14% (n = 8), the term delivery rate 49% (n = 28) and the live birth rate was 63% (n = 36). CONCLUSIONS: Hysteroscopic metroplasty improves the live birth rate for women with a T-shaped uterus and a history of primary infertility, recurrent abortion or preterm delivery, although it is not a treatment of infertility.

21 Article [Fertility following myomectomy by laparotomy in women aged over 38]. 2011

Roux, I / Faivre, E / Trichot, C / Donnadieu, A-C / Fernandez, H / Deffieux, X. ·Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris, université Paris-Sud, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #21050677.

ABSTRACT: OBJECTIVES: Uterine fibroids is the most common benign pathology during reproductive age. Fibroids are implicated as a possible cause of infertility. The mechanism of infertility may depend on the size and the location of the fibroids and remain unclear. Myomectomy is performed in case of symptomatic patients who want to preserve their reproductive potential or in case of infertile patients. There are few data concerning fertility following abdominal myomectomy in patients over the age of 38. PATIENTS AND METHODS: Retrospective study of a case series. Assessment of reproductive outcome after abdominal myomectomy among patients older than 38 years. RESULTS: Abdominal myomectomy was performed on 34 patients aged over 38 during. Among these patients, 25 (74%) were contacted and 15 (60%) tried to obtain a pregnancy. Seven patients (46%) needed a new intervention. Five patients (33%) required intra-uterine insemination or in vitro fertilization and embryo transfer postoperatively. Three patients obtained a pregnancy and two (13%) had a delivery. All pregnancies were obtained spontaneously. None infertile or nulliparous woman before surgery became pregnant postoperatively. CONCLUSION: After 38 years old, nulliparity and infertility before abdominal myomectomy seem to be a factor of poor prognostic to become pregnant after surgery.

22 Article [Fertility after ectopic pregnancy]. 2010

Desroque, D / Capmas, P / Legendre, G / Bouyer, J / Fernandez, H. ·Service de gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 le Kremlin-Bicêtre, France. ·J Gynecol Obstet Biol Reprod (Paris) · Pubmed #20478667.

ABSTRACT: BACKGROUND: The subsequent fertility of women who had experienced ectopic pregnancy (EP) is the best criteria of the effectiveness of the treatment. In the absence of randomised trials comparing laparotomy, laparoscopy, medical treatment by methotrexate (MTX) and expectative, the only way to compare treatments is to make use of data from observational studies. METHODS: The databases consulted were Medline, Cochrane Library, National Guideline Clearinghouse and Health Technology Assessment Database. Keywords used for research: fertility; ectopic pregnancy; expectative; methotrexate; salpingectomy; salpingotomy. RESULTS: Twenty-four papers of randomised control trial (RCT) or observational studies were analysed. No difference between laparotomy and laparoscopy for fertility was found. Tubal suture does not modify the subsequent fertility. The risk of normal pregnancy or ectopic recurrence is similar between salpingotomy or salpingectomy when controlateral tube is normal. Conversely, in case of altered tube, the fertility appears higher after conservative treatment. Between conservative treatments, surgical or medical, no difference appears. CONCLUSIONS: Conservative surgical treatment is the gold standard. However, the fertility seems similar with the other treatments. Three ongoing RCT could answer to the three main questions: Which is the best fertility between medical and conservative surgical treatment? Which is the best fertility between radical and conservative surgical treatment? Which is the best fertility between MTX and expectative?

23 Article Laparoscopic ovarian drilling using a 5-French bipolar energy probe. 2010

Fernandez, Hervé / Faivre, Erika / Gervaise, Amélie / Deffieux, Xavier. ·Université Paris-Sud, Paris, France. herve.fernandez@abc.aphp.fr ·Fertil Steril · Pubmed #19446807.

ABSTRACT: OBJECTIVE: To report a new technique of laparoscopic ovarian drilling using a 5-Fr bipolar electrode. DESIGN: Retrospective study (case series). SETTING: University hospital. PATIENT(S): Patients presenting with polycystic ovarian syndrome. INTERVENTION(S): Laparoscopic ovarian drilling using a 5-Fr bipolar probe. MAIN OUTCOME MEASURE(S): Feasibility of operative technique. RESULT(S): No perioperative complication was noted. CONCLUSION(S): We describe a new technique of laparoscopic ovarian drilling using a bipolar electrosurgical probe.

24 Article Fertility after hysteroscopic management of osseous metaplasia of the endometrium. 2009

Lousquy, Ruben / Deffieux, Xavier / Gervaise, Amélie / Faivre, Erika / Frydman, René / Fernandez, Hervé. ·University Paris-Sud, Clamart, France. ·Int J Gynaecol Obstet · Pubmed #19428009.

ABSTRACT: -- No abstract --

25 Article Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility. 2009

Touboul, Cyril / Fernandez, Hervé / Deffieux, Xavier / Berry, Richard / Frydman, René / Gervaise, Amélie. ·University of Paris-Sud, Clamart, France. ·Fertil Steril · Pubmed #18937941.

ABSTRACT: OBJECTIVE: To determine the rate of uterine synechiae after bipolar hysteroscopic myomectomy in patients suffering from infertility. DESIGN: Retrospective case series study. SETTING: University obstetrics gynecologic and assisted reproduction center. PATIENT(S): A group of 53 patients with primary (n = 30) and secondary (n = 23) infertility. INTERVENTION(S): Patients underwent bipolar hysteroscopic resection of myomas between 2001 and 2006, and an outpatient hysteroscopy was performed 2 months after the fibroid resection. MAIN OUTCOME MEASURE(S): The formation of uterine synechiae and pregnancy rates were collected from the patients' clinical notes. RESULT(S): The submucosal myomas were intracavitary class 0 (n = 12), intramural class 1 (n = 19), and intramural class 2 (n = 22). The mean age of the women was 35.0 +/- 4.8 years. The mean myoma size was 25 +/- 11 mm. Postoperative office hysteroscopies revealed synechiae in four (7.5%) of 53 patients. Sixteen (32.7%) of the 49 patients not lost to follow-up conceived, and 12 (24.5%) of them delivered at term. Myoma size >or=3.5 cm and age <35 years were associated with a significantly higher pregnancy rate in univariate and multivariate analysis. CONCLUSION(S): The incidence of uterine synechiae after bipolar hysteroscopic resection of fibroids was 7.5%. This appears to be lower than that reported in previous studies using monopolar energy. Bipolar hysteroscopic myomectomy may be a better option for infertile women.

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