Frydman R, Lamazou F, Gallot V, Grynberg M, Fanchin R, Hesters L, Frydman N, Taieb J

POOR RESPONDER: IS THERE A SOLUTION?

AMH is considered like a major prognostic factor of ovarian response during controlled ovarian hyperstimulation. IVF in modified natural cycle has gained attention recently, even for both normal and poor responder. We conducted a retrospective study on 415 cycles of IVF in modified cycles with an objective to evaluate the impact of serum AMH concentration on day 3 on the outcomes. Patients of less than 37 years of age have been regrouped by AMH concentration: 0.04-0.49 ng/ml, 0.5-0.99 ng/ml, 1-1.49 ng/ml, 1.5-1.99 ng/ml, 2-2.249 ng/ml and 1.5-5 ng/ml. No statistically differences have been observed on cancellation rate, failure of oocyte retrievals, embryo transfers rate, pregnancy or implantation rate. The embryo quality based on the morphology on day 2 was similar in all the groups. In conclusion serum AMH concentration in day 3 does not seem to be correlated to pregnancy rate nor implantation rate, nor embryo morphology in IVF in modified cycle for patients of less than 37 years of age. IVF in modified cycle should be proposed in first intention to the patients with a poor prognosis characterized by a low AMH concentration inferior to 0.5 ng/ml with an implantation rate of 27.18%.

 

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Sedbon E

DEVELOPED COUNTRIES AND REPRODUCTION

The world’s developed countries are no doubt undergoing since a few years a social mutation partly due to the changes in the woman’s status and place in society. Major gains in the 20th century, such as contraception, emancipation and man-woman parity, have fundamentally changed the social system. The traditional socio-cultural rules of a married heterosexual stable couple with children, slowly giving way to the reality of several unions and several “families” in a lifetime owing to the increase in the number of “reconstituted” couples, a source of multi-parental families. The advent of assisted reproductive technology since 30 years also modify the demand and access to maternity and paternity. The technical possibilities of new biotechnologies generate legitimate demands, and also at the limit of what is actually reasonable, even marginal in a given social-cultural context in full evolution. Finally, the technological promises of Research in the domain of Reproduction Medecine are such that specialists will have to adapt to new types of novel demands, as industrialised societies will progressively have to modify their practices and “bioethics” laws to avoid “procreative tourism”.

 

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Spitz IM

ROLE OF PROGESTERONE RECEPTOR ANTAGONISTS (PAS) IN THE TREATMENT OF BREAST CANCER

Results from the WHI and other trials have shown an increased risk of breast cancer in women receiving a combination of progestin and estrogen for HRT as compared to estrogen alone. This implies that PAs may be of value in breast cancer treatment and is supported by studies in the DMBA rat breast cancer model where PAs including mifepristone, onapristone and CBD-4124 (Proellex) all decrease the tumor load. In this model CDB-4124 appears to be more efficacious than mifepristone in decreasing cell proliferation and increasing apoptosis (1). Results from clinical trials using mifepristone as second or third line treatment in metastatic disease were disappointing. Mifepristone is a potent antiglucocorticoid and the poor results may be related to the increase in estradiol secondary to aromatization of androgens. More promising results were obtained with onapristone (2). Both ornapristone and CDB-4124 are PAs with less antiglucocorticoid activity than mifepristone. PAs may also have a role in preventing breast cancer. Mifepristone decreased mammary gland cell proliferation in normal breast (3). In BRCA1/p53 deficient mice, mifepristone inhibited mammary tumorigenesis by decreasing ductal branching and alveolar proliferation and delayed the onset of breast cancer (4). One unresolved question is the potential effect of long term PAs on the endometrium. This issue must be fully resolved before long-term treatment with PAs can become a viable therapeutic option in the treatment of breast cancer.

 

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Tabar L

MULTIMODALITY APPROACH TO THE DIAGNOSIS OF BREAST DISEASES

The development of modern breast imaging methods has resulted in a paradigm shift in our approach to diagnosing and treating breast cancer. Regular mammography screening can bring about a profound change in the spectrum of the disease since it shifts the balance of breast cancers from mainly palpable to mainly impalpable cases, most of which are still localized to the breast. Breast cancer is a heterogeneous disease, therefore a multimodality approach is required to correctly describe the nature and extent of the different subtypes of this complex disease. This lecture aims to demonstrate the capabilities and limitations of the different imaging methods with implications on management of the breast cancer patient. The regular use of high quality mammography examination performed at sufficiently frequent intervals has brought about a new dimension to the traditional interaction between pathologists and radiologists. The mammographic, ultrasound and MRI examination of the breast provides an excellent overview of the whole breast, showing the relative proportions of all the different tissues within the breast. The conventional microscopic examination of breast specimens employs a resolution far superior to that of the mammogram, but only the tissue contained within the 4 micron thick tissue specimen obtained from a small paraffin block is examined. Progress in histologicmammographic correlation can be best made by examining a histology specimen at greater length, width and depth. The subgross, 3D histology technique serves to bridge the gap that separates the pathologist and radiologist, bringing them to a common ground for a better understanding of breast morphology. Combining the large section (10x8 cm) histology technique with the subgross, thick section (3D) histologic examination method makes a precise correlation with the imaging methods possible.

 

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von Schoultz B

MAMMOGRAPHIC DENSITY AS A RISK FACTOR FOR BREAST CANCER

Mammographic breast density has been identified as strong and independent risk factor for the development of breast cancer. Odds ratios ranging between 2 – 6 are higher than for many other risk factors, such as age at menarche, menopause, parity, body weight and hormonal treatments. It has been suggested that mammographic density may account for as much as 30 % of all breast cancer cases. Density may be of particular importance since it is the only known risk factor for breast cancer that is present in the breast itself. It is associated with sex steroid hormones and ovarian function and also varies with age, parity, height and body weight. Breast density is also related to reproductive status, endogenous sex steroids, peptide hormones, growth factors and their binding proteins. When mammographic density occurs during hormonal treatment, it is generally an early event which is apparent after a few months of treatment and thereafter remains stable unless the treatment regimen is changed. The histologic correlate to density is unclear but is likely to reflect an increased amount of epithelial, connective and stromal tissue. During hormonal treatment, there is a marked difference in breast density between individual women. Not all women respond in the same way to the same treatment. Constitutional and hormonal factors are important predictors for the individual response. The impact of hormonal treatments may vary with women’s age, BMI , parity as well as dose and type of regimen.

 

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