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RÉSUMÉ
Résumé. L’infertilité constitue un véritable problème de santé publique et l’âge maternel demeure un facteur important dans l’appréciation des chances de grossesse. Objectif. Reporter les facteurs influençant la survenue d’une grossesse au décours d’une AMP pour les femmes âgées de plus de 38 ans dans notre centre. Matériel et méthodes. Nous avons mené une étude cas-témoin au Centre Hospitalier de Recherche et d’Application en Chirurgie Endoscopique et Reproduction (CHRACERH) entre le 1er Octobre 2015 et le 31 Mai 2018. Les cas étaient constitués des femmes de plus de 38 ans qui au décours d’une Assistance Médicale à la Procréation avaient un test de grossesse positif. Les témoins étaient celles dont le test de grossesse était négatif au cours de la même période. Résultats. Nous avons ainsi comparé 29 cas de grossesse à 56 témoins. Lorsque le spermogramme du conjoint était anormal, quand il s’agissait d’une azoospermie, les femmes avaient 5,5 fois plus de chance de concevoir (p=0,04) et lorsqu’elles étaient à plus de 3 tentatives d’AMP, les chances de grossesse étaient multipliées par 2,5. En analyse multivariée après régression, aucun de ces facteurs ne s’est avéré significatif. Conclusion. L’azoospermie chez le conjoint, l’âge de plus de 45 ans, avoir fait au moins 03 tentatives augmentaient significativement les chances de grossesse sans pour autant être des facteurs indépendants. Des études sur des échantillons plus grands pourraient améliorer l’appréciation de ces facteurs.
ABSTRACT
Abstract. Infertility is a public health problem and maternal age is an important factor in assessing pregnancy chances. Objective. To report the factors influencing the occurrence of pregnancy after an in vitro fertilization (IVF) for women over the age of 38 at our centre. Materials and methods. We conducted a case-control study at the Gynecological Endoscopy surgery and Human Reproductive Teaching Hospital(GESHRTH) between October 1, 2015 and May 31, 2018. The cases were women over the age of 38 years who had a positive pregnancy test after an IVF attempt. The controls were those whose pregnancy test was negative during the same period. Results. We compared 29 cases of pregnancy to 56 controls. When the spouse's abnormal spermogram was azoospermia, women were 5.5 times more likely to conceive (p =0.04) and when they were at more than 3 IVF attempts, the chances of pregnancy were multiplied by 2.5. In multivariate analysis after regression, none of these factors was found to be significant. Conclusion. Azoospermia in the spouse, the age of over 45 years, having made at least 03 attempts of IVF significantly increased the chances of pregnancy without being independent factors. Studies on larger samples could improve the appraisal of these factors.
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References
- Boivin J, Bunting L, Collins JA, Nygren KG. Erratum: International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care (Human Reproduction (2007) vol. 22 (1507)). Hum Reprod. 2007;22(10):2800.
- Leke RJI, Oduma JA, Bassol-mayagoitia S, Maria A, Grigor KM, Brogan P. Brogan & Partners Regional and Geographical Variations in Infertility : Effects of Environmental , Cultural , and Socioeconomic Factors Source : Environmental Health Perspectives , Vol . 101 , Supplement 2 : Impact of the. 2014;
- Murdock W, Wong BC-M, AlAsiri S, Lee F, Dwyer C, Graham J, et al. Advanced Reproductive Age and Fertility. Int J Gynecol Obstet [Internet]. 2011;117(1):95–102. Available from: http://dx.doi.org/10.1016/S1701-2163(16)35087-3
- Liu KE, Case A. No. 346-Advanced Reproductive Age and Fertility. J Obstet Gynaecol Canada [Internet]. 2017;39(8):685–95. Available from: http://dx.doi.org/10.1016/j.jogc.2016.12.004
- Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH. One last chance for pregnancy: A review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril. 2005;84(2):435–45.
- Serour G, Mansour R, Serour A, Aboulghar M, Amin Y, Kamal O, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above. Fertil Steril [Internet]. 2010;94(5):1707–12. Available from: http://dx.doi.org/10.1016/j.fertnstert.2009.09.044
- Lebovitz O, Haas J, James KE, Seidman DS, Orvieto R, Hourvitz A. The expected cumulative incidence of live birth for patients starting IVF treatment at age 41 years or older. Reprod Biomed Online [Internet]. 2018;37(5):533–41. Available from: https://doi.org/10.1016/j.rbmo.2018.08.014
- Mariappen U, Keane KN, Hinchli PM, Dhaliwal SS, Yovich JL. Neither male age nor semen parameters in fl uence clinical pregnancy or live birth outcomes from IVF. 2018;(November).
- Moncef. Paternal age : Negative impact on sperm genome decays and IVF outcomes. 2018;(January).
- Volodarsky-perel A, Buckett W, Tulandi T. Treatment of hydrosalpinx in relation to IVF outcome: a systematic review and meta-analysis. 2019;00(0):1–20.
- Ozmen B, Diedrich K. Article Hydrosalpinx and IVF : assessment of treatments implemented prior to IVF. Reprod Biomed Online [Internet]. 2007;14(2):235–41. Available from: http://dx.doi.org/10.1016/S1472-6483(10)60792-4
- Orvieto R, Saar-Ryss B, Morgante G, Gemer O, Anteby EY, Meltcer S. Does salpingectomy affect the ipsilateral ovarian response to gonadotropin during in vitro fertilization – embryo transfer cycles ? Fertil Steril [Internet]. 2011;95(5):1842–4. Available from: http://dx.doi.org/10.1016/j.fertnstert.2010.11.061
- Hassa H, Aydin Y. The role of laparoscopy in the management of infertility. 2014;(January):1–7.
- Malizia BA, Hacker Michele R,Penzias Penzias AS. Cumulative Live-Birth Rates after In Vitro Fertilization. N Engl J Med 2009;360:236-43;
- Penzias AS. Recurrent IVF failure : other factors. Fertil Steril [Internet]. 2012;97(5):1033–8. Available from: http://dx.doi.org/10.1016/j.fertnstert.2012.03.017
References
Boivin J, Bunting L, Collins JA, Nygren KG. Erratum: International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care (Human Reproduction (2007) vol. 22 (1507)). Hum Reprod. 2007;22(10):2800.
Leke RJI, Oduma JA, Bassol-mayagoitia S, Maria A, Grigor KM, Brogan P. Brogan & Partners Regional and Geographical Variations in Infertility : Effects of Environmental , Cultural , and Socioeconomic Factors Source : Environmental Health Perspectives , Vol . 101 , Supplement 2 : Impact of the. 2014;
Murdock W, Wong BC-M, AlAsiri S, Lee F, Dwyer C, Graham J, et al. Advanced Reproductive Age and Fertility. Int J Gynecol Obstet [Internet]. 2011;117(1):95–102. Available from: http://dx.doi.org/10.1016/S1701-2163(16)35087-3
Liu KE, Case A. No. 346-Advanced Reproductive Age and Fertility. J Obstet Gynaecol Canada [Internet]. 2017;39(8):685–95. Available from: http://dx.doi.org/10.1016/j.jogc.2016.12.004
Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH. One last chance for pregnancy: A review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril. 2005;84(2):435–45.
Serour G, Mansour R, Serour A, Aboulghar M, Amin Y, Kamal O, et al. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above. Fertil Steril [Internet]. 2010;94(5):1707–12. Available from: http://dx.doi.org/10.1016/j.fertnstert.2009.09.044
Lebovitz O, Haas J, James KE, Seidman DS, Orvieto R, Hourvitz A. The expected cumulative incidence of live birth for patients starting IVF treatment at age 41 years or older. Reprod Biomed Online [Internet]. 2018;37(5):533–41. Available from: https://doi.org/10.1016/j.rbmo.2018.08.014
Mariappen U, Keane KN, Hinchli PM, Dhaliwal SS, Yovich JL. Neither male age nor semen parameters in fl uence clinical pregnancy or live birth outcomes from IVF. 2018;(November).
Moncef. Paternal age : Negative impact on sperm genome decays and IVF outcomes. 2018;(January).
Volodarsky-perel A, Buckett W, Tulandi T. Treatment of hydrosalpinx in relation to IVF outcome: a systematic review and meta-analysis. 2019;00(0):1–20.
Ozmen B, Diedrich K. Article Hydrosalpinx and IVF : assessment of treatments implemented prior to IVF. Reprod Biomed Online [Internet]. 2007;14(2):235–41. Available from: http://dx.doi.org/10.1016/S1472-6483(10)60792-4
Orvieto R, Saar-Ryss B, Morgante G, Gemer O, Anteby EY, Meltcer S. Does salpingectomy affect the ipsilateral ovarian response to gonadotropin during in vitro fertilization – embryo transfer cycles ? Fertil Steril [Internet]. 2011;95(5):1842–4. Available from: http://dx.doi.org/10.1016/j.fertnstert.2010.11.061
Hassa H, Aydin Y. The role of laparoscopy in the management of infertility. 2014;(January):1–7.
Malizia BA, Hacker Michele R,Penzias Penzias AS. Cumulative Live-Birth Rates after In Vitro Fertilization. N Engl J Med 2009;360:236-43;
Penzias AS. Recurrent IVF failure : other factors. Fertil Steril [Internet]. 2012;97(5):1033–8. Available from: http://dx.doi.org/10.1016/j.fertnstert.2012.03.017