ANGIOPLASTY (PTCA, PCI)


Description:
Angioplasty is a technique used to reopen the arteries of the heart (coronary arteries) narrowed or blocked without resorting to major surgery. Practiced for the first time in 1977, angioplasty is now an intervention as common as bypass surgery. This technique is sometimes called percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). Angio means that a "blood vessel of interest" and plasty means "repair ". Angioplasty can also be used in other parts of the body, typically to treat peripheral vascular disease.



Balloon Angioplasty

Preparation for intervention:
A person must be treated by angioplasty should not eat after midnight the day before angioplasty, but may drink clear liquids. Patients can usually continue to take their medication, provided first talking to their doctor. Those taking medications for "blood thinners" such as warfarin * must inform the doctor as it may be necessary to stop taking them five days before the intervention. Patients taking insulin may have to reduce the dose of insulin. It must also notify the doctor if you are allergic to iodine or shellfish, since the surgeon injects a dye-based iodine during angioplasty. Some blood tests are sometimes necessary preliminary before angioplasty. Smoking is prohibited for 24 hours before and after angioplasty, of course it is best to quit completely to ensure better results.

Intervention:
The patient who underwent angioplasty remains conscious, but he received a local anesthetic. Intervention is sometimes uncomfortable, but usually it is not painful. The surgeon a small incision in the groin or arm and inserts a flexible hollow tube (catheter) into a main artery. It then injects a substance contrast radiolabeled with iodine in the blood can easily observe the arteries to radiography, the X-ray machine that takes pictures every five seconds as the surgeon moves the catheter up the blocked artery. When the catheter reached the site of obstruction, the surgeon introduces the probe in the balloon catheter. When the probe reaches the balloon segment narrowed blood vessel, the surgeon inflates the balloon. The fat deposits are then compressed against the artery walls, thus increasing its diameter. The operation can last from 30 minutes to two hours.

New methods of angioplasty sometimes used in combination with the probe balloon:
1. The stents (also known as extenders or guardians) are small hollow metal tubes that can be inserted and deployed using the balloon to keep the artery open. Approximately 30% of those treated by an angioplasty balloon catheter to return to classic after less than six months to unblock the artery again because it has narrowed again (restenosis), where the balloon was inflated . The use of stents reduces this percentage by half. The establishment of a stent will soon be the standard treatment.

2. The drug-coated stents are stents that have undergone special treatment and which, once implemented and deployed, gradually release a drug into the arterial wall. They further reduce the risk of having to repeat the intervention and it is used particularly in subjects at risk of arterial restenosis after initial intervention.

3. The directional atherectomy is a technique in which the surgeon uses a miniature rotating blade to remove fat deposits and dispose of the body.

4. The rotational atherectomy allows spraying resistant fat deposits with a diamond tip drill.

5. The intracoronary radiation to irradiate the segment of the artery dilated with angioplasty balloon probe; studies have shown that this experimental technique decreases by 70% the risk of restenosis of the artery.

After intervention:
Most people are admitted to the hospital and their condition was monitored overnight after angioplasty. In general, they can go home early the next day. They must verify that there is no bleeding at the entry point of the catheter and absolutely contact the doctor if the wound is bleeding, is purulent or discolored, or if they experience chest pain or entry point of the catheter. The patient should avoid any efforts for a week. Patients who received a stent usually have to take another medication to "thin" the blood called clopidogrel plus acetylsalicylic acid at least during the first months to prevent clots from forming on the metal stent. It may also be preferable to postpone dental care because of the risk of endocarditis.

Angioplasty or coronary artery bypass graft (CABG) surgery?
The bypass is an effective but more invasive to restore blood flow to the heart It usually stop heartbeat and cooling of the heart, the patient being kept alive with a heart-lung machine . It must also take segments of vein usually in one or both legs which serve as grafts for bypass.

Angioplasty offers the advantage of restoring normal caliber of the artery without the need for a large surgery. In contrast, angioplasty involves a risk of restenosis. This means that the artery becomes blocked again by the formation of scar tissue and possibly new plates. If resistant angioplasty restenosis six months, there are good chances that the results are permanent, but the risk of restenosis is significantly greater after angioplasty and after CABG.

For against, angioplasty allows patients to receive other treatments later. When the artery clogging again after CABG, the number of venous or arterial segments is sometimes insufficient to take a second graft. In addition, a second angioplasty results in a less severe trauma to the body a second open heart operation.

Sometimes the circumstances require a choice. For example, people who have many serious blockages, a diffuse disease, particularly if they are diabetic, may have advantage to bypass surgery. Moreover, in most hospitals, it does not perform angioplasty in patients with several major arteries are blocked. Indeed, during angioplasty, the artery is completely blocked on a temporary basis when the balloon is inflated. If other arteries are blocked, the patient may suffer a heart attack. In patients aged over 80 or suffering from another serious condition, an open heart operation may be too severe trauma. Therefore, in such cases, angioplasty may be a better choice, regardless of the number of blocked arteries.

Complications:
Angioplasty is a procedure safer than bypass surgery. Fewer than one in 100 dies from complications of angioplasty. As for serious non-fatal complications, they occur in 1% to 5% of patients. These complications include:

1) A tear in the lining of the artery causing an obstruction and a total risk of heart attack - the device can usually repair this tear
2) A stroke caused by a clot that dislodges while the catheter is inside the body
3) Bleeding or bruising (blue)
4) Renal complications, particularly among people who suffer from kidney disease and diabetes, and this complication is caused by the substance-based contrast iodine used for radiography. You can administer fluids and medications intravenously before and during surgery to reduce this risk.

TECHNOLOGY OF DNA MICROARRAY

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DNA Microarray Technology

The DNA microarrays are manufactured using high speed robotics, generally on glass but sometimes on nylon substrates, for which probes of known identity are used to determine the routes, enabling the expression and massively parallel genetic studies and the discovery of genes. An experiment using a single DNA microarray can enable researchers to simultaneously obtain information on thousands of genes - a dramatic increase in performance compared to old methods involving the observation of the expression genetics.

The Microarray Facilities Located at the National Research Council Biotechnology Research Institute (NRC-BRI) of Montreal:

Portion of a Biochip:
The microarray facilities of the NRC-BRI in Montreal, was established in 2000 following an investment of $ 2 million of the IGS. It was one of the first laboratories of its kind in Canada and is recognized for its excellence.

A DNA chip or biochip consists of a microscope slide treated chemically to allow attachment of the DNA. DNA molecules are deposited in the form of very regular arrays of instruments with high precision robotic. Each deposit represents a different DNA fragment from a different gene. The chips are mainly used to study gene expression profiles for example between a normal cells and cancer cells where genes repressed cancer cells would be visualized by green dots, while the genes are turned red. Biochips are a very powerful screening that will distinguish between the genes responsible for the cancerous condition and those that are the consequence. This new technology now allows researchers to examine the interaction between all the genes of an organism at the same time instead of watching a few genes at once.

The NRC is a leader in the development of this new industry. Basic facilities include several elements, including bioinformatics, synthetic oligonucleides high performance, amplification, and stippling of biochips. DNA chips were provided to several programs of the intergenic spacer region (IGS), as well as universities and external partners and customers. The first chip Candida albicans (fungal pathogen) in the world was produced in these facilities.

CREATION OF MICE FROM iPS CELLS

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Live Mice Created from Adult Cells Reprogrammed
Mice were born and have even been able to procreate after being created from stem cells from reprogrammed adult cells, depending on the work of a Chinese team published in 2009.

Induced Pluripotent Stem (iPS) cells - Watch Video:
Below is a TV news segment from NBC News






It is "the first definitive proof, to our knowledge, that the iPS cells are truly pluripotent, ie as versatile as embryonic stem cells, a characteristic" critical to therapeutic applications, "concluded by Qi Zhou (Chinese Academy of Sciences, Beijing) and his colleagues.

The ability of embryonic stem cells to differentiate to produce all types of human cells (blood, nerve, muscle ...) has made the challenge of medicine "regenerative" which would in future repair the heart or other organs, but their use raises ethical issues.

Thanks to the pioneering work in 2006 and 2007, Japanese researcher Shinya Yamanaka to program adult differentiated cells to become multi-purpose, cells induced pluripotent stem (iPS) are seen as an alternative to embryonic stem cells .

Since then, this technique was commonly used to reprogram the genomes of cells in a pluripotent state similar to embryonic cells, "recalls Qi Zhou in the study published online by the British scientific journal Nature.

To prove that the iPS cells are as versatile as embryonic stem cells, he showed that they could afford to produce live fertile mice.

Team Fani Qi Zeng and Zhou (Shanghai Jiao Tong University) has created 37 lines of iPS cells, three of which led to the birth of 27 mice, including the first-born named Tiny.


MAN-MADE: Tiny, live mice from iPS cells

One of them, a brown male adult was able to impregnate a female white coat and lead to second-generation mice in good health, according to researchers.

To produce viable mice, the researchers used as a cradle of biological cells called blastocysts with four sets of chromosomes (instead of two normal, one from the father and the other from the mother).

In this cradle (suitable for creating the placenta), they then injected iPS cells that have sent their own genetic heritage to all daughter cells forming the embryo. This proves, according to researchers, the iPS cells are pluripotent as embryonic stem cells.

Even if the cloning was not the objective of the experiment, it nevertheless leads to create animals with the same genetic program that the reprogrammed adult cells. The use of four sets of chromosomes (not both) to avoid mixing the DNA of the blastocyst, doomed to disappear, with iPS cells.

This technique avoids complex to create chimeras, animals whose cells all have the same genetic heritage. Small second-generation mice have uniformly brown coat, a sign that their parents are not chimeras, researchers stress.

At a press conference, they were encouraged to pursue "all forms of stem cell research, but are not limited to iPS cells."

INTERSPECIES GENE TRANSFER

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Interspecies Gene Transfer
This transfer occurs in nature. Interspecies hybrids from sexual reproduction can lead to the emergence of new species have the genetic characteristics of two species of departure. Interspecies hybridization has played an important role in the selection of crops. We can also produce interspecies hybrids between sexually incompatible species. You can merge cells of plants and animals to produce hybrid cell lines viable. As hybrids of plant cell culture can, by regeneration, producing whole plants, cell fusion allows crosses between sexually incompatible species. Most animal cells can not regenerate to restore complete specimens, but the fusion of antibody producing cells (difficult to cultivate) and cells "transformed" gives rise to immortal cell lines, each producing a particular antibody, called monoclonal antibodies. These cell lines can be used for commercial manufacturing of diagnostic products and antibodies used in the treatment of diseases. They play an major role in research on human heredity character and diseases.

In nature, gene transfer between sexually incompatible species also occurs. Thus, genes can be transported from one species to another during a viral infection. In its narrowest sense, genetic engineering exploits the possibility of such transfers between species that are not related.

There are two main methods:
In the first, it implements the genes from one organism to another so that they operate in the host.

In the second, the new host (usually a microorganism) produces a certain amount of the segment of DNA that contains the foreign gene, we can analyze and modify test-tube before returning to the case where the gene is derived. (changing the structure of the gene is carried by a technique known as invitro mutagenesis)

This sustained progress of modern genetic engineering is based on a number of important technical breakthroughs such as:

  • Cloning,
  • Gene Cloning and
  • DNA Sequencing.

CLONING


Cloning
"Cloning means producing a cell or group of genetically identical individuals from a single cell." All clones have the same genetic heritage. Most single-celled organisms, many plants and some multicellular animals reproduce by cloning (asexual reproduction). In humans, identical twins are clones, because they develop after the separation of the first cells formed from a single fertilized ovum.

Cloning is not strictly speaking part of genetic engineering since the genome normally remains unchanged, but it is a practical method for multiplying organisms created by genetic manipulation.

Alta Genetics, Calgary, is a world leader in genetic engineering of livestock. This company uses artificial polyembryonnie combined with in vitro fertilization and embryo transplantation. The manipulation of plant hormones in plant cells in culture can produce clones, namely the millions of seedlings that can be the seed artificial.

The cloning of animals produced by genetic engineering techniques is usually difficult. It has produced clones of frogs by transplanting several eggs without nuclei identical core taken from a single embryo. This technique does not apply to mammals. It can be used with cells cloned from very young embryos of mammals (embryonic stem cells) for reconstructing whole animals. It relies heavily on this technique to produce genetically engineered mice. There is no known example of human cloning by artificial means, which does not preclude people from claiming the regulations frequently on human cloning and genetic engineering, for the same reasons why most commentators to reject eugenics.

Gene Cloning
This type of cloning is a fundamental component of genetic engineering. A segment of DNA from any donor in vitro is combined with another molecule of DNA, called a vector, to form a DNA molecule "recombinant".

The design of suitable vectors is an important branch practice of genetic engineering. The insertion of DNA requires the mediation of different vectors according to the type of cell. Mammalian vectors usually come from mammalian viruses.

The cloning of genes in microbes has reached the stage of commercial applications, including one of the most remarkable is the marketing of human INSULINE produced by bacteria. You can now purchase many products such as growth hormones, clotting factors and blood interferon antiviral. The cloning of genes has revolutionized our knowledge of genes, cells and diseases, especially of CANCER. In addition the diagnosis of hereditary diseases in the highest scientific level and provided us with accurate diagnostic tools for infectious diseases, it is essential for DNA testing that is in the forensic medicine.

BIOTECHNOLOGY APPLICATIONS


Biotechnology
Biotechnology is a set of methods and techniques using genetic and physiological capabilities of living organisms to develop new products.



Biotechnology progress
integrate several disciplines such as microbiology, biochemistry, genetics, molecular biology and computing, and generate a variety of tools to disrupt multiple industries and to modify the environment.

Biotechnology Applications
Pharmaceutical Research (Health)
Health is the first application of biotechnology. They bring new life to the entire pharmaceutical research. Because many drugs are created through a better understanding of micro-organisms and study of DNA, biotechnology and pharmaceuticals can not happen from one another.

Antibiotics
Some infectious diseases have been controlled since the 1940s by antibiotics, partially or wholly obtained by fermentation and vaccines through genetic engineering.

Polymerase Chain Reaction
New diagnostic biotechnology emerged in the years 1980-1990: the technique of molecular probes and the polymerase chain reaction. In a sequence to combine with inherited their complements, these probes may indicate the presence of a defective gene or a gene intruder, due to an invasion of microbes in the body. Similarly, antibodies are able to identify with precision the non-compliant cells (cancerous) or foreign to the body such as bacteria. Thus was born the industry kits for rapid diagnosis based on the use of antibodies. In the case of pregnancy tests, which detect the presence of a specific hormone of the fetus in the urine of women.

Sequencing of Human Genone (Proteomics / Genomics)
The sequencing of the human genome heralds a new era in pharmaceutical research. Of more effective drugs can now be considered as the knowledge of the genome offers the possibility of targeting one or a few genes directly associated with a disease. Proteomics takes over from genomics to determine the role of proteins produced by each gene.

Gene Therapy
Some conditions are related to an anomaly or a lack of synthesis in the body of one or more molecules, as in cases of diabetes or hemophilia. It is now possible to produce large quantities of therapeutic substances similar to those produced by the body through bacteria, yeasts, insect cells or genetically altered mammals that are then injected in the patient. You can also transfer the gene responsible for production of the active molecule missing the individual in need is gene therapy.

Agriculture and Agri-Food (Plant Biotechnology)
The second major application of biotechnology is the agricultural research in which there are three application fields: agriculture, food and environment. Of transgenic varieties (GMOs) are created to increase resistance to pests and diseases or to improve the nutritional quality of products. Many plant varieties are being tested such as those owned by naturally secrete their own insecticides or genes controlling the quality of growth and conservation. When all the genes involved will be identified, transgenic plants may be resistant to cold, frost, drought and salty soil.

Transgenic Animals (Animal Biotechnology)
Transgenic animals in which genetic heritages have been introduced one or more foreign genes, are employed in research laboratories for studying the mechanisms of genesis of cancer, cardiovascular diseases, diseases of bacterial or viral.

BIOTECHNOLOGY: SCOPE AND IMPORTANCE


Biotechnology
Definition:

Any technological application that uses biological systems, living organisms, or derivatives thereof, to make or modify products or processes for specific use. Examples of biotechnology, there are traditional applications such as making bread, cheese, wine and beer, as well as modern applications such as cell culture, genetically modified foods and the cloning of plants and animals.

Genetic engineering
Word (s) like (s): genetic modification, recombinant DNA technology.

Definition:
Technique of removing, modifying or adding genes to a DNA molecule of [an agency] so as to change the information it contains.

By changing this information, genetic engineering changes the type or amount of proteins an organism is able to produce and allows it to create new substances or to provide new functions.

The aim of genetic engineering is to produce desired characteristics and to eliminate those that are undesirable.

Among the desirable characteristics sought for plants, we can cite as examples the rapid growth, resistance to pests and greater size.

Modified organisms through genetic engineering are sometimes called transgenic organisms, genetically modified or derived from biotechnology.

Recombinant DNA technology.
Definition:

Laboratory manipulation of DNA in which DNA, or DNA fragments from different sources, are cut and recombined using enzymes.

This recombinant DNA is then inserted into a living organism. The recombinant DNA technology is often used synonymously with genetic engineering. With this technique, researchers can study the characteristics and actions of specific genes.

A body manipulated by recombinant DNA techniques is known as genetically modified organism (GMO).

Cloning
Definition:

Set of genetically identical, from the asexual reproduction of a single ancestral organism. Cloning refers to the fact generate identical copies of cells and segments of DNA.

STEM CELLS


Stem cells
A stem cell is an undifferentiated cell is characterized by its ability to generate specialized cells in differentiating and its ability to grow almost infinitely to the same (self), particularly in culture.

A cell is said to stem cell (or undifferentiated cell) in two conditions:
1. It can provide specialized cell by cell differentiation and
2. It can virtually be renewed indefinitely.

They are present in the embryonic stage and in the adult organism, but they are much more rare in the adult organism (such as hematopoietic stem cells continuously regenerate blood cells, intestinal stem cells, neural stem cells in regions specific regions of the brain (hippocampus, an area subventriculaire)). In general, stem cells are present in all living multicellular. They play a very important role in the development of organisms and in maintaining them.

The most undifferentiated cell is the zygote or fertilized egg, since the egg will produce all the cells of an organism. We talk about stem cells in animals, but the plant meristems are also formed. In a more comprehensive, all multicellular organisms have stem cells.

Stem cells of animals and in particular human stem cells are the subject of much current research, including medicine to regenerate tissues or create any piece of tissue and organs is the goal of therapy Cell. The origin of stem cells used in research also raises ethical issues: indeed, they come mostly from embryos, although it has recently discovered the possibility of using other sources such as blood cells umbilical cord, or stem cells from adipose tissue. When they allow research on stem cells, the legal limit it to cells from spare embryos from procedures for medically assisted procreation (PMA), prohibiting in particular the creation of embryos solely for the purpose of search. Moreover, given the potential benefits that they seemed to present, trials of therapeutic cloning have been developed to control the production in large numbers.

Stem cell culture


Origin of stem cells
For medical or scientific research, human stem cells (and more generally mammalian) may also be classified in relation to their origin: embryonic, fetal or adult.

Embryonic Stem Cells
Also called ES cells are pluripotent stem cells present in the embryo shortly after fertilization until the stage of blastocyst development said they are still the inner cell mass (the other cells of the blastocyst are the cells of the trophectoderm).

These cells are the source of all tissues of the adult organism and are pluripotent. They can be isolated and cultured in vitro in the undifferentiated state. In terms of specific cultures (on suspension growth ...), individuals can direct their differentiation to a given cell type (neurons, melanocytes, muscle cells, blood cells ...).

Embryonic stem cells were isolated and grown in mice from the early 1980s and helped develop the technique of gene invalidation by homologous recombination (or knock-out) which, after reintroduction of these cells mutated into a recipient embryo and crossings, to obtain mice homozygous for a mutation in a gene.

They are in practice taken from cells of the internal mass of the blastocyst (an embryo that is less than 150 cells), which requires the destruction of the embryo. They can be obtained from frozen embryos from in vitro fertilization or by cloning (by transferring the nucleus of a cell into an egg).

These cells could enable the development of a cell therapy for many degenerative diseases (eg regeneration of injured dopamine neurons in Parkinson's disease after reintroduction into the brain, repair of damaged heart muscle tissue after a heart attack ... ).

Research on embryonic stem cells are currently not very advanced, mainly because of ethical and legal.

Fetal stem cells
A fetal stem cell is a type of multipotent stem cells of fetal origin. They can be harvested from fetuses from a voluntary interruption of pregnancy. Fetal stem cells have the characteristic of being directed to a particular cell type.





Adult Stem Cells
Adult stem cells are undifferentiated cells that are found in tissues that are composed mainly of differentiated cells in most adult tissues and organs. These are generally multipotent cells. They are capable of giving rise to different cell lines of a given tissue. They are the basis of a natural renewal and tissue repair in response to injury.

They are already used in the processing of more than one hundred diseases. They are called "somatic" as opposed to germ cells, and can be found not only among adults but also among children and even in the umbilical cord.










Interest in Research
  1. Molecular Study on the human embryo in its early stage of development.
  2. Interest of such cell lines to study the process of biological development from its initial phase and see how far back and the defects that cause chromosomal abnormalities like Down syndrome (or trisomy 21).
  3. These cells, in some of its features (speed of division, biochemical reactions, expressions of genes), closely akin to precancerous cells. They are thus by their unstable state, an interesting model to address a situation in which a cell can switch to the cancerous condition, in conjunction with genomic research.
  4. The research on human pluripotent stem cells may also induce changes in the way of drug development and to test them in a safe and healthy by testing for varieties cellular many more.
Therapeutic application
1. Pluripotent stem cells have the potential for practitioners unlimited source of tissues or specific cells. It hopes to expand the scope for interventions cell therapy for diseases such as Alzheimer's, Parkinson's disease of the bone marrow, heart attack or stroke, burns, diabetes, osteoarthritis or rheumatoid arthritis.
2. It is hoped that these cells can replace cells destroyed (ischemia, irradiation, self, chemotherapy, ...) or overcome cellular functional deficits (Parkinson enzymopathies, etc.)..
3. Stem cells could also contribute to the development of tissue engineering. They have proven their ability to produce four types of muscle fibers exist and could be located on the substrate or tissue on smooth muscle of blood vessels of the heart.
4. Hopes for gene therapy are numerous:
  • first applied to abnormal tissues or organs due to the presence of a gene mutated in individuals or young adults.
  • second consists in the correction, by somatic gene therapy, an abnormal gene carried by the parents and sent to the fertilized egg. The aim would be that the child does not have the disease resulting from abnormal gene from his parents.
  • third is to correct an abnormal gene cloned intra-couple, ie to obtain a cure through cloning: cloning from oocytes of women through nuclear transfer cell, corrected and from a couple of the blastocyst. This solution is the only way to eliminate and certainly the gene abnormality, while creating an egg reconstituted from the genomes of both parents. It is both a cloning and germ line therapy, but within the couple. This means that embryos used to produce the cells will not be sacrificed but will, instead, his chances of leading to the birth of a child free from the anomaly.

ENDOMETRIOMAS and IN VITRO FERTILISATION

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ENDOMETRIOMAS and IN VITRO FERTILIZATION OUTCOMES
This article reports the effects of endometriomas and infertility treatments on their out-come mainly in cases of in vitro fertilization.

The main conclusions are: the absence of any deleterious effects on IVF results in cases of endometriomas, the conservation of the stock oocytes in the ovary after any type of surgery for ovarian endometriomas (Cystectomy or more drainage laser vaporization), the poor out-come of iterative surgical approach of endometriomas, the risk of ovarian abscess after puncture during an IVF procedure.





INTRODUCTION

The presence of endometriomas in the course of a cycle of in vitro fertilization (IVF) raises several concerns among practitioners
  1. The risk of poor ovarian response,
  2. The low chance of pregnancy,
  3. The risk of an "outbreak" of the endometriomas by hormonal stimulation, and
  4. The risk of infection after follicular puncture.
Most of these concerns about endometriomas and IVF date from a study in 1989 Dlugi become obsolete since the advent of analogues of Gn-RH [1]. This study suggested a deleterious effect of endometriomas and called for their removal prior to IVF.

On the other hand, surgery for endometriomas has often been accused of being "destructive" for the ovarian reserve.


Endometriotic Lesions - Endoscopic Image



Endometriosis Human Ovary


Endometriomas AND RISKS OF IVF
Most of the fears reported in the introduction are quite imaginary. Indeed, no cases have been reported endometriosis cyst rupture after IVF or any outbreak of endometriosis or endometriomas after ovarian stimulation. Only one case of endometriosis cyst rupture during pregnancy IVF is found in the literature.

However, there are a dozen publications reporting cases of infection of endometriomas. Team Clermont-Ferrand reported a case of bilateral endometriomas abscess in early pregnancy with birth of twins. This case (unpublished) was instructive in many respects.

1.The germ of 2 identical sides, which proves that the good seed punctures IVF follicles and, despite aseptic precautions and antibiotic prophylaxis, as the authors emphasize.
2. Drainage percoelioscopique these endometriomas proved as ineffective in many publications.
3. This is a vaginal drainage that resulted in the healing of the patient.
4. Nevertheless, the pregnancy continued.

Thus, it is necessary to avoid a drain on endometriomas during IVF to avoid the risk of abcedation. This is not to drain through a endometriomas is not always easy or even feasible. The antibiotic appears to be ineffective.

IMPACT OF SURGERY ON endometriomas ovarian response in IVF
As we have seen, there is no scientific evidence that proves the need for the endometriomas to improve the outcome of IVF.

In contrast, the surgical treatment of endometriomas can achieve spontaneous pregnancy in many cases, but it has also been accused of having a negative impact on ovarian reserve and thereby to risk compromising the chances of IVF.

CONCLUSION
Our conclusion were made in the form of FAQ:

Should we make the endometriomas before IVF?
1. Yes, because the intervention results in spontaneous pregnancies and surgery and not well made does not iterative any future IVF.
2. No, if one considers that the surgery has been very fortunate to achieve a pregnancy and that IVF is indicated. This is particularly the case of recurrence or in the case of endometriosis ultrasound and clinically very severe.

Should reoperer a recurrent endometriomas before switching to IVF?
1. No, because this will not impact either positive or negative effect on IVF.
2. Similarly, the discovery of a endometriomas during stimulation for IVF is not an indication to stop IVF.
3. However, if very large endometriomas, drainage preventif could facilitate the puncture. The best technique is the drainage under ultrasound.

Which surgical technique should be used?
1. Finally, there is no big difference between the drainage and kystectomie LASER vaporization with respect to the alteration of the oocyte stock.
2. The first is the more accessible material and appears to have a lower recidivism rate.
3. However, all endometriosis cysts are not readily clivables and in this case, the technique of coagulation drainage is preferable.

Should drains an endometriomas during IVF puncture?
1. No, because this is not enough to make and increase the risk of abcedation.
2. Yes, it is with pain, but with caution and under antibiotic coverage.

Can we drain follicles by passing through a endometriomas?
1. Clearly, it is best to avoid in order not to risk a abcedation.
2. However, this complication is not frequent and if it is sometimes impossible to do otherwise. The presence of liquid chocolate in the sample did not affect the outcome of IVF when the oocytes were treated immediately by the biologist.

What is the best treatment for endometriomas on ovarian abscess after oocyte aspiration?
1. The drainage vaginally, if possible, is the technique most effective and least aggressive.
2. The approach coelioscopique is a second-best, because there is often a pelvic armor that makes the start of the ovary very difficult.

IN VITRO FERTILIZATION (IVF)



Definition
IVF literally means "fertilization in a test tube." IVF (in vitro fertilization) is a method to achieve fertilization outside the human body by combining laboratory oocytes of women and the man's sperm. The fertilized eggs that result (embryos) are then placed in the woman's uterus.

The conduct of an IVF cycle involves several stages:
  1. Ovarian stimulation
  2. The timing of ovulation
  3. The follicular puncture
  4. The collection and preparation of semen
  5. Fertilization
  6. The development and transfer of embryos
  7. Cryopreservation of supernumerary embryos
Ovarian stimulation
Oocytes grow within ovarian follicles in. In the natural menstrual cycle, several follicles are growing at the beginning of menstruation. Only one or two of these follicles will mature about 2 weeks later and will be released during the follicular rupture (ovulation). Follicles that are not mature stop growing and degenerate. Thus, very few oocytes reach the final stage of ovulation in a woman's life.

The goal of ovarian stimulation in IVF is to prevent the degeneration of the follicles by exposure to a sufficient dose of FSH. Administering of FSH by injection, you get higher circulating levels that support the development of multiple follicles and maturation of several oocytes. This proliferation of follicular recruitment, also known as controlled ovarian hyperstimulation, improves the chances of success of IVF by increasing the number of embryos available

Of ovulation (the timing of ovulation)
When the follicles have reached the desired size and estrogen levels are sufficient, the final phase of maturation of oocytes is induced by an injection of hCG (Choriomon ® Ovitrelle ®, Pregnyl ®). Follicular aspiration (oocyte collection) is scheduled approximately 35 hours after injection.

Follicular puncture
Under light general anesthesia, an ultrasound probe with a guide is inserted into the vagina and the follicles are identified. A thin needle is inserted through the guide in the vaginal wall and the ovary and the follicles are punctures one by one. The follicular fluid containing the egg is sucked and collected in a tube. The intervention is short (15-20 minutes). During surgery, the tubes containing the follicular fluid are kept at body temperature in an incubator. They are then immediately transported to the laboratory where the biologist determines the number of oocytes harvested. After ovarian stimulation, we get an average of 8 to 10 oocytes. The patient is then transferred into a room where the result of the drain will be communicated in one hour. After 3 to 4 hours of observation, it can go home.

The collection and preparation of semen
On the day of oocyte aspiration, the spouse takes a sample by masturbation semen to be used for fertilization.

In the event of major difficulty of sampling, it is possible to arrange in advance, a cryopreservation of sperm, which can be used for fertilization.

In cases where semen was collected at surgery or testicular excretory channels before the treatment cycle is generally the cryo sperm to be used.

Whatever its origin, the sperm is analyzed and prepared in the same way. Seminal plasma that limits the power of the fertilizing sperm is eliminated and the most mobile sperm, which are a priori most pollinators are selected.

The oocyte insemination is performed. Depending on the type of infertility, fertilization is left to chance (IVF) or to run (ICSI).

Fertilization
There are two ways to fertilize ova:

1. in vitro fertilization "classic" (IVF) and
2. intra-cytoplasmic injection of sperm (ICSI).

IVF is used as the origin of infertility is female and the sperm quality is normal or slightly altered. A few hours after follicular puncture, the oocytes are reunited with sperm in a culture medium conducive to their survival. They are placed at 37 ยบ C for a period of 4 to 20 hours. Only one spermatozoon - the most active - will cross the zona pellucida and the plasma membrane of the egg and achieve fertilization.

After 18-20 hours of incubation, the biologist look under a microscope if fertilization has occurred. The fertilized ovum (or "impregnated") comes in the form of a cell with two nuclei (pronuclei), one of paternal origin, the other of maternal origin. This stage is called the zygote.

The zygote is not yet an embryo because the genetic heritage maternal and paternal have not yet merged.

At this point, the biologist for the custody transfer 2 or 3 zygotes. The supernumerary zygotes were frozen (cryopreserved) and may be used at a future attempt.

There is sometimes fertilization anomalies that make it impossible to transfer or freezing that these zygotes.

The development and transfer of embryos
Two to three days after the collection of oocytes, embryos are transferred into the uterus. On Day 2, embryos were divided into 2 to 4 cells, the 3rd day, they reached 6 to 8 cells.

The transfer is a painless process. The embryos are placed in a thin flexible catheter. After explaining the cervix with a speculum, the doctor inserts the catheter gently into the uterine cavity. In some cases, the transfer is performed under ultrasound to guide the establishment of the catheter within the uterus and to ensure that the embryos have been tabled in the right place.

Two or three embryos are usually transferred. The number of embryos was decided after discussion with the doctor, depending on the age of the woman and the couple's choice.

Approximately 12 days after the transfer, a pregnancy test performed on a blood test will know the outcome. If the test is positive, an ultrasound will be scheduled approximately 4 weeks after transfer to verify the proper development of the pregnancy.

Cryopreservation of supernumerary zygotes
It is not uncommon that we get more zygotes than the desired number for the transfer. The supernumerary zygotes can be kept at very low temperatures in liquid nitrogen (freezing or cryopreservation).

The aim of cryopreservation of zygotes is to give the couple the best chance to achieve pregnancy, while limiting the occurrence of multiple pregnancy and its complications. The zygote can be thawed and transferred if no pregnancy in the first round. In this case, the stages of the ovarian stimulation and follicle puncture need not be repeated.
The five stages of IVF treatment: (short way of explanation)

1. Hormonal Stimulation of the Ovaries
The woman receives 10 to 14 days, a natural hormone preparations by injection, in order to develop more eggs. In a traditional cycle, one egg is released, but thanks to the hormonal preparation, there are several.

2. Grab or Ovum Pick Up
Puncture or ovum pick up takes place just before ovulation. In this way, the follicles are punctured and sucked so that eggs can be gathered. Around the same time, the man must give a semen sample.

3. Insemination
The insemination is to collect the eggs and sperm.

4. Fertilization
After 16 hours, we can examine whether fertilization took place. Two days later, we can see if the embryos are formed.

5. Transfer of Embryos
Finally, we introduce the (s) best (s) embryo (s) in the uterus.

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