Reproductive Medicine Unit

The Reproductive Medicine Unit
of the American Hospital of Paris
treats male and female infertility
using the most recent techniques,
implemented by highly skilled
professionals.

Contents

Who We Are

One of the most important ART Unit in France

The Team

Gynecologists, andrologist, biologists...

What Sets Us Apart

Highly experienced specialists, an ultra-modern facility ..

The Main ART Techniques

Artificial insemination, IVF-ET, ICSI and IMSI

Receiving Treatment

Application, pre-ART assessment

What to Expect During Your ART Attempt

The main steps of a ART procedure

Conferences

14th MAP Day (2013)

Who We Are

The Reproductive Medicine Unit of the American Hospital of Paris was one of the first Centers of its kind in France. It was created in 1984 by a team of professionals who had taken part two years earlier in the birth of Amandine, the first French “test tube baby”.

In the years that followed, the American Hospital team pioneered the development of intracytoplasmic sperm injection (ICSI).  In 1994, the team achieved the birth of Audrey at the American Hospital, the first baby born in France thanks to this new in vitro fertilization technique.

Today, with the birth of around 500 babies per year, the Reproductive Medicine Unit of the American Hospital of Paris is one of France's leading facilities for medically assisted procreation.


  Key figures (2016)

  • 1,923 in vitro fertilization attemps
  • 730 artificial inseminations
  • 706 frozen embryo transfers

.

In January 2013, the Reproductive Medicine Unit moved into a new, totally renovated 300m² facility offering couples the best in terms of service and comfort throughout every step of their ART procedure.
Find out more about the new premise.

The Unit treats couples with all types of infertility problems, whether caused by female or male infertility. Couples receive personalized care from the same doctor throughout the entire process.

The Unit employs all currently available ART techniques. All requisite biological and medical exams can be performed on-site at the American Hospital of Paris.

Anesthesiologists: 


Dr GOLDSTEIN Ivan   
Dr KORVIN Milan   
Dr LE COSQUER Philippe   
Dr LE GOFF Line   
Dr MAHASSEN Alain   
Dr MARRET Emmanuel   
Dr PERRE Jean-François   
Dr SEROR Bernard   
Dr TUIL Olivier

Biologists : Dr Pascal BRIOT and Dr Carine PESSAH

ART operating manager : Dagmar TRONEL

Laboratory technicians specializing in ART techniques
Nurses
Administrative assistants

What Sets Us Apart

A team of experienced specialists.

A modern, spacious facility offering couples treatment with enhanced comfort and safety levels.

Latest-generation equipment enabling the use of all ART techniques, under optimal conditions of safety and efficacy.

A state-of-the-art hospital environment: all supplementary exams can be performed on site, and consultations are available in all medical specializations.

The ART Unit is part of the hospital’s wide range of  Women’s Health Care services, which include: Unit of Gynecology and Obstetrics, Fetal Medicine Unit, Maternity and many diagnostic and testing services specially designed to screen for diseases in women.

The Main ART Techniques

The term “ART” (Assisted Reproductive Technology) refers to all of the techniques employed to treat infertility in couples.

The three main ART techniques are artificial insemination (AI), conventional in vitro fertilization (IVF-ET) and in vitro fertilization by microinjection (ICSI or IMSI).

Artificial insemination (AI)

- AIH: artificial insemination with sperm from the husband or male partner

- AID: artificial insemination with sperm from a donor

After the ovulatory period has been evaluated, artificial insemination can be performed.

This procedure consists in introducing, via a catheter, a minimum number of motile sperm into the neck of the cervix or, in most cases, directly into the uterus (intrauterine insemination: IUI).

The sperm are prepared beforehand at the laboratory (the male partner must provide a semen sample approximately two hours before insemination takes place). The most motile sperm are then isolated and selected.

 

 

In vitro fertilization and embryo transfer (IVF-ET)

The aim of IVF-ET is to allow male and female reproductive cells, or gametes, to interact outside of the woman’s body, in vitro.

This step takes place in a laboratory, in the appropriate culture medium where the woman’s oocytes and the man’s sperm spontaneously interact.

Fertilization can be detected after about twenty hours (formation of male and female pronuclei) and cellular division (two to four cells) occurs after two days.

The gynecologist then transfers the embryo(s) into the uterus by inserting a thin, flexible catheter into the cervix, via the natural passages.

 

 

IntraCytoplasmic Sperm Injection (ICSI)

IntraCytoplasmic Sperm Injection is a modified IVF technique.

In cases of low sperm count or poor motility, conventional IVF is useless because fertilization will not occur. The only way to obtain embryos is through ICSI, a technique developed in 1992 that involves injecting a single sperm into each oocyte using a micro-needle.

This procedure is performed in a laboratory under a microscope and requires the use of micromanipulation devices due to the cells’ extremely small size.

After the micro-injection, the culture, fertilization verification and embryo transfer procedures are all identical to conventional IVF.


Intracytoplasmic Morphologically Selected sperm Injection (IMSI)

With ICSI, sperm are selected at 400x magnification. Some anomalies, such as vacuoles, cannot be detected at this level of magnification.

A technique combining an optical system with image analysis makes these anomalies visible, enabling a more informed decision about which sperm to inject.

This is not useful as a first-line treatment but may be indicated in certain cases, such as previous ICSI failures.

This technique is currently undergoing evaluation and its indications need to be more precisely defined.

Embryo freezing for later transfer

When a large number of embryos remain following a conventional IVF or ICSI procedure, the laboratory can freeze part or all of the untransferred embryos. They are frozen the day of the transfer, following oocyte retrieval (D2, D3 or D5), and cryopreserved at the lab in liquid nitrogen (-196 °C).

In the event of a failed IVF attempt or when another pregnancy is desired, these embryos can be thawed and transferred into the female patient.

This technique eliminates the need to repeat the entire IVF cycle (oocyte retrieval, semen collection, fertilization, embryo culture, and so on).

However, the success rate for frozen embryo transfer is not 100%, since around 20% of embryos do not survive the freezing-thawing process.


Receiving Treatment

You and your partner have already undergone exploratory exams that led your doctor to suggest medically assisted procreation, and you would like to receive treatment from the ART Unit of the American Hospital of Paris.

Application

First of all, you must consult one of our Reproductive Medicine Unit gynecologists, all of whom have received individual ministerial approval and are exclusively authorized to provide treatment to you - List of authorized gynecologists at the American Hospital of Paris

During this initial consultation, the gynecologist will review your medical file and prescribe any supplementary exams needed to make sure ART treatment is appropriate to your situation.

If the gynecologist confirms that a ART procedure is indeed appropriate, he or she will give you an application file. It includes a medically assisted procreation consent form to be signed after taking sufficient time to ponder your decision and gather all the necessary information.

To help you in your decision, regular information meetings are held by the Unit - Find out more about these information meetings

The Pre-ART Assessment

In addition to the exams you have already undergone, you must provide in your application file the results of several other exams, including serological screening as well more specific tests that could be required for certain types of infertility or after several failed ART attempts.

If a surgical procedure under general anesthesia is required for oocyte retrieval, you must have an anesthesia consultation less than two months and more than eight days before the retrieval procedure. An appointment for this consultation can be made by contacting the Department of Anesthesiology of the American Hospital of Paris - To contact the Department of Anesthesiology

What to Expect During Your ART Attempt


In vitro fertilization and embryo transfer (IVF-ET) take place in seven steps, described below.

In the event of artificial insemination (AI), the procedure is simplified because it only entails ovarian stimulation and the injection of the sperm into the uterus.

In the case of intracytoplasmic sperm injection (ICSI), the procedure for you is identical to an IVF-ET procedure; only the laboratory procedure changes.

1 - Ovarian stimulation

Although IVF is theoretically possible following spontaneous ovulation (a single oocyte), its randomness and low success rate at every attempt make prior ovarian stimulation the preferred solution. 


The goal is to make the ovaries, under the influence of FSH (follicle stimulating hormone, known under the commercial names of Gonal F, Menopur, Puregon and Fostimon) produce a greater number of mature oocytes and thereby obtain more embryos. These hormones are injected subcutaneously. Devices for self-administration allow you to do the injections yourself.

Two main types of treatment are available:

- FSH supplements to boost your own secretions. With this treatment, the number of required doses is limited. The drawback is the possibility of spontaneous ovulation occurring prior to oocyte retrieval, possibly resulting in the cancellation of the attempt. A substance called an agonist (Cetrotide or Orgalutran) can be added to prevent spontaneous ovulation.
 
- Prior blockage of your own hormones using an LH-RH analogue (commercial name: Décapeptyl, Enantone) followed by stimulation using FSH.


Because the response to hormonal stimulation varies from one woman to the next and from one cycle to the next, monitoring is necessary:

- Measurement of estradiol, a hormone produced by the ovaries. The measurement can take place daily or every two to three days depending on secretion levels. It can be performed by the American Hospital laboratory or by another lab, following instructions from your doctor.

- Pelvic ultrasound to measure the size and number of developed follicles in the ovary.


You need to inform your primary physician or his/her secretary the day your period begins, so the first measurements and/or ultrasound can be scheduled.
If the exams are performed outside the American Hospital, the results must be sent to your doctor’s office as quickly as possible so the necessary decisions can be made.

By comparing the hormone levels and ultrasound results, your doctor can estimate the best date to "trigger" ovulation.

2 - Triggering ovulation

 Another hormone, called LH, triggers ovulation (the oocyte matures and is released from the follicle). This process spans a period of 36 to 40 hours.

You will receive an injection of a hormone with the same biological effect as LH: a single intramuscular injection of HCG (Gonadotrophine Chorionique Endo) or a subcutaneous injection of Ovitrelle at a specific time.

You will be informed of the time by the secretary’s office: the injection takes place in the evening between 8 pm and 1 am, and oocyte retrieval is scheduled two days later, between 8 am and 2 pm.

3 - Gamete retrieval

[The couple must go to the Reproductive Medicine Unit the same day for oocyte and semen retrieval.

Currently, oocyte retrieval is performed vaginally, under ultrasound guidance. The procedure takes place in an operating room under local or general anesthesia.


• For local anesthesia, you must arrive 30 minutes before the procedure in the Unit’s waiting room, where a nurse will call you. After getting undressed and using the restroom, you will be settled into the retrieval room, where you will see your doctor. The procedure lasts approximately 15 minutes. Afterwards, you will be taken to a room to rest. Then you will be allowed to go home, accompanied. You should avoid working in the afternoon.

For general anesthesia, you must check in two hours before the procedure, at the Admissions department. You must have an empty stomach. Following the procedure, you will be taken to the recovery room for one hour before returning to your hospital room. You will be allowed to go home a few hours after the operation.

The liquids aspirated from your ovaries (follicular fluids) are immediately taken to the lab where they are evaluated to locate the oocytes. You will be informed of the number of oocytes after the procedure. A semen sample must be collected at the lab immediately before or after the oocyte retrieval. Unless otherwise indicated, three days of abstinence are recommended. The requisite conditions for semen collection (asepsis) are specified in the room reserved for this purpose.

Come with a full bladder (requirements are the same as for the preliminary spermatology exam).

4 - Laboratory steps

Before being placed together in an in vitro culture medium, the gametes must be prepared:

• The oocytes are examined to evaluate their maturity. Some are discarded if they appear to be of poor quality (atresia). In the case of ICSI fertilization, the oocytes are “stripped”, meaning the cluster of cells surrounding each oocyte, which would otherwise prevent successful sperm injection, is removed.


• The semen undergoes several density gradient centrifugations to separate the sperm from the seminal fluid, and then the most motile gametes are put back into a culture medium.

The oocytes and sperm are then placed together in specific culture conditions (temperature, atmosphere).
If ICSI (or IMSI) is indicated, a single sperm is directly injected into each isolated oocyte, under a microscope.

The next day (D1), the ovocytes are examined to determine whether or not fertilization has occurred.
At this stage, an average of 50% to 70% of oocytes show pronuclei, the first signs of fertilization.

This information will be provided to you over the phone by the laboratory. You will also be told what time the embryo transfer is to take place the next day (D2) or the day after (D3). The total number of embryos obtained will only be known at that time.

 

5 - Embryo transfer

After 48 or 72 hours, the fertilized eggs have divided (two to four cells, sometimes eight) and can be transferred into the uterus. The transfer takes place in a dedicated room and can be ultrasound guided if any difficulties arise. 


Now is when the essential decision is made regarding the number of embryos to be transferred.

Because you will only find out the definite number of embryos a few minutes before the transfer, you and your partner, along with the biomedical team, must reflect on the question sufficiently in advance, and on a hypothetical basis.

In short, the probability of conceiving increases with the number of embryos transferred, but so does the risk of multiple pregnancies. In France, the average number of embryos transferred is slightly greater than two.

• Your doctors will suggest transferring a lower number of embryos (one or two) if you have a good chance for success (first attempt, under 35 years old, many embryos, good quality embryos according to the lab, infertility originating in the male partner).

• However, the transfer of three or, in rare cases, four embryos may be indicated if you have experienced several failed attempts, if you are over 38 years of age or if the embryos appear to be of poorer quality. This strategy is used to improve success rates, but also increases the risk of multiple pregnancies.


You will stay a few minutes in the transfer room and then be allowed to go home.

Your partner must be present on the day of the transfer or, as an exception (with permission from the Clinical-Biological Team) sign a document (dated several days before the transfer) indicating his consent for the transfer along with the maximum number of embryos to be transferred.

The "extra” embryos that meet the requisite biological quality criteria can be frozen, with your permission. These embryos can be transferred at a later time, without the need for oocyte retrieval and with a simplified treatment.

6 - Embryo freezing

To improve your chances for success, fertilization is usually attempted for all of the oocytes retrieved.

However, it is important to limit the number of embryos transferred into the uterus after IVF in order to limit the risk of multiple pregnancies.

In the consent document, you will be asked for permission to freeze some of the surplus embryos. In this case, the embryos that survive the freezing-thawing process can be transferred at a later time, and before any new attempts at IVF or ICSI.


Embryo freezing is currently a common practice in France, and has enabled the birth of many babies who suffer no residual effects from this technique.


The frozen embryos are stored at the Reproductive Medicine Unit. You will receive a document, in line with the French bioethics law, specifying:

• The number of embryos frozen and the date on which they were frozen
• That in the absence of pregnancy, the frozen embryos must be transferred before any new attempts are made
• That the frozen embryos can only be thawed on the request of both partners, in order to attempt pregnancy, within five years

Every year, you and your partner will be asked if you wish to:
• Keep your embryos frozen
• Forego your plan to have a child. In this case, and in accordance with the legal provisions (French bioethics law), you may opt for one of the following:
   - Ask that your embryos be used by another couple
   - Give your consent to remove your embryos from storage
   - Donate your embryos to medical research

While embryos remain in storage, it is essential for you to inform the hospital of any change in your address or marital status.

If you decide against the freezing and storage of any surplus embryos, a limited number of oocytes will undergo attempted fertilization (usually two or three) so that all of the embryos may be transferred (as there are never more than two or three).

7 - The days following the transfer

Treatment will be prescribed after the transfer, to improve the outcome. In all cases, progesterone will be given, but other substances might also be indicated (HCG, aspirin, corticosteroids). Bed rest does not seem to improve embryo implantation and is therefore not an essential requirement. The side effects of stimulation can last for eight days following the retrieval procedure, sometimes causing pain or discomfort (bloating, abdominal pain, nausea).


If these symptoms are moderate, there is no need for treatment. However, if they increase rapidly following the day of the transfer, you should contact your doctor. Hospitalization may be necessary in some rare cases.

The waiting period to learn the outcome cannot be reduced. It takes twelve days for the pregnancy hormone (HCG) to be detectable in the mother’s blood, through a blood test. If this test is not performed at the American Hospital, please inform us of the results by calling or faxing the Reproductive Medicine Unit.

Monitoring will continue with further HCG tests and ultrasound exams.

 

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Contact Information

Reproductive Medicine Unit

Wing D, Level 2

Telephone : + 33 (0)1 46 41 28 81

Monday to Friday,
from 8:00 am to 6:00 pm
Saterday,
from 8:00 am to 3:30 pm

Prior to arrival

Make sure you bring your personal ID and your carte vitale if you are covered by French social security (Assurance Maladie)

Video


The new Reproductive Medicine Unit of the American Hospital of Paris

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Your information

The information meetings organized by the Reproductive Medicine Unit teams - Meeting location and dates

American Hospital of Paris - 63, Bd Victor Hugo 92200 Neuilly-sur-Seine - France - Tél : +33 (0)1 46 41 25 25

HDN CODE

American Hospital Of Paris