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A previous study had demonstrated the superiority of hysteroscopy over hysterosalpingography for the detection of intrauterine lesions in infertile patients. One hundred and sixty-nine patients were examined by a combined laparoscopic and hysteroscopic technique as the means of detecting tubal, peritubal, peritoneal, or intrauterine causes of infertility. Laparoscopy was successful in 168 and hysteroscopy in 162. The rate of diagnosis by laparoscopy of 49.4% was increased to 66% when the hysteroscopic findings were included. Only one serious complication was recorded, the inadvertent visualization of an intrauterine pregnancy. Arguments are advanced for the replacement of hysterosalpingography with combined laparoscopy and hysteroscopy as the primary means of investigating the ovulatory infertile female.

Seventy-five infertile patients and twenty-five in whom displacement of an intrauterine device (IUD) had occurred were examined under general anesthesia. The Storz 4-mm hysteroscope was utilized. In all cases Hyskon, high-molecular weight dextran, was used as the distention medium. Concurrent laparoscopy was performed in 80 patients. The hysteroscopic findings were compared with preoperative salpingograms or pelvic x-radiographs.

Endometrial biopsy specimens were obtained from 107 normally menstruating infertile women 2 to 3 days before the anticipated onset of menses and were day-dated according to histologic criteria. A simultaneous blood sample was obtained for measurement of progesterone (P) and beta-subunit of human chorionic gonadotropin. Of 98 biopsies which could be accurately dated, 56 were in-phase (IP) and 42 were out-of-phase (OOP). Mean serum P levels were significantly lower in women with OOP biopsies undertaken more than 4 days before the onset of menses. A sharp decline in serum P levels was observed in women with IP but not OOP biopsies, so that on the final premenstrual day serum P levels were significantly higher than normal in women with OOP biopsies. Pregnancy continued without interruption in two of six patients who underwent biopsy in the cycle of conception. One patient had an ectopic pregnancy; and the three remaining pregnant patients, all with subnormal P values, aborted. The study suggests that there is a high frequency of minor abnormalities in luteal function in normally menstruating, infertile women for whom tubal and male factors were normal. The frequency of subclinical pregnancy (2 of 107) was lower than anticipated from earlier studies.

Several studies have emphasized the relationship between body composition and the initiation and/or maintenance of cyclic ovarian function in women. A number of methods of indirectly calculating percent body fat have been used, but there is no clear evidence that the various calculations produce consistent results. We therefore compared five different ways of estimating the “percent body fat” in a total of 18 young women, including 6 normal control subjects who did not exercise, 6 regularly menstruating runners, and 6 amenorrheic runners. There was considerable individual variation in the estimates of body fat; and significant differences among groups were found by some, but not all, methods of calculation. It is suggested that because of the inconsistency of estimates, the use of the term “percent body fat” is misleading and that opposite conclusions may result from the use of different methods of calculating body fat in the same groups of individuals.