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Objective: To investigate whether any parameter in the routine semen analysis of electroejaculates is correlated with success in achieving pregnancy by IUI., Design: Retrospective observational study., Setting: An Assisted Reproductive Program at a tertiary care university center., Patient(s): Twenty-seven anejaculatory men with spinal cord injury (n = 24) or history of retroperitoneal lymph node dissection (n = 3), thirteen of whom attempted conception with their wives., Intervention(s): Anejaculatory men underwent rectal probe electroejaculation and electroejaculates were used for IUI., Main Outcome Measure(s): Statistical correlation of semen parameters between electroejaculates that resulted in pregnancy and those that did not., Result(s): Seven pregnancies resulted from 56 IUIs using electroejaculates (pregnancy rate = 12.5% per IUI). The total motile sperm count and percentage of normal morphology were significantly higher in the specimens that resulted in pregnancies than those that did not. However, there was no statistically significant difference observed in pH, sperm concentration, or percentage of motility between the two groups. Swim-up techniques used to process electroejaculates significantly improved the motility of the specimens. No pregnancy occurred beyond the fifth IUI attempt. Repeated electroejaculation and duration of spinal cord injury had no effect on the quality of the ejaculates., Conclusion(s): The total motile sperm count and the percentage normal morphology of electroejaculates correlate with success in achieving pregnancy by IUI. Because repeated electroejaculation does not improve quality of ejaculate, the initial semen analysis of electroejaculates is not only useful in counseling couples undergoing such treatment program but should be planned for use as an inseminate.

Objective: To present a case of a Sertoli-Leydig cell ovarian tumor and discuss the endocrinologic findings., Methods: We describe the clinical manifestations in a female patient with an ovarian tumor and summarize the results of hormonal studies., Results: A 33-year-old woman with abrupt cessation of menses, progressive hirsutism, and weight gain because of a unilateral ovarian mass identified sonographically and an increased serum testosterone level underwent laparotomy, which disclosed a left ovarian Sertoli-Leydig cell tumor. Hysterectomy and bilateral adnexectomy were performed. Tissue extraction studies revealed 17-hydroxyprogesterone as the predominant steroid in tumor tissue in conjunction with substantially increased testosterone, free testosterone, dihydrotestosterone, androstenedione, and dehydroepiandrosterone levels and left ovarian vein effluent., Conclusion: A unilateral ovarian mass associated with substantially increased serum testosterone should suggest the presence of a functioning ovarian tumor. Androgenic symptoms are a consequence of disturbed steroidogenesis from multipotential steroidogenic cells of ovarian stromal origin whose clinical effects depend on enzymatic specificity and the relative concentrations of steroids produced.

Objective: To describe and assess the incidence and impact of ovarian maldescent in infertile women., Design: Observational clinical study., Setting: Referral infertility practice., Patients: Women undergoing operative intervention as part of infertility evaluation or treatment., Interventions: Anatomic observation at laparoscopy or laparotomy., Results: Failure of the gonad to descend into the true pelvis occurred in 5 of 2,025 operative observations of patients evaluated and treated for infertility. Inappropriate descent of the ovary is associated with a short infundibulopelvic ligament and attachment of the superior pole of the ovary above the pelvic brim adjacent to the fimbriated end of an elongated, ipsilateral fallopian tube. It may be bilateral or unilateral and sometimes is associated with Mullerian duct abnormalities., Conclusions: The incidence of ovarian maldescent is low, its relationship to infertility is unclear, and it does not necessarily preclude conception when other infertility factors are recognized and treated. Its rarity and altered anatomy has the potential for therapeutic misadventure at laparoscopy, laparotomy, and IVF oocyte retrieval.

The current literature reflects a trend toward alternatives to abdominal hysterectomy for the treatment of symptomatic leiomyomata uteri. Precision in diagnosis is aided by new techniques in ultrasound and magnetic resonance imaging. Gonadotropin-releasing hormone agonists reduce tumor and uterine bulk; relieve symptoms of bleeding and discomfort; are clearly useful as an adjunct to surgery; and in some patients may resolve symptoms, thus obviating the need for surgery, at least in the short-term. Repeated courses or long-term therapy with gonadotropin-releasing hormone agonists remain limited by the potential risks associated with long-term hypoestrogenemia. Myomectomy can be offered to symptomatic women desiring preservation of reproductive potential without incurring significant alteration in operative risk compared with hysterectomy and with a likelihood of subsequent conception exceeding 50%. Endoscopic removal of submucous or intracavitary leiomyomata is clearly technically feasible with acceptable risk by hysteroscopy and with good conception rates thereafter. Laparoscopic removal of intramural and subserosal leiomyomata uteri is also technically feasible with acceptable perioperative risk, but the need for removal of small tumors and the safety of subsequent pregnancy after removal of large intramural tumors has yet to be put into appropriate perspective.

Objective: To review, evaluate, and synthesize current published reports assessing the value of abdominal myomectomy in infertile women and those desiring to preserve fertility potential., Data Identification: Major studies dealing with myomectomy were identified through Medline Searches., Study Selection: Those papers reporting the results of myomectomy, factors influencing them, and potential future innovations were obtained., Results: More than half of women not previously pregnant and undergoing myomectomy to preserve childbearing capacity for treatment of recurrent pregnancy wastage or previous infertility conceive. The long duration of infertility before surgery, absence of other factors to explain their not conceiving, and short time interval subsequent to surgery in which conception occurs suggests myomectomy has value in treatment of patients with leiomyomata and otherwise unexplained infertility. The operation carries acceptable risk. Approximately 25% of women undergoing myomectomy have recurrent leiomyomata, but most recurrences are sufficiently delayed to allow adequate opportunity for conception., Conclusions: Abdominal myomectomy is an appropriate alternative to hysterectomy for most women who wish to preserve childbearing potential or enhance it. For the future, myomectomy by endoscopic techniques may hold similar potential.

Objective: We sought to determine clitoral size in normal women and the possible effect of age, height, weight, parity, and oral contraceptive (OC) use., Methods: Prospective measurement was made of clitoral dimensions in 200 consecutive normal women at routine gynecologic examination in an office setting., Results: The mean (+/- standard deviation) transverse diameter of the glans clitoris was 3.4 +/- 1.0 mm. The longitudinal diameter of the glans was 5.1 +/- 1.4 mm. Total clitoral length including glans and body was 16.0 +/- 4.3 mm. The mean clitoral index was 18.5 mm2. Measurements of all diameters were normally distributed. Age, height, weight, or current use of OCs did not influence clitoral size, but parous women had significantly larger measurements., Conclusions: It is possible to obtain useful clitoral measurements in the office setting. Parity influences clitoral size, but age, height, weight, and OC use do not.

Objective: To determine whether gonadotropin-releasing hormone analogs (GnRH-a) initiated either in the luteal phase or in the early follicular phase immediately preceding menotropin will improve the fertilization, implantation, and pregnancy rates (PR) in all IVF patients, when compared with menotropins alone., Design: In a prospective, controlled, randomized study we compared a pure follicle-stimulating hormone (FSH) human menopausal gonadotropin (hMG) protocol (group A = control) (n = 93 cycles) to two protocols in which GnRH-a pretreatment plus pure FSH and/or hMG was used in in vitro fertilization candidates. In group B (n = 64) GnRH-a was initiated during the luteal phase and in group C (n = 35) during the follicular phase., Results: We found (1) no differences in fertilization and implantation rates between the three protocols; (2) similar pregnancy rates per transfer when similar number of conceptus were transferred (A = 30%, B = 22%, C = 21%); (3) an increase of the number of oocytes obtained; and (4) a reduction in the cancellation rate with both GnRH-a protocols., Conclusions: These findings suggest that there is no obvious superiority between the two GnRH-a protocols in the dosage schedule used and that the major advantage of GnRH-a over non-GnRH-a protocols is in decreasing the cancellation rate and increasing the number of oocytes and conceptus obtained. The follicular phase GnRH-a protocol required less hMG-pure FSH than the luteal phase GnRH-a protocol.

Infertility may have many etiologies. Of 141 systematically and completely evaluated couples, 40.4% were found to have multiple factors contributing to their inability to conceive. In 33.3% two factors were present, and in 7.1% three or more factors were found. A total of 53.2% of patients had a single identified factor, and in 6.4% no apparent cause was identified. Long-term pregnancy rates calculated by life-table methodology revealed no significant differences between those with single-factor, multifactorial, or unexplained infertility when all identified factors were treated.

Aberrant breast tissue may occur anywhere along the embryonic milk line. Only 17 instances of breast tissue of the vulva have been recorded in the English literature between 1900 and 1976. Review of these cases, as well as features of the patient herein reported, serve as a basis for presenting a clinical profile of this interesting entity, its potential complications, and a rationale for appropriate management.