John Quagliarello

Uterine arteriovenous malformation successfully embolized with a liquid polymer, isobutyl 2-cyanoacrylate

A uterine arteriovenous malformation was diagnosed angiographically in a 27-year-old woman presenting with recurrent menometrorrhagia. Bilateral hypogastric artery embolization with a liquid polymer, isobutyl 2-cyanoacrylate (Bucrylate), resulted in subsequent normal menses. Bucrylate offers a number of advantages over other agents previously used to embolize uterine arteriovenous malformations.

Inaccuracy of basal body temperature charts in predicting urinary luteinizing hormone surges

Sixty basal body temperature (BBT) charts were reviewed by three reproductive endocrinologists in an attempt retrospectively to predict the urinary luteinizing hormone (LH) surge. LH surges had been previously detected in all cycles with the use of a commercially available monoclonal antibody kit, Ovustick (Monoclonal Antibodies, Inc., Mountain View, CA). Surges were correctly predicted to the day (day 0) 18.3% to 30.0% of the time, to within 1 day on either side of day 0 56.7% to 70.0% of the time, to within 2 days 83.3% to 98.3% of the time, and to within 3 days 96.7% to 98.3% of the time. The BBT remains an inaccurate predictor of the day of the LH surge but does provide a reasonably accurate guide to the 2- to 3-day period on either side of the surge.

Semen quality before and after processing by a swim-up method: relationship to outcome of intrauterine insemination

Twenty-five couples with normal semen analyses and postcoital tests of less than or equal to 3 motile sperm/high-power field were treated by intrauterine insemination (IUI) with sperm prepared by a swim-up method. Eight women conceived (32%). Influence of semen parameters both before and after swim-up, patient age, and duration of infertility on outcome of IUI was assessed with logistic discriminant analysis. The percent motility of sperm after swim-up allowed significant differentiation of pregnant and nonpregnant patients (P = 0.0009). For patients with greater than 79% motility after swim-up, discrimination provided by post-swim-up motility (P = 0.0063) was enhanced by inclusion in the analysis of either total number of motile sperm used for insemination (P = 0.0021) or sperm concentration after swim-up (P = 0.0019), Predictions of nonpregnancy and pregnancy were correct at rates of 93.3 and 70%, respectively. There were no significant differences between semen parameters of conception and nonconception cycles of patients who conceived.

Clomiphene citrate in the management of infertility associated with shortened luteal phases.

Repetitively short luteal phases were found in eight infertile women. The short luteal phase was defined as 10 days or less from the presumed time of ovulation (as assessed by basal body temperature recording) to the onset of menses. Clomiphene citrate (Clomid) therapy resulted in pregnancy in two patients and lengthened the luteal phase in the other six. Ultimately, seven of eight patients conceived during Clomid therapy. Clomid therapy can lengthen the luteal phase in patients with luteal temperature elevation of 10 days or less. The occurrence of short luteal phases may be associated with infertility.

Intracervical versus intrauterine insemination: correlation of outcome with antecedent postcoital testing

Thirty-four infertile women alternated cycles of intracervical insemination (ICI) with whole ejaculate homologous semen (mean, 3.2 cycles/patient) versus intrauterine insemination (IUI) with washed sperm (mean, 3.4 cycles/patient). Twenty of the 34 women had prior postcoital tests consistently demonstrating less than or equal to 3 motile sperm per high-powered field (HPF). Six of those 20 conceived during IUI cycles (30.0%); 0 conceived during ICI cycles (P = 0.06, Mantel-Haenszel chi-square test). The pregnancy rate per IUI cycle was 6/72 (8.3%), compared with 0/66 (0.0%) per ICI cycle, a statistically significant difference (P = 0.04, Fishers exact chi-square test). Fourteen of 34 women had prior postcoital tests consistently demonstrating greater than or equal to 5 motile sperm per HPF. One of the 14 conceived during an IUI cycle (7.1%), and 2 conceived during ICI cycles (14.3%), a difference that was not significant. The pregnancy rate per IUI cycle was 1/42 (2.4%), compared with 2/42 (4.8%) per ICI cycle (not significant). IUI may be helpful in the management of infertility associated with relatively poor postcoital tests (less than or equal to 3 motile sperm per HPF) but not with relatively good postcoital tests (greater than or equal to 5 motile sperm per HPF).

Isolated endometriosis in an inguinal hernia

Presented is the case of a patient with inguinal endometriosis adjacent to a hernia sac in whom laparoscopy revealed no evidence of pelvic endometriosis.

Declining serum concentrations of the β-subunit of human chorionic gonadotropin and ruptured ectopic pregnancy

Declining values of the beta-subunit of human chorionic gonadotropin may be associated with ectopic pregnancy or missed abortion. Sonography may not always establish a definitive diagnosis. A case is presented where expectant management of declining levels resulted in rupture of an ectopic pregnancy. Declining values of the beta-subunit of human chorionic gonadotropin should not give the clinician a false sense of security in managing first-trimester pregnancy disorders.

Relationship of within-patient semen variability to outcome of intrauterine insemination.

To define the subpopulation of infertility patients who would benefit from intrauterine insemination (IUI) with swim-up homologous sperm, the relationship of within-patient semen variability to outcome of IUI was studied. The 61 women in the study had negative workups. Men had at least one semen sample with greater than or equal to 20 x 10(6) sperm/ml. The 6-month cumulative pregnancy rate for all patients was 31.8%. Patients with original sperm motilities consistently greater than or equal to 30% had a higher cumulative pregnancy rate (62.9%) than patients with one or more motility less than 30% (22.0%, P = 0.0015, log-rank test). Patients with post-swim-up motilities consistently greater than or equal to 70% had a cumulative pregnancy rate (51.2%) significantly greater than patients inconsistent for this parameter (15.6%, P = 0.0116). Consistency of sperm motility is a useful parameter for defining the subpopulation of patients who would benefit from IUI.

Symptomatic endosalpingosis in a postmenopausal woman

The presence of ectopic fallopian tube epithelium (endosalpingosis) in postmenopausal women is rare and usually asymptomatic. A case is presented of symptomatic endosalpingosis in a postmenopausal woman who had none of the previously described predisposing factors.

Raynaud's phenomenon in infertile women treated with bromocriptine.

Two cases are reported of infertile women who developed cold-induced digital vasospasm (Raynauds phenomenon) on low-dose Parlodel (5.0 to 7.5 mg/day). The cases are reported to alert clinicians to the potential relationship between Raynauds phenomenon and low-dose Parlodel usage in women using the drug for hyperprolactinemic or infertility indications.