Faculty Bibliography

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

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, Fisher's 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)

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

PIP: The accuracy of basal body temperature (BBT) in retrospectively predicting the urinary luteinizing hormone (LH) surge was assessed in 60 cycles from 21 women undergoing artificial insemination with their husbands' semen. LH surges previously had been detected through use of commercially available monoclonal antibody kit, Ovustick. BBT charts were reviewed by 3 reproductive endocrinologists. Surges were correctly predicted to the day 18.3-30.0% of the time, to within 1 day on either side of day 0 56.7-70.0% of the time, to within 2 days 83.3-98.3% of the time, and to within 3 days 96.7-98.3% of the time. In addition, the physician who performed the inseminations calculated the relationship between the thermal nadir and the urinary LH surge. The nadir was noted on the day of the surge in 30% of cycles, between days -1 and +1 in 78.3%, and between days -2 and +2 in 100%. The results confirm the impression that the BBT is an inaccurate predictor of the precise day of the LH surge. On the other hand, it does provide a reasonably accurate guide to the 2-3 day period on either side of the LH surge. It is concluded that prospective use of the BBT, in which the endpoint for identifying the LH surge is the lowest temperature at midcycle before a sustained rise, can be useful in timing artificial insemination if multiple inseminations at 48-hour intervals are feasible

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

Virilization in pregnancy has been reported with various ovarian neoplasms. Presented is a case of maternal virilization resulting from an unclassified sex-cord stromal neoplasm

The association between serum prolactin (PRL) and the presence of pituitary tumors as determined by third generation computed tomography scan was studied in hyperprolactinemic patients. Patient charts from a four-year period were reviewed to identify those patients with elevated PRL (greater than or equal to 25 ng/mL). All patients with hyperprolactinemia underwent computed tomography scan evaluation of the pituitary gland. Hyperprolactinemia was identified in 79 patients, mean PRL 59 +/- 6.1 ng/mL SEM. Pituitary tumors were identified in 35 of these patients, mean PRL 65 +/- 11.9 ng/mL. This level was not significantly different from the level in 43 patients with normal computed tomography scans (52 +/- 5.7 ng/mL). This review found that computed tomography scan identified pituitary tumors in 44% (35 of 79) of patients with hyperprolactinemia. The likelihood of finding a pituitary tumor did not correlate with the level of hyperprolactinemia. Computed tomography scan is indicated for the diagnosis of prolactinomas in all hyperprolactinemic patients regardless of the serum PRL level