Fertility and Sterility 

Abstract: Since the 1990 NIH-sponsored conference on polycystic ovary syndrome (PCOS),it has become appreciated that the syndrome encompasses a broader spectrum of signs and symptoms of ovarian dysfunction than those defined by the original diagnostic criteria. The 2003 Rotterdam consensus workshop concluded that PCOS is a syndrome of ovarian dysfunction along with the cardinal features hyperandrogenism and polycystic ovary (PCO) morphology. PCOS remains a syndrome and,as such,no single diagnostic criterion (such as hyperandrogenism or PCO) is sufficient for clinical diagnosis. Its clinical manifestations may include: menstrual irregularities,signs of androgen excess,and obesity. Insulin resistance and elevated serum LH levels are also common features in PCOS. PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.

Abstract: It is asserted that examination of the endometrium during the secretory phase yields more information about the time of ovulation degree of progestational change and normality of the endometrium than any other test used in sterility studies. Attention to qualitative changes in 8 morphological factors is most useful in dating the endometrial biopsy. During the 1st week of luteal activity attention should be focused on changes occurring in gland epithelium: gland mitosis pseudostratification of nuclei basal vacuolation and secretion. During the 2nd week stromal changes (including edema) predecidual reaction stromal mitosis and leukocytic infiltration are the key criteria. Tissue from the fundus of the uterus gives the most reliable information. These critera were used in 300 sterility biopsies taken from normally menstruating women over a 3-year period. Absence of organic endometrial disease and availability of accurate menstrual history were the only selection criteria. 12 observers dated the biopsies. 42 of the 300 patients (14%) menstruated on the day predicted 36 (12%) menstruated later and 222 (74%) menstruated earlier. When a +or- 1 day error was allowed 112 patients (38%) were found to menstruate at the time predicted. When these same slides were reviewed by a single observer and the date for the most advanced area of the biopsy was used 179 patients (60%) menstruated within 1 day of prediction. To test the validity of the dating criteria change in basal body temperature was used to correlate endometrial dating with ovulation rather than onset of menstruation. Of the 40 patients who had adequate temperature records 31 (78%) ovulated as predicted allowing a +or- 1 day error indicating that dating is a better gauge of duration of progesterone effect than predictor of onset of menses. To determine whether biopsy caused early menstruation the secretory phases of the 25 patients who had recorded temperatures in at least 2 cycles in addition to that in which the biopsy was taken were examined. The secretory phase was definitely shorter in the biopsied than control cycle suggesting that biopsy does accelerate the onset of flow. However further analysis showed that biopsy does not interfere with length of flow or succeeding menstrual rhythm.

Abstract: There is accumulating evidence that workplace exposure to toxic substances contributes to male infertility. Men suffering from infertility problems may do well to look at their occupations, where exposure to certain substances may be a contributory factor, if not a direct cause, of infertility. Most of the studies to date are either case reports or epidemiological studies (population-based, case-control, or cohort studies). Additional, controlled studies need to be done to ascertain the effects of occupational toxins on male infertility. Until then, men and their employers should work together to minimize exposure to these substances.