Ovarian maldescent.

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.

Synthesis and secretion of proteins by postpartum human oviductal tissue in culture.

An explant culture system that used labelled leucine and two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) with fluorography was used to identify specific de novo synthesized and released polypeptides by the human postpartum oviduct. Both ampulla and isthmus tissue in culture exhibited de novo synthesis and release of a large number of polypeptide subunits. Immunoglobulins A and G appear to be the major proteins produced in the ampulla. In addition, two complexes of acidic (pI less than 5) polypeptide subunits are found primarily in ampulla culture medium. Two families of proteins (Mr 51,000 and 60,000) are released by the isthmus but appear to be minor in the ampulla cultures.

Estrogen and progesterone production by granulosa cell monolayers derived from in vitro fertilization procedures: lack of evidence for modulation by androgen.

The role(s) of androgens in the steroidogenic regulation of human granulosa cell production of estrogen and progesterone during monolayer culture was studied. These cells were exposed in vivo to human menopausal gonadotropin and hCG gonadotropin with or without clomiphene citrate. Steroid production rates were compared between cells cultured in control medium and those cultured in medium containing a nonaromatizable androgen [dihydrotestosterone (DHT)] or an aromatizable androgen [androstenedione (A'D)]. Some cultures received A'D from 3-12 days; other cultures received DHT alone for 3, 6, or 9 days before the addition of A'D for 3 days. The effect on steroid production during the culture interval before the addition of A'D also was evaluated. Exposure to A'D increased estrogen production over 50-fold compared with that in control cells or those treated with DHT (P less than 0.001). DHT also failed to alter estrogen production when A'D was added to cultures. Furthermore, the delay in introducing A'D to the cultures for up to 9 days did not decrease subsequent estrogen production compared with that in cultures continually exposed to A'D or DHT plus A'D. Progesterone production was substantial for at least 12 days of culture and was unaffected by the presence of androgen. These results do not confirm previous studies using murine or porcine granulosa cells, which suggested that androgen receptor-dependent mechanisms were involved in increasing estrogen and/or progesterone production in vitro. Rather, they indicate that androgen may not be required to maintain aromatase capability per se in human granulosa-luteal cells previously exposed to ovulation-inducing quantities of gonadotropin.

Unusual mullerian anomalies associated with distal extremity abnormalities.

A 13-year-old girl was evaluated with nonfamilial mullerian anomalies consisting of bilateral blind uterine horns, a separate cervical remnant, and total vaginal agenesis. The observed musculoskeletal abnormalities of the distal extremities differed from those usually associated with both nonfamilial mullerian agenesis (Rokitansky-Küster-Hauser syndrome) and the familial syndromes associated with mullerian anomalies. The pattern of mullerian dysgenesis is unusual in that the entire vagina is absent and a cervical remnant separate from the two blind uterine horns is present in the midline in the normal course of the paramesonephric ducts.