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Obstetricians & Gynecologists, Family Physicians, Pediatricians Learning Objectives: After completion of this article, the reader should be better able to evaluate the clinical presentations of pregnancy luteomas; examine the complexities involved in the diagnosis of neoplasms suspicious for pregnancy luteoma; and counsel patients on appropriate management and treatment for suspected luteomas.

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Institute of Clhkal Medlclne, Unlvenky of Tsukuba, lbarakl (A Tamaoka) Evidence of disturbed meiosis in a man referred for intracytoplasmic sperm injection M H E C Pieters, R M Speed, P de Boer, J T M Vreeburg, G Dohle, P A ln't VeldIntracytoplasmic sperm injection (ICSI) has become the treatment of choice in male infertility due to extreme oligozoospermia. Initially, the technique was limited to the selection and injection of motile spermatozoa with normal morphology; although it has now been shown that spermatozoa with abnormal morphology can also be used successfully.' We describe a patient referred for ICSI who presented with phenotypically abnormal sperm and we show that in this patient the disturbed spermatogenesis was associated with chromosome abnormalities and abnormal meiosis.A couple of south Mediterranean descent was referred to the in-vitro fertilisation clinic in Rotterdam for ICSI because of oligoasthenoterato-zoospermia in the 35-year-old man. His semen analyses showed a mean volume of 4.8 mL, mean sperm count of 7X 106/mL, and a mean progressive motility of 6%. By WHO criteria, only 1% of the spermatozoa were of normal morphology. Most spermatozoa were malformed with a mean number of 3.3 abnopalities per sperm. The most frequent head abnormalities were absence of the acrosome in 65% of the spermatozoa, large and amorphous shape of the head in 32%, and of two to four tails in 61%.Light microscopy showed normal seminiferous tubules and no evidence of inflammation or germ-cell neoplasia. The Johnson scores of right and left testes were five and six respectively. Microscopy of biopsy samples showed few spermatozoa and spermatids were found next to large numbers of spermatocytes and Sertoli cells; we surmised that spermatogenesis was decreased with partial arrest at the spermatocyte stage. Chromosome analysis in peripheral blood lymphocytes yielded a normal 46 XY karyotype.Meiotic studies of surface-spread spermatocytes by electron microscopy showed normal synaptonemal complex morphology and behaviour at the first meiotic prophase. Light microscopy of C-banded bivalent-chromosomes at both meiotic divisions, obtained after challenging meiotic prophase with ocadiac acid, showed normal diakinesismetaphase I (MI) (ie, chiasma counts