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Female mammals are born with a lifetime's supply of oocytes individually enveloped in flattened epithelial cells to form primordial follicles. It is not clear how sufficient primordial follicles are maintained to sustain the reproductive lifespan, while providing an adequate supply of mature oocytes for ovulation. Locally produced growth factors are thought to be critical regulators of early follicle growth, but knowledge of their identity and source remains incomplete. Here, we have used a simple approach of spatial analysis of structures in histological tissue sections to identify likely sources of such regulatory molecules, narrowing the field for future screening for candidate growth factors or antagonists. We have quantified the relative spatial positions of primordial (resting) follicles and growing follicles in mice on days 4, 8, and 12 after birth, and calculated interfollicular distances. Follicles were significantly less likely to have started growing if they had 1 or more primordial follicles close by (within 10 m), predicting that primordial follicles inhibit each other. This approach allows us to hypothesize that primordial follicles produce a diffusible inhibitor that prevents neighboring primordial follicles from growing. Such an approach has wide applicability within many branches of developmental and cell biology for studying spatial signaling within tissues and cells.diffusing inhibitor ͉ follicle growth ͉ signal gradient

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This study involved 136 women who underwent successful tension-free vaginal tape (TVT) placement for treatment of urodynamic stress incontinence. Postoperative evaluations ranged from 5 weeks to 2 years after surgery and included clinical examination with independent flowmetry, translabial ultrasound for residual urine and tape position and mobility, and a standardized questionnaire for evaluation of symptoms of incontinence. Translabial ultrasound identified the position of the superior tape margin relative to the inferoposterior symphyseal margin and the bladder neck both at rest and on Valsalva. Craniocaudal tape mobility, dorsoventral tape mobility, and total tape mobility were calculated.The patients ranged in age from 20 to 83 years of age at the time of surgery (average, 54.7 years). Postoperative urinary symptoms reported by patients included stress incontinence (12%), urinary incontinence (46%), frequency (13%), nocturia (21%), and voiding dysfunction (hesitancy, poor stream, stop-start voiding, or straining to void) (69%).At rest, ultrasound images showed the tape at positions ranging from 30 mm above to 12.7 mm below the symphysis pubis. On Valsalva, the tape was between 15 mm and 18.7 mm below the symphysis. The distance between the caudal and the bladder neck ranged from 0.3 to 3.3 mm at rest.No significant associations were seen between tape position or mobility and urinary symptoms. However, stress incontinence was somewhat more likely in women with greater horizontal distances from the tape to the symphysis pubis (P ϭ 0.048), and urge incontinence, frequency, and voiding dysfunction were somewhat more likely with a more cranial tape on Valsalva (P ϭ 0.03, 0.048 and 0.029, respectively). Patient reports of subjective cure and satisfaction had no association with tape position or mobility. GYNECOLOGYVolume 60, Number 1 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTTo investigate the symptoms among women with bacterial vaginosis, the authors conducted a longitudinal study comparing symptoms experienced by women with and without a diagnosis of bacterial vaginosis confirmed by Gram stain and Amsel clinical criteria. Subjects were recruited from women making routine healthcare visits to clinics in Birmingham, Alabama.Participating patients were interviewed intensively for information about lower genital tract symptoms, including vaginal wetness, vaginal discharge, vaginal odor, persistent vaginal itch, pain with urination, and abdominal or pelvic pain. All subjects underwent an initial clinical assessment with pelvic examination and lower genital tract microbiologic evaluation, as well as detailed questioning, which included demographic factors, obstetric and gynecologic history, dental symptoms and practices, feminine hygienic and health behaviors, sexual history and practices, history of genital tract infections or sexually transmitted diseases, alcohol and drug use, and psychosocial status.There were 2888 eligible patients who had Gram stain results available. These women were predominantly black, you...

The importance of polycystic ovary syndrome (PCOS) as a cause of anovulatory infertility and of hirsutism has been recognized for more than half a century but it has become increasingly obvious that the presence of polycystic ovaries has wider implications within and beyond the field of reproductive function. This is largely due to recent advances in ultrasound imaging of the ovaries. It is clear that polycystic ovaries are not only much more prevalent in patients with anovulation or hirsutism than would be predicted from endocrine investigation alone (Adams, Poison & Franks, 1986; Fox, Corrigan, Thomas & Hull, 1991) but also occur in over 80% of 'fertile' women who have a history of recurrent early pregnancy loss (Sagle, Bishop, Ridley et al. 1988) and in a significant proportion (22%) of the normal population (Polson, Adams, Wadsworth & Franks, 1988). The latter findings have called into question the specificity of the polycystic appearance on ultrasound imaging but more detailed analysis suggests that despite the heterogeneity of clinical and biochemical presentation of women with polycystic ovaries, there is a common thread in the biochemical profile of these various groups, which implies that a specific ovarian disorder forms the basis of the syndrome.The polycystic morphology is a sign of disordered androgen secretion An examination of serum testosterone concentrations in various groups of women with polycystic ovaries provides support for the hypothesis that PCOS rep¬ resents varying clinical and biochemical expression of a disorder of androgen biosynthesis which is inti¬ mately linked with the characteristic ovarian morphology. As shown in Fig. 1, the elevation in serum testosterone is most obvious in anovulatory hirsute women but serum testosterone concentrations are higher than normal in all groups of women with ultrasound evidence of polycystic ovaries.What, then, is the nature of the putative abnor¬ mality of androgen secretion in women with polynorm n-pco mise figure 1. Mean ( + s.d.) serum concentrations of testoster¬ one in 60 women with normal ovaries and regular menstrual cycles (norm) and in five groups of women with polycystic ovaries, normal volunteers with an incidental finding of polycystic ovaries on ultrasound (n-pco), women with spon¬ taneous ovulatory cycles but a history of recurrent mis¬ carriage (mise), hirsute women with regular cycles (h-ov), and anovulatory women with or without hirsutism (h-anov, anov). Testosterone levels in all groups with polycystic ovaries were significantly different from those in controls.

A 29-year old male and his wife presented with an 18 month history of primary infertility. History and initial investigations suggested no major female pathologic component but a semen analysis revealed azoospermia. There was no history of any sexual dysfunction and neither partner was receiving any medication. Clinical examination revealed normal secondary sexual characteristics. Both testicles were of normal consistency with a volume of approximately 15mls but a 4x2cm mass was palpable at the lower pole of the left testis. Laboratory investigations revealed: serum testosterone 37.1nmol/l (NV:10.0-38.0 nmol/l), LH<0.3U/L (NV:3.0-12.0 U/L), and FSH <0.1IU/L (NV:3.0-11.0 U/L). Serum b-HCG, aFP, LDH, oestradiol and inhibin levels were within the normal range. A repeated semen analysis confirmed azoospermia. Testicular ultrasound demonstrated a well-defined hypoechoic mass, measuring 31x23x17mm and containing several flecks of calcification, arising from the lower pole of the left testis. A left orchidectomy was performed. Macroscopical histopathological examination revealed a single firm dark brown nodule 2.8 cm in diameter arising from the lower pole of the testis. The tumor distended the capsule of the testis without extending through it. Microscopical examination was consistent with a Leydig cell tumor. Computerised tomography of the chest, abdomen and pelvis was normal. Six months later, laboratory investigations revealed a serum testosterone of 14.3 nmol/l, an LH of 5.4U/L and an FSH of 4.3U/L, respectively. A repeated semen analysis was normal: volume 1.8 ml(2-10 ml), count 124x10 6 (20-350x10 6 ), motility 80%(>60%), abnormal forms <15%(<15%). Three months later his wife was pregnant. In summary, our patient presented with azoospermia, secondary to a Leydig cell tumor, which was reversible after removal of the tumor. A 35-year old woman and her 29-year old husband were referred to our infertility clinic with an eighteen month history of primary infertility. The female partner had a regular 4/28day menstrual cycle. Her past medical history included a termination of pregnancy at 6 weeks, with another partner, ten years previously. Neither sexually transmitted diseases nor a history of pelvic inflammatory disease were reported. She had never had a surgical operation. She was on no medical treatment and she did not report any drug intake. She was a non-smoker and she reported no alcohol intake.

A role for the regulation of cellular Ca2+ homeostasis in the dopaminergic control of prolactin secretion was investigated in rat anterior pituitary glands. Withdrawal of dopamine stimulated the uptake of 45Ca2+ into hemipituitary tissue by 48% after 3 min. Radioisotope desaturation from tissue prelabelled with 45Ca2+ was significantly retarded in the presence of dopamine. Withdrawal of dopamine rapidly stimulated 45Ca2+ efflux from prelabelled tissue by 79% and was accompanied by a three- to fourfold rise in prolactin secretion. The 45Ca2+ efflux response to dopamine withdrawal was reduced in tissue prelabelled in the presence of dopamine. Agonist displacement with metoclopramide mimicked the effect of dopamine withdrawal on 45Ca2+ efflux and prolactin secretion. These observations demonstrate that the stimulation of prolactin release by dopamine withdrawal is accompanied by a redistribution of cellular Ca2+ and support the hypothesis that dopamine inhibits secretion by decreasing Ca2+ influx in the mammotroph cell.