To determine whether women with secondary infertility have a lower prevalence of tubal pathology as evidenced by hysterosalpingographic (HSG) analysis. A cross-sectional study was performed on 551 women seen for evaluation of infertility at an academic medical center. Each patient's chart was reviewed for the presence of primary vs. secondary infertility. History of sexually transmitted infection, prior surgery and details of prior pregnancies were recorded. HSG reports and films were evaluated for evidence of tubal disease. Controlling for 5-year age category, history of sexually transmitted disease and history of surgery, the adjusted risk ratio for abnormal HSG in women with secondary vs. primary infertility was 1.75 (95% CI 1.16-2.64). Among patients with secondary infertility, there was no difference between mode of delivery in the prior pregnancy (vaginal vs. cesarean delivery) and abnormal HSG. In the population we studied, accounting for confounding variables, women with secondary infertility had a higher likelihood of having fallopian tube obstruction on hysterosalpingography than did those with primary infertility. Our study supports continued routine evaluation for tubal patency in patients with secondary infertility. Among parous women, there is no evidence that cesarean delivery places patients at increased risk of abnormal hysterosalpingograms.

To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.

BACKGROUND: Pregnant women are susceptible to visual disturbances, particularly with hypertension. Vision generally recovers postpartum within hours to days. A rare condition known as Purtscher-like retinopathy presents abruptly postpartum with visual field defects and blindness. Recovery of vision is unpredictable, occurring over several weeks and months. CASE: A 38-year-old woman presented at 34 weeks' gestation with contractions and heavy bleeding. Placental abruption was confirmed after a repeat cesarean was performed. Hours after delivery, she complained of central vision loss despite normal blood pressure and preeclamptic laboratory results. The diagnosis of Purtscher-like retinopathy was made, presumably from multiple infarcts to the retina caused by the placental abruption. CONCLUSION: Recovery from Purtscher-like retinopathy may result in permanent visual impairment.

BACKGROUND: Office endometrial biopsy with a Pipelle cannula is the main method for sampling the endometrial lining. The Pipelle biopsy is safe, efficient, and cost effective. This office endometrial sampling method is also an accurate and safe procedure for endometrial sampling of patients with endometrial carcinoma. It is associated with minimal pain and does not require anesthesia. CASE: Pipelle is the most common method used for sampling the endometrial lining. No data are available of infectious complications related to endometrial biopsy. The incidence is presumed to be negligible. We present an unusual case of a 52-year-old woman who experienced septic shock and multiple organ failure following Pipelle endometrial sampling. CONCLUSION: Lower abdominal pain is the cardinal presenting symptom in woman with pelvic infection. Our case emphasizes that an atypical symptom such as abdominal pain after endometrial biopsy could be a sign of infectious complications.

Sex reversal syndrome is a genetic anomaly caused by the disorder of sex development (DSD) with the characteristics of inconsistent phenotype normal penile size but small testes and infertility re- stulting from azoospermia. A male patient was diagnosed with the karyo- type of 45,XO/47,XXX/46,XX male sex reversal syn- drome with normal pubic hair and normal penile size, high levels of follicle-stimulating hormone and luteiniz- ing hormone, but small testes and infertility resulting from azoospermia. Sex reversal syndrome is a genetic con- dition caused by DSD. Many factors can lead to DSD, but the accurate mechanism has not been completely discovered. between gonadal sexuality and chromosome sexuality, including 46,XX male and 46,XY female for the most part, but the rare type 45,XO male also can be found. Approximately 80% of males with 46,XX present' with normal pubic hair and.

To describe the prevalence and risk factors for ejaculation failure on the day of operation in Chinese men undergoing assisted reproductive technique (ART) treatments. A pro- spective study of 843 men undergoing ART treatments at Zhongnan Hospital of Wuhan University . and Tongji Hospital of Huazhong - University of Science and Technology, Wuhan, China. Surveys included age, BMI, education, duration of marriage, duration of infertility, smoking, type of infertility, infertility causes, history of ejaculation failure, financial burden of the treatment, anxiety, and whether ejaculation failure happened during obtainment of sperm samples by masturbation on the day of oocyte retrieval or operation for intrauterine insemination. Their anxiety statuses were assessed using the State-Trait Anxiety Inventory. Logistic regression models were used to identify risk factors for ejaculation failure. On the day of operation 70 (8.3%) men undergoing ART treatments had ejaculation failure (OR= 12.29, 95% CI 6.98-21.64) and state of anxiety (OR=1.90, 95% CI 1.13-3.20). History of ejaculation failure and state of anxiety are associated with an increased risk for ejacu- lation failure on the day of operation.

Cervical ectopic pregnancies (CEPs) are increasingly being managed conservatively. However, the efficacy of specific conservative approaches such as the single-dose intramuscular (IM) methotrexate (MTX) therapy has not been evaluated. We reportthe successful management of 2 consecutive CEPs in the same patient with single-dose IM MTX therapy, and review published cases of CEPs treated with a similar regimen, to determine the efficacy of this approach. In our case, both CEPs resolved with single-dose IM MTX, and the patient subsequently had a successful term delivery. A Medline/OVID English language search, covering the period 1982-2012, identified 38 additional cases of CEPs treated with single-dose IM MTX. Of the total 40 cases analyzed, including our 2 cases, 30 (75%) were successfully treated, with complete remission. Of the 27 cases with no embryonic cardiac activity, 25 (93%) were successfully treated with single-dose IM MTX. Appropriately selected cases of CEPs can be successfully managed with single-dose IM MTX with very low complication rates and preservation of future fertility potential.

To explore the relative safety of heparin thromboprophylaxis by comparing complication rates of 2 retrospective cohort groups. After a change in departmental protocol to include 3 doses of unfractionated heparin for all patients undergoing cesarean deliveries, complication rates of cesarean deliveries before (n=501) and after (n=500) the policy change were compared. Outcomes for postoperative hematocrit, estimated blood loss, platelet counts, and wound complications were not different between the 2 groups. This regimen of heparin does not increase adverse acute postoperative outcomes, but more research is required to determine if it is efficacious in reducing rates of veinous thromboembolism.