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Dyspareunia is a common complaint in general gynecological practice. Many patients with dyspareunia suffer from vulvar vestibulitis syndrome (VVS). This syndrome constitutes severe pain on vestibular contact or attempted vaginal entry, tenderness to pressure within the vulvar vestibule and physical findings of vulvar erythema of various degrees. As a last resort, and only when all conservative treatments have failed, surgery is attempted. It has been our observation that a considerable percentage of patients with VVS present with concomitant vaginismus. Furthermore, surgery is less successful in this subgroup of patients unless the vaginismus is first treated. This report describes the evaluation and treatment of 14 patients with VVS.

Objective To assess the efficacy of prostaglandins in enhancing bladder function after vaginal hysterectomy. Design Prospective randomised study of women who underwent vaginal hysterectomy between November 1989 and August 1990. Setting Sackler School of Medicine Tel Aviv University Medical Center, Department of Obstetrics and Gynaecology ‘B’. Subjects 24 women who underwent vaginal hysterectomy and anterior and posterior colporrhaphy for prolapse. Intervention Administration of prostaglandin F2α 5 mg intravesically or E2 3 mg intravaginally versus 100 ml saline intravesically (control) daily, starting on the first post operative day, until adequate spontaneous voiding was established. Results Women receiving either PGF2 or PGE2 resumed spontaneous bladder function earlier, required significantly fewer days catheterisation and had significantly less febrile morbidity compared to women in the control group. Conclusions Prostaglandins, either intravesical or intravaginal, are beneficial in enhancing bladder function after vaginal hysterectomy.

Forty-one congenital malformations were found in 28 newborns in a group of 197 cases of chronic polyhydramnios in singleton pregnancies. Of these, a total of 61% ( 17 28 ) was antenatally diagnosed ultrasonically. Nine newborns (4.5%) had malformations of the central nervous system (CNS), 9 (4.5%) cardiovascular malformations, 8 (4.1%) musculoskeletal anomalies, 7 (3.6%) malformations of the urinary and reproductive system, 4 (2%) respiratory system anomalies and 3 (1.6%) anomalies of the gastrointestinal system. Chromosomal abnormalities were found in three cases. As the association of polyhydramnios with fetal congenital anomalies is quite high (14.2% in our series), it is imperative to make a major effort to antenatally detect as many cases as possible. This means that in the case of hydramnios the following are required: ultrasound examination by an expert, echo ultrasonography when no other abnormalities are detected, and maybe even a chromosomal analysis.

The case of a 30-year-old pregnant patient suffering from panhypopituitarism is presented. Pregnancy induced by HMG/HCG had been uneventful. Induction of labor by PGE2 vaginal tablets and by intravenous oxytocin at 42 gestational weeks failed and the patient was operated. Following the operation severe exacerbation of her diabetes insipidus occurred. Fluid balance mechanism failed and electrolyte status deteriorated rapidly. The importance of pitressin in maintenance of fluid and electrolyte balance in panhypopituitaric patients in labor and surgical trauma is stressed.

Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy.A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial gestational sac 58 mm in diameter and containing an embryo with a crownrump length of 29 mm and embryonic heartbeats. Serum beta-human chorionic gonadatropin (hCG) level was 97,950 mIU/mL. The patient was treated with a systemic MTX/leucovorin regimen. At the end of the one-week course, no embryonic cardiac activity was detected, and a decrease in beta-hCG levels commenced. Persistent trophoblastic tissue, manifested by a low (26 mIU/mL) beta-hCG level in plateau, was successfully removed by way of hysteroscopy.Early detection of interstitial pregnancy may facilitate conservative medical treatment.

Malignant melanoma is the second most common vulvar malignancy. The superficial inguinal lymph nodes are the main site of metastases. Endometrial metastasis of vulvar malignant melanoma has not been previously reported.Vulvar malignant melanoma was diagnosed in a 60-year-old, postmenopausal woman. Immunohistochemical stains were positive for vimentin and S-100 protein and negative for HMB-45. Six months following vulvectomy, right inguinal lymphadenectomy and immunotherapy, curettage was performed due to postmenopausal bleeding. Histologic and immunohistochemical examinations revealed metastatic malignant melanoma with the same staining reactivity as the primary vulvar neoplasm had. Hysterectomy and bilateral salpingo-oophorectomy was performed, disclosing invasion of the endometrium and the inner two thirds of the myometrium.Only 10 other cases of endometrial metastases from malignant melanoma have been previously reported. All those cases involved a primary tumor occurring in the trunk and extremities. This is presumably the first report on endometrial and myometrial metastases from vulvar malignant melanoma.

Severe ovarian hyperstimulation syndrome is a life-threatening complication of ovulation induction. The clinical picture includes ovarian enlargement, accumulation of ascites and pleural effusion, increased coagulability and electrolyte disorders. Accumulation of ascites increases the intraabdominal pressure so that breathing difficulties ensue. Paracentesis is the only treatment that can immediately prevent respiratory deterioration.Nine women with severe ovarian hyperstimulation syndrome were treated by paracentesis for the drainage of massive ascites. Unilateral vulvar edema developed in all cases in which the lower abdomen was the puncturing site. This phenomenon was not observed when paracentesis was carried out through the upper abdomen. The edema resolved spontaneously over the subsequent 10 days.Apparently the puncturing needle created a fistulous tract through which the ascitic fluid was forced, by the increased intraabdominal pressure, into the subcutaneous tissues, presenting as unilateral vulvar edema. This can be prevented by using one of the abdominal hypochondriac regions as the puncturing site. This phenomenon is self-limited and causes only mild discomfort without late sequelae.

The study was undertaken to assess the reproducibility of endometrial thickness measurements by transvaginal ultrasonography (TVS).In a prospective blind study, two examiners measured the endometrial thickness of 25 patients by TVS on two separate occasions 30 minutes apart.The reliability test performed for each examiner was statistically less significant for the intra-observer variation of each observer (r = 0.95 and r = 0.93), than between both examiners (r = 0.85). Although there was no statistically significant difference between the observations, the mean range of observations was 2.12 + 1.27 mm.A safety margin of error should be taken into consideration while recommending a cutoff under which no curettage is needed.

The study was undertaken to evaluate the diagnostic accuracy of transvaginal sonohysterography in postabortion and postpartum patients suspected of having residual trophoblastic tissue.Twenty two women with late postabortion and postpartum bleeding were evaluated by transvaginal sonography and transvaginal sonohysterography. The patients were prospectively divided into two groups according to the sonohysterographic findings. Women with an empty uterine cavity or with free-floating masses received conservative treatment. Those with suspected attached residual trophoblastic tissue underwent curettage.Sonohysterography confirmed the findings of two-dimensional sonography of an empty uterus in 8 patients; however, a free floating endometrial mass was found in 4 patients and that of an empty uterine cavity in another 2 of 14 patients suspected of having residual trophoblastic tissue by the two-dimensional ultrasound. All 14 patients who were treated conservatively ceased bleeding. The 4 patients with a free-floating mass reported ejection of a vaginal mass within 6 days of treatment. Eight patients underwent curettage. Residual trophoblastic tissue was found in all of them.Transvaginal sonohysterography is a simple and effective method for the evaluation of residual trophoblastic tissue in patients with postpartum and post-abortion bleeding. Its use may eliminate unnecessary curettage procedures.

To examine the efficacy of extending ovulation induction for the in vivo maturation of oocytes.Fifty-nine high responders underwent 72 in vitro fertilization (IVF) cycles with a conventional protocol of human menopausal gonadotropin and a gonadotropin-releasing hormone analog. These patients donated oocytes to 81 recipients. The same 59 patients underwent 90 subsequent cycles in which the duration of induction was extended by two to three days. The oocytes were also donated to 138 patients.With the extended protocol, significantly more oocytes were retrieved (29.1 vs. 20.6), and a greater proportion of them were mature. Fertilization rates were significantly higher for both donors (67.7% vs. 36.2%) and recipients (67.5% vs. 47.1%). Conception rates were also significantly higher for both donors (24.4% vs. 11.1%) and recipients (38.4% vs. 24.7%).Extending the duration of ovulation induction in high responders is associated with in vivo maturation of oocytes and improved success rates in IVF and ovum-donation programs.

To assess the effect of P levels on oocyte and embryo quality and pregnancy rates (PRs) in IVF and oocyte donation.Retrospective analysis of PRs in ovum donors and their recipients with regard to P levels on day of hCG administration.In Vitro Fertilization Units, oocyte donation programs.In vitro fertilization patients who agreed to donate oocytes were treated by hMG alone (53 cycles) or in combination with a GnRH analog (122 cycles).Uterine preparation in oocyte recipients consisted of 6 mg/d E2 valerate. Progesterone (100 mg/d) was added when oocytes became available. Hormonal treatment was continued until 12 weeks of gestation.Using a series of Fisher's Exact Tests, a critical threshold for P was identified at 1.9 ng/mL (conversion factor to SI units, 3.185). With elevated P levels (1.9 ng/mL), lower PRs were noted for the donors (7.1% versus 17%), as well for the recipients (8.3% versus 26.7%).Exposure to elevated P levels resulted in lower PRs for the donors and significantly lower PRs in the recipients. Because the endometria in the recipients were prepared uniformly, we conclude that this is the result of detrimental effects of P on oocyte or embryo quality.

The precerclage and postcerclage term delivery rate (TDR), premature delivery rate (PDR) and late abortion rate (LAR) were evaluated in 260 parturients undergoing elective cerclage at 12-16 weeks' gestation. The TDR increased from 0.49 to 0.78, the PDR dropped from 0.35 to 0.18, and the LAR dropped from 0.16 to 0.04. The rate of early and late complications was acceptable, and the fetal survival rate was significantly improved. The fetal salvage rate increased from 0.73 to 0.92, establishing a fetal salvage ratio of 1.26. Based on this experience, cerclage placement in cases of incompetent cervical os may prolong the duration of pregnancy and improve the outcome.

The outcomes in 125 cases of elective, outpatient cerclage placement were compared to those in 101 cases of elective, inpatient cerclage placement with the same technique at the same institution. There was no difference between the two groups in the rates of early and late complications or in the effect of the procedure on the duration of gestation. As expected, a statistically significantly shorter hospital stay occurred in the outpatient group. The outpatient procedure is as effective as the inpatient one, with no increased risk of early and late complications, and offers patients a shorter absence from home, thus possibly decreasing their anxiety, and considerable financial savings.

One hundred and thirteen cases of polyhydramnios diagnosed by repeated ultrasonic examinations in singleton pregnancies were divided into two groups according to the trend of change in the amniotic fluid volume between the first and the second ultrasonic examination. Group A patients (65 cases) showed an increase or no change in amniotic fluid volume, and in group B (48 cases) a reduction in amniotic fluid volume to mild polyhydramnios or to normal amniotic fluid volume was observed. A significantly increased rate (p < 0.05) of maternal complications such as diabetes mellitus, pregnancy-induced hypertension, urinary tract infections, premature rupture of membranes and premature delivery was observed in group A. More abdominal deliveries and an increased rate of fetal anomalies, fetal abnormal presentations, intrauterine fetal death and neonatal death also occurred in this group. Group B patients, most of whom were idiopathic, showed a very favorable outcome.

The removal of a cervical polyp is routinely accompanied by a fractionated dilatation and curettage (D&C) in various institutions. In order to assess the necessity of performing a D&C on all the patients admitted with the diagnosis of a cervical polyp, we reviewed the charts of 362 patients admitted for a cervical polypectomy and D&C during a 5-year period. The procedure was performed on a day clinic basis under general anesthesia. No serious complications were noted. In 218 women (60%) the discovery of the cervical polyp was incidental and in this group no malignant change was found in the polyp or in the endometrium. Six cases of atypical hyperplasia and 2 cases of adenocarcinoma of the endometrium were found in the symptomatic group of patients (40%). Removal of the polyp as an outpatient procedure is recommended of the asymptomatic patient. Hospitalization and removal of the polyp under general anesthesia, accompanied by D&C should be reserved for the symptomatic patients only, or even then, replaced by ambulatory polypectomy and endometrial sampling.

In a retrospective study we evaluated 4 controlled ovarian hyperstimulation (COH) protocols for in vitro fertilization (IVF) treatment. Treatment cycles 4 through 8 were analyzed in patients, who in 3 previous attempts reached the stage of embryo transfer (ET) but did not conceive. The 426 recorded cycles included all indications for IVF, but not the male factor. The age range was 25-46 years. Patients underwent from 4 cycles (169 women) to 8 cycles (27 women). The COH protocols used included established combinations of menotropins, clomiphene citrate/hMG, and short and long protocols of GnRH analogs followed by hMG. There were no statistically significant differences in patient age, etiology and duration of infertility, or distribution of the various COH protocols among the groups of patients. No single protocol was significantly superior to any other when the pregnancy rate per cycle was assessed. The results did not justify changing a COH protocol which had lead to ET but not to pregnancy, for another protocol.

Although pelvic inflammatory disease (PID) is a common complaint in young, fertile women, it is quite rare during pregnancy. Clinically it is characterized by abdominal pain, sometimes presenting as an acute abdomen with fever. Since PID has no characteristic clinical or laboratory findings, and is rare during pregnancy, it is understandable why the diagnosis is missed in most cases, and the patient is treated as an abdominal emergency. Since surgery during pregnancy in the presence of an infection leads to abortion in most cases, accurate diagnosis and appropriate treatment is of the greatest importance. A case of PID during pregnancy is presented.

One hundred and forty-nine cases of hydramnios were detected among 13,750 parturients undergoing 25,000 routine ultrasonographic examinations. The prevalence of hydramnios was 1.08%. Ninety-seven patients (65.1%) had no apparent cause for the increased amount of fluid volume. Twenty-eight newborns (18.8%) were congenitally malformed, and 22 (14.8%) patients had diabetes mellitus. Rh incompatibility accounted for only 1.3% of the cases. It seems that with the improvement of modern obstetrics, mainly improving the antenatal management of diabetes and Rh incompatibility, there is a decrease in the relative incidence of these two conditions as etiological factors of hydramnios.

Ninety-eight cases of congenital uterine malformations were diagnosed with hysterosalpingography (HSG). Symmetric uterine malformations, composed of bicornuate uterus, uterus didelphys and septate uterus, constituted 80% of the cases. Of them, 75% were of the bicornuate type. Infertility (55%) and a suggestion of cervical incompetence (24%) were the main indication for HSG. Premature deliveries (29%), spontaneous first-trimester abortions (24%), ectopic pregnancies (3%), abnormal fetal presentations (23%) and a high cesarean section rate (27.5%) occurred in those patients. The highest rate of first-trimester abortions (47%) and the lowest rate of term deliveries (21%) occurred in the group with T-shaped uteri as compared to a 7% rate of early abortions (P less than .05) and 61% rate of term deliveries (P less than .03) in the unicornuate uterus group. In 30% of the patients with uterine malformations, cervical incompetence was diagnosed. Improved obstetric outcomes occurred in patients treated with cervical cerclage. There was a statistically significant difference between the number of premature deliveries and spontaneous late abortions in the group without cerclage (50%) and that with cerclage (21%) (P less than .001).

Ultrasonic measurements of endometrial thickness and recording of the echogenic pattern were performed daily throughout an ovulatory cycle in 20 women, aged 20-30, who had normal ovulatory cycles. There were 10 women in whom the cycle terminated in pregnancy and 10 in whom it ended in menstruation. The echogenic pattern of the endometrium was similar in both groups, but the endometrial growth pattern showed a significantly thicker endometrium (p less than 0.05) 8-13 days after ovulation in those who became pregnant.

The efficiency of cryopreserved donor semen versus fresh donor semen in an in vitro fertilization/embryo transfer programme was evaluated. Thirty-nine in vitro fertilization/embryo transfer cycles were performed using fresh donor semen (group A) and 74 cycles were carried out using cryopreserved semen (group B). All patients underwent a uniform controlled ovarian hyperstimulation using high doses of human menopausal gonadotropins. Oocytes were retrieved transvaginally under ultrasound imaging. Semen (fresh or frozen-thawed) were prepared for insemination by a washing technique. Each ovum was inseminated with 500,000-600,000 motile spermatozoa. No significant difference was noted between the two groups regarding female age, duration of infertility, and number of ova retrieved per aspiration. Even though the fertilization rate in group B was significantly lower than in group A (55.5 +/- 3.8 vs 70.4 +/- 3.5, P = 0.008), pregnancy rates per embryo transfer were similar--39.3 and 38.5%, respectively.

One hundred two postmenopausal women underwent ultrasonographic evaluation of adnexal masses before surgery. Twenty-nine (28%) had malignant tumors and 73 (72%) had benign tumors. Two of 33 patients with a "simple cyst" smaller than 5 cm in diameter by ultrasound had malignant ovarian tumors. Twenty-two of the 52 women (42%) with "complex masses" by ultrasound and five of the 17 (29%) with solid tumors had ovarian cancer. For predicting malignancy in ovarian tumors, abdominal ultrasonography had a positive predictive value of 39% and a negative predictive value of 94%. If a negative sonogram had been relied upon, 6% of malignant ovarian tumors in postmenopausal women might have been missed.

Pregnant women with high estrogen levels were more sensitive to barbiturate-induced narcosis and hypothermia than nonpregnant and postmenopausal women. Within each group, there was a negative correlation between estrogen level and decreased sensitivity to barbiturates. It appears that estrogen alters resistance to barbiturates through its effect on the activity of dopamine receptors.

The observation of a very severe peritoneal reaction to translocated copper-bearing devices in five women necessitated operative removal. Three Copper-T (Ortho Gyne-T, Ortho, Saunderton, High Wycombe, England) and two Copper-7 (Gravigard, Searle, High Wycombe, England) devices were involved. Similarly severe peritoneal reactions were noted in 90% of female rats who had small-sized modified copper devices inserted into their peritoneal cavities. In a control group of rats with the same device but without a copper wire, mild adhesions were observed in the majority (85%), and none had a severe peritoneal reaction. It seems evident that the severe peritoneal reaction is induced by the copper wire in both women and female rats.The translocation of an IUD from the uterus to the peritoneal cavity is an uncommon but important complication of IUD use. The peritoneal reaction to translocated copper devices is much more pronounced than the reaction to inert devices. The contribution of the copper is investigated after 5 women with translocated copper IUDs were treated by the authors for serious involvement of the peritoneum. In 20 female albino rats, modified (adapted to the size of the animal) copper-bearing IUDs were inserted into the peritoneal cavities. In an additional 20 rats, the copper was removed from the devices before insertion. In 5 rats, only an incision was made. The animals were sacrificed after 14 days. In the copper device group, 90% of the animals had severe adhesions, while in the inert device group, no severe adhesions were noted, 10% had moderate adhesions and 85% had mild reactions. Reactions were absent in the laparotomy only group. The peritoneal reaction to the copper devices was severe in this experimental study, and is consistent with other case reports and the authors' clinical experience. Copper IUDs that are translocated should be removed as soon as possible after diagnosis to minimize their harmful effect. Removal by laparoscopy should be attempted before peritoneal involvement; by laparotomy thereafter.

In vitro penetration tests of human sperm into cervical mucus were introduced in order to study the interaction between sperm and cervical mucus. In the present study the correlation between sperm velocity and penetration value has been assessed. 197 semen samples were run in the in vitro penetration test using semen of different qualities and cervical mucus of good quality. No differences were found either between sperm velocity in cervical mucus (17.3 +/- 0.9 micrometers/s) and in semen (19.9 +/- 0.8 micrometers/s) or at different distances measured along the flat capillary tube (1, 2 and 3 cm). A highly significant correlation was found between sperm velocity and penetration value rates (p less than 0.0001, r = 0.9). Thus, sperm velocity in semen is a variable of great importance in the assessment of the quality of the ejaculate.

Changes in the temperature, pH, and partial pressure of oxygen (Po 2 ) in the cervical canal and cavum uteri were measured in women with or without an intrauterine device and in the uteri of rats throughout the cycle. Only the Po 2 exhibited significant variations, rising during the ovulatory phase in both cervices of women and uteri of rats. It is speculated that the rise in Po 2 is related to the function of these organs as reservoirs for spermatozoa.

Summary: A unique case of severe cord entanglement and knotting in a monoamniotic twin pregnancy is described resulting in 2 live babies. An interesting phenomenon of a possible fetal placental transfusion during labour was noted.

The mean length of twin pregnancies is shorter than that of singleton pregnancies. The possibility that the shorter gestation of twins is associated with advanced fetal maturational changes was studied in relation to placental maturation. For this purpose, the sonographically determined placental gradings of 158 twin pregnancies and 474 singleton pregnancies were compared at different gestational ages. The percent distributions of placental grades, from I to III, were significantly different throughout the third trimester, with a preponderance of Grade III placentas in the twin group (p less than 0.001). Considering the reported association of Grade III placentas with advanced gestation as well as fetal lung maturity, the present study suggests earlier maturational changes in twin fetuses compared with singleton fetuses.

Pregnancy is a natural allograft and the mechanisms for its non-rejection are obscure. Depression of maternal cellular immunity was suggested as a possible explanation. Interleukin-2(IL-2) is a lymphokine release from OKT4+ lymphocyte. This factor has a crucial role in the proliferation and differentiation of T cell subsets, and controls functions associated with immune rejection mechanisms. We therefore examined the ability of lymphocytes from women in the 3 trimesters of pregnancy to produce IL-2 in culture. Mononuclear cells were cultured with PHA for 48 h. The IL-2-containing supernatant was added to and supported the proliferation of an IL-2 dependent T cell line. Proliferation of this line indicated the IL-2 content of the added supernatant. Using this assay, IL-2 production in all 3 trimesters of pregnancy was adequate and comparable to that of lymphocytes from non-pregnant women. These results suggest that the proposed defect in cellular immunity during pregnancy is not mediated by an inability of the lymphocytes to produce IL-2.

Ninety-four singleton vaginal breech deliveries conducted under extradural analgesia were compared with 277 singleton vaginal breech deliveries conducted without extradural analgesia. Mean duration of the first stage of labour was similar in both groups. Mean duration of the second stage of labour was prolonged and mean 1-min Apgar scores were less in fetuses weighing more than 2500 g in the extradural group. Mean 5-min Apgar scores, perinatal morbidity and maternal complications were similar in both groups.

A system for determination of sperm penetration into cervical mucus in a glass capillary tube is described. Repeated counts are made of the number of sperm at fixed horizontal distances from the semen reservoir. The yields indices for total numbers of spermatozoa entering the mucus per unit time and the rate migration of the sperm through the mucus. It was found that the rate of entry was sensitive to changes in motility such as those induced by caffeine, and differences in cervical mucus quality. The system allowed quantitation of these differences.

A total of 212 stools specimens from diarrhoeal children were analyzed for the detection of pathogenic agents (parasites, bacteria and rotavirus). There were only 80 negatives specimens. In the 132 positive ones, a total of 192 pathogenic agents (81 parasites, 76 bacteria and 35 rotavirus) were found. There results are very similar to those obtained in the hospitalized children. The etiology of this African intestinal polymicrobism must be searched by comparison to the European monomicrobism . In the low conditions of hygiene and nutrition, the concept of "Herd infection" is discussed. In conclusion, specific pathogen agents must be considered as "opportunist pathogen agents of the unfortunate human collectivities ".

Fifty-one women with only minimal and moderate intrauterine adhesions (Asherman's syndrome) underwent dilatation of the cervix, lysis of adhesions and insertion of intrauterine contraceptive devices (IUDs). A pregnancy rate of 90% was achieved. In 85% of the pregnancies a viable infant was delivered, and 15% terminated in abortions. No complications of pregnancy or of the third stage of labor were noted. The most common procedure preceding the appearance of intrauterine adhesions was curettage for spontaneous abortion and less frequently for missed and induced abortions. It seems that in mild and moderate Asherman's syndrome, lysis of adhesions and IUD insertion without estrogen administration yield satisfactory results.

The pattern of penetration of human ejaculated spermatozoa into human cervical mucus (HCM) and bovine cervical mucus (BCM) was studied in an in vitro penetration system by means of plate capillary tubes. Sperm penetrate the HCM in a unique pattern making their way progressively forwards in a one-way direction in between the filaments. In contrast, sperm move preferably forward in BCM. The different patterns are probably due to different organizations of the glycoproteins. The penetration values (PV) were also different in the two systems when studied after short periods of incubation (15 and 30 min), but incubation for 1 h brought both systems to the same rate of PV. Thus, this period is enough to overcome the differences between the patterns of penetration. Sperm velocity in semen, in HCM, and in BCM were the same. Cervical mucus (CM) did not affect sperm velocity. A strong correlation (r = 0.8) was found between sperm velocity in the semen and its PV rate either in HCM or in BCM. The results of this study recommend the use of BCM as a reference CM in cross penetration tests and suggest its establishment as a routine method for assessment of sperm quality.