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ObjectiveTo examine the impact of central nervous system (CNS) stimulants on the growth of children with attention-deficit/hyperactivity disorder (ADHD), and to assess the efficacy and feasibility of weight recovery interventions on growth.MethodA total of 230 children aged 5 to 12 years with ADHD with no history of chronic CNS stimulant use were randomly assigned to receive daily CNS stimulants (78%, primarily osmotic release oral system-methylphenidate [OROS-MPH]) or behavioral treatment (22%) for 30 months. After 6 months, children evidencing a decline in body mass index (BMI) of >0.5 z-units were randomized to 1 of 3 weight recovery treatments (WRTs): monthly monitoring of height/weight (MON) plus continued daily medication; drug holidays (DH) with medication limited to school days; or daily caloric supplementation (CS) with a 150-kcal supplement plus daily medication.ResultsBefore WRT assignment, medication was associated with significant reductions in standardized weight and height (p values&nbsp

Adolescence is a common period for eating disorder (ED) onset. The availability of psychometrically sound measures of ED psychopathology enables clinicians to accurately assess symptoms and monitor treatment outcomes continuously from adolescence and adulthood. The purpose of this study was to assess if the Eating Pathology Symptoms Inventory (EPSI) is invariant across adolescents and adults. Participants (N = 29,821) were adolescent (n = 5250) and adult (n = 24,571) users of the Recovery Record (RR) mobile phone application who provided EPSI responses through the application. Measurement invariance testing was conducted to assess invariance of the EPSI Body Dissatisfaction, Restricting, Excessive Exercise, Purging, Cognitive Restraint, and Binge Eating scales across adolescents (age 13 through 17) and adults (age 18 and older). Findings indicated that all EPSI factors administered in the RR app replicated in both adolescent and adult users. The EPSI factor structure was largely equivalent in adolescents and adults, demonstrating evidence for configural and metric invariance, as well as some evidence for scalar invariance. Our results indicated that EPSI scales measured the same constructs across development. Clinicians and researchers may benefit from utilizing the EPSI to measure ED psychopathology in adolescents and for continued progress monitoring into adulthood.

Previous research has failed to find differences in eating disorder and general psychopathology and impairment between people with sub- and full-threshold bulimia nervosa (BN). The purpose of the current study was to test the validity of the distinction between sub- and full-threshold BN and to determine the frequency of objective binge episodes and inappropriate compensatory behaviors that would best distinguish between sub- and full-BN. Community-recruited adults (83.5% female) with current sub-threshold (n = 105) or full-threshold BN (n = 99) completed assessments of eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse. Receiver operating characteristic curve analysis was used to evaluate whether eating-disorder psychopathology, clinical impairment, internalizing problems, and drug and alcohol misuse could empirically discriminate between sub- and full-threshold BN. The frequency of binge episodes and inappropriate compensatory behaviors (AUC = 0.94) was “highly accurate” in discriminating between sub- and full-threshold BN; however, only objective binge episodes was a significant predictor of BN status. Internalizing symptoms (AUC = 0.71) were “moderately accurate” at distinguishing between sub- and full-BN. Neither clinical impairment (AUC = 0.60) nor drug (AUC = 0.56) or alcohol misuse (AUC = 0.52) discriminated between groups. Results suggested that 11 episodes of binge eating and 17 episodes of inappropriate compensatory behaviors optimally distinguished between sub- and full-BN. Overall, results provided mixed support for the distinction between sub- and full-threshold BN. Future research to clarify the most meaningful way to discriminate between sub- and full-threshold is warranted to improve the criterion-related validity of the diagnostic system.

// Xinhua Chen 1, * , Yiling Chen 2, * , Jianwen Jiang 1 , Liming Wu 1 , Shengyong Yin 1 , Xudong Miao 3 , Robert J. Swanson 4 and Shusen Zheng 1 1 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Zhejiang, 310003, China 2 The Department of Anatomy, Tianjin Medical University, Tianjin, 300070, China 3 The Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University, Zhejiang, 310003, China 4 Anatomical Sciences Department, College of Osteopathic Medicine, Liberty University, Lynchburg, VA, 24515, USA * These authors have contributed equally to this work Correspondence to: Shusen Zheng, email: shusenzheng@zju.edu.cn Xudong Miao, email: mxd5172@163.com Robert J. Swanson, email: rjswanson@liberty.edu Keywords: nano-pulse stimulation (NPS), nanosecond pulsed electric field (nsPEF), non-thermal, ablation, palliative therapy Abbreviations: nsPEF: nanosecond pulsed electric field; ALP: alkaline phosphatase; NPS: nano-pulse stimulation Received: December 16, 2016 Accepted: March 26, 2017 Published: April 18, 2017 ABSTRACT Background: Nanosecond pulsed electric field (nsPEF), which is also termed as nano-pulse stimulation (NPS), has the potential of stimulating immune responses toward cancer cells. The current study investigates its local and systemic antitumor efficacy in vivo in late stage tumors with lung metastasis. Method: The 12 canines with spontaneous osteosarcomas and 12 nude mice transplanted with human hepatocellular carcinoma were divided randomly and were given NPS treatment, surgery or no treatment control. Nanosecond pulsed electric field was delivered with puncture electrodes at 40 kV/cm with 500 pulses at 1 Hz. The survival time, tumor volume, serum alkaline phosphatase (ALP), joint capsule damage and lung metastasis were followed up. The efficacy was compared with control. Results: Nanosecond pulsed electric field reduced primary tumor volume and extended the survival significantly compared to the control group ( P

Horses are stabled overnight for a number of practical reasons; however, there is little research quantifying nocturnal equine behavioral patterns or the extent to which different environments influence nocturnal behavior. The aim of this study was to establish whether differences in duration of sleep and ingestive behaviors were apparent for horses bedded on straw (group 1) or shavings (group 2). Ten geldings of mixed breed (mean age: 7.3 ± 3.53 years) bedded on either shavings (n = 5) or straw (n = 5) were observed between 7 pm and 7 am. Duration of behaviors according to a predefined ethogram was recorded in minutes using a video recorder and continuous focal sampling. Mann–Whitney U tests were used to identify whether any significant differences in duration of ingestion and sleep behaviors occurred for horses bedded on straw compared with shavings. Of the total observation period, group 1 spent, on average, 29.3% of their time budget engaged in recumbent behaviors, compared with 12.2% for group 2. However, no significant differences in duration were established between horses bedded on straw or shavings for standing sleep, sternal recumbency, and lateral recumbency behaviors ( P > 0.05). Ingestive behaviors occupied approximately one-third of the time budget, with no significant difference ( P > 0.05) observed between groups. On average, group 1 spent a longer proportion of the observation period ingesting bedding (8.1%) compared with group 2 (1%). Duration of bedding ingestion appeared to peak between 1 am and 7 am for both groups. Although not quantified, general observations revealed horses were motivated to alternate between eating hay and bedding in both groups, owing to the prevalence of bedding ingestion. The results indicate that straw bedding facilitates the display of ingestive and sleep behaviors, whereas horses bedded on shavings spent a greater proportion of their nocturnal time budget engaged in "other" behaviors. Further research is required to investigate the extent to which different types of bedding material enrich the environment of horses that are stabled overnight.

Objective To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). Method Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. Results Three patterns of functional outcomes emerged. Post−secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. Conclusion Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

This chapter presents an overview of the processes of fertilization, gestation, and parturition. Fertilization in humans is a well-orchestrated, highly specific set of events between an ovum and a spermatozoon. These events have begun to be elucidated in great detail over the past few decades.

A recent study has shown that nanosecond pulsed electric fields (nsPEF) can affect the intracellular structures of melanoma within weeks. nsPEF is a non-drug, non-thermal treatment using ultrashort, intense pulsed electric fields with nanosecond durations. In the current study we followed up melanoma histopathology and metastasis with tissue micro-array 5 months post-nsPEF. After nsPEF treatment, tumor growth, tumor histology, metastasis, peri-tumor vessel and micro-vessel density were examined for the effect of nsPEF treatment on melanoma in vivo. The 17 nsPEF-treated mice were tumor-free for 169 days, significantly longer than those 19 control mice bearing melanoma without nsPEF. Histopathology follow-up showed that melanoma did not recur to the primary injection place after complete elimination. Compared with the control tumor, nsPEF-treated tumors present decreased micro-vessel density in a time-course manner in this survival study. Treatment with nsPEF caused continuous histopathological changes in melanomas, eliminated melanoma without recurrence at the primary site and prolonged animal survival time by inhibiting tumor blood supply and leading to tumor infarction. Thus, nsPEF could be applied in a non-ionizing therapeutic approach, without other agents, to locally treat tumors within a defined boundary.

Nanosecond pulsed electric fields (nsPEFs) can affect the intracellular structures of cells in vitro. This study shows the direct effects of nsPEFs on tumor growth, tumor volume, and histological characteristics of normal skin and B16-F10 melanoma in SKH-1 mice. A melanoma model was set up by injecting B16-F10 into female SKH-1 mice. After a 100-pulse treatment with an nsPEF (40-kV/cm field strength; 300-ns duration; 30-ns rise time; 2-Hz repetition rate), tumor growth and histology were studied using transillumination, light microscopy with hematoxylin and eosin stain and transmission electron microscopy. Melanin and iron within the melanoma tumor were also detected with specific stains. After nsPEF treatment, tumor development was inhibited with decreased volumes post-nsPEF treatment compared with control tumors (P< 0.05). The nsPEF-treated tumor volume was reduced significantly compared with the control group (P < 0.01). Hematoxylin and eosin stain and transmission electron microscopy showed morphological changes and nuclear shrinkage in the tumor. Fontana–Masson stain indicates that nsPEF can externalize the melanin. Iron stain suggested nsPEF caused slight hemorrhage in the treated tissue. Histology confirmed that repeated applications of nsPEF disrupted the vascular network. nsPEF treatment can significantly disrupt the vasculature, reduce subcutaneous murine melanoma development, and produce tumor cell contraction and nuclear shrinkage while concurrently, but not permanently, damaging peripheral healthy skin tissue in the treated area, which we attribute to the highly localized electric fields surrounding the needle electrodes.

Objective: To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published during the past decade as three sets of articles. Method: In the second of a two part article, we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I (the Executive Summary). Results: We present details about the gold standard used to produce scientific evidence, the randomized clinical trial (RCT), which we applied to evaluate the long-term effects of two well-established unimodal treatments, Medication Management (MedMGT) and behavior therapy (Beh), the multimodal combination (Comb), and treatment “as usual” in the community (CC). For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses, we discuss our definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years, and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles. Conclusions: Using a question and answer format, we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 15-43)

Context:Hip and pelvic injuries are often associated with direct trauma, but spe-cific fractures to the acetabulum are rare. The signs and symptoms of an acetabular fracture can mimic those of conditions that are more common at the hip area, and therefore the specificity of the diagnostic testing is crucial.Objective:To present the case of a female Division I college field-hockey player who developed a superomedial acetabular fracture.Background:The athlete’s initial complaint of intolerable hip pain decreased after a 3-week rest period but persisted with passive internal and external hip rotation. Additional diagnostic testing was needed to differentiate the various pathologies that were associated with her symptoms.Conclusions:Clinicians should be aware of the potential differential diagnoses of the hip and should investigate all potential possibilities even though they might not coincide with the initial injury.

Objective Recent results from the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD; MTA) have demonstrated impairments in several functioning domains in adults with childhood ADHD. The childhood predictors of these adult functional outcomes are not adequately understood. The objective of the present study was to determine the effects of childhood demographic, clinical, and family factors on adult functional outcomes in individuals with and without childhood ADHD from the MTA cohort. Method Regressions were used to determine associations of childhood factors (age range 7–10 years) of family income, IQ, comorbidity (internalizing, externalizing, and total number of non-ADHD diagnoses), parenting styles, parental education, number of household members, parental marital problems, parent–child relationships, and ADHD symptom severity with adult outcomes (mean age 25 years) of occupational functioning, educational attainment, emotional functioning, sexual behavior, and justice involvement in participants with (n = 579) and without (n = 258) ADHD. Results Predictors of adult functional outcomes in ADHD included clinical factors such as baseline ADHD severity, IQ, and comorbidity; demographic factors such as family income, number of household members and parental education; and family factors such as parental monitoring and parental marital problems. Predictors of adult outcomes were generally comparable for children with and without ADHD. Conclusion Childhood ADHD symptoms, IQ, and household income levels are important predictors of adult functional outcomes. Management of these areas early on, through timely treatments for ADHD symptoms, and providing additional support to children with lower IQ and from households with low incomes, could assist in improving adult functioning.

Progressive motility with high velocity that exhibits normal lateral head displacement is one of the most important characteristics of spermatozoa directly influencing their fertilizing capacity. A subfertile condition often depends more on sperm motility than count. Application of noninvasive methods of motility stimulation is an important treatment modality for male infertility. In this chapter, we demonstrate the efficacy of an intermittent hypoxic training (IHT) regimen on improving sperm motility in humans. The IHT consisted of 14 consecutive days having four repetitions of 5–7 min each of induced hypoxia interspersed with 5 min periods of ambient inspiration. Initial inspiration began with atmospheric air (20.9%) O2. During the procedure, inspired O2 fell to a value of 5–7%, with the final arterial O2 saturation typically at 84–85%. This IHT regimen produced a stimulatory effect on male reproductive function in the gametes, and this significant increase in the number of spermatozoa with high motility was coupled with a decrease of seminal plasma chemiluminescence (ChL), while sperm count and morphology did not change. Motility and free radical status are some of the most labile parameters when compared to other characteristics of male reproductive function, and their response to external influences is very rapid. Sperm count is more inert. Of course, sperm count also depends on spermatozoal survival. Lack of mitochondrial enzyme activity, high-energy phosphates, oxidative stress, or other stress factors can lead to decreased motility and eventually to apoptosis or necrosis. The increase we have found in motility after 2 weeks of IHT implies that experimenting with the parameters and regimens of the IHT might produce an increase in sperm count along with the motility increase. Our future investigations will include prolonged IHT duration in multiple protocols. We propose that the mechanism of sperm motility augmentation that occurred in our study is due to inhibition of free radical processes. Positive changes in free radical processes should lead to membrane stabilization and improvement of spermatozoal function. Decrease of free radical levels in blood and increase of erythrocyte superoxide dismutase activity could be two likely causes of decreased free radical oxidation in sperm leading to our improved motility results.

We have discovered a new, ultrafast therapy for treating skin cancer that is extremely effective with a total electric field exposure time of only 180 microsec. The application of 300 high-voltage (40 kV/cm), ultrashort (300 nsec) electrical pulses to murine melanomas in vivo triggers both necrosis and apoptosis, resulting in complete tumor remission within an average of 47 days in the 17 animals treated. None of these melanomas recurred during a 4-month period after the initial melanoma had disappeared. These pulses generate small, long-lasting, rectifying nanopores in the plasma membrane of exposed cells, resulting in increased membrane permeability to small molecules and ions, as well as an increase in intracellular Ca(2+), DNA fragmentation, disruption of the tumor's blood supply and the initiation of apoptosis. Apoptosis was indicated by a 3-fold increase in Bad labeling and a 72% decrease in Bcl-2 labeling. In addition, microvessel density within the treated tumors fell by 93%. This new therapy utilizing nanosecond pulsed electric fields has the advantages of highly localized targeting of tumor cells and a total exposure time of only 180 microsec. These pulses penetrate into the interior of every tumor cell and initiate DNA fragmentation and apoptosis while at the same time reducing blood flow to the tumor. This new physical tumor therapy is drug free, highly localized, uses low energy, has no significant side effects and results in very little scarring.

Objective: To review the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published over the past decade as three sets of articles. Method: In a two-part article—Part I: Executive Summary (without distracting details) and Part II: Supporting Details (with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings. Results: We discuss the basic features of the gold standard used to produce scientific evidence, the randomized clinical trial, for which was used to contrast four treatment conditions: medication management alone (MedMgt), behavior therapy alone (Beh), the combination of these two (Comb), and a community comparison of treatment “as usual” (CC). For each of the three assessment points we review three areas that we believe are important for appreciation of the findings: definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term, and qualification of the interim conclusions about long-term effects of treatments for ADHD. Conclusion: We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 4-14)

Objective To investigate the effect of different training modalities on various markers of semen quality. Design Crossover study. Setting Medical school. Patient(s) Forty-five men participated voluntarily in the study, being allocated into three groups according to their sports practice. Intervention(s) None. Main Outcome Measure(s) Sperm parameters (volume, liquefaction time, pH, viscosity, sperm count, motility, and morphology). Result(s) Sperm concentration; total sperm number; type "a," "b," and "d" velocity; and morphology were significantly different among the practitioners of the three different training modalities. Morphology was the parameter showing the greatest difference, even reaching clinical relevance for the triathlete group (4.7%, poor prognosis pattern). In addition, these parameters tended to decrease as training requirements increased. Conclusion(s) There are differences in the seminal profiles of individuals exercising in different modalities. The differences are more marked as intensity and volume of exercise increase, especially for morphology. These variables ought to be carefully analyzed and taken into account when designing a training protocol, especially with higher-level athletes, so that reproductive function is not compromised.

Nanosecond pulsed electric fields (nsPEF) have been shown to penetrate into living cells to permeabilize intracellular organelles and release Ca2+ from the endoplasmic reticulum. They provide a new approach for physically targeting intracellular organelles with many applications, including initiation of apoptosis, enhancement of gene transfection efficiency and inhibiting tumor growth. We have been working with the murine melanoma model system and here we show that 40 kV/cm electric field pulses 300 nanoseconds in duration can rapidly stimulate pyknosis, reduce blood flow and fragment DNA in murine melanoma tumors in vivo with a total field exposure time of 1.8 microseconds. Three treatments of 100 pulses each results in a mean tumor size regression of 90% within two weeks. Another round of treatments at this time can completely eliminate the melanoma. This new therapy is the first to simultaneously trigger pyknosis and reduce tumor blood flow.

A prospective study was planned to evaluate sperm morphology as a parameter to predict the fertilization outcome in an in vitro fertilization program. Couples applying to in vitro fertilization were admitted into this project when the sperm concentration was greater than 20 million per mL and motility greater than 30 per cent. Based on new strict criteria for evaluating normal sperm morphology, patients were divided prospectively into 2 groups. In group I (25 patients) normal sperm morphology was less than 14 per cent, and in group II (71 patients) normal sperm morphology was greater than 14 per cent, using a threshold established previously. Multiple regression analysis was used to evaluate different parameters: concentration, motility, and morphology against the dependent variables, fertilization, and cleavage. The only factor which was significantly correlated with fertilization and cleavage was normal sperm morphology (P less than 0.0001). The fertilization rate (per oocyte) and the cleavage rate were 49.4 per cent and 47.6 per cent in group I and 88.3 per cent and 87 per cent in group II (P less than 0.0001). The ongoing pregnancy rate per laparoscopy and per embryo transfer was 4 per cent and 5.5 per cent, respectively, in group I and 18.3 per cent and 18.5 per cent, respectively, in group II (no significant difference). This study demonstrates the value of analyzing sperm morphology using the criteria recommended in terms of predicting fertilization and perhaps pregnancy outcome. Patients can be better counseled and the probability of fertilization or no fertilization can be more accurately established. Furthermore a trend is shown in the pregnancy rate that may indicate the importance of the male genome in establishing a pregnancy.

In vitro fertilization (IVF) followed by embryo transfer (replacement) to the patient donating the female gametes and using the husband’s sperm for fertilization purposes is the classic form of therapy, devised in the 197Os, to overcome the problem of female infertility due to irreparable tubal damage.’ As experience increased with the procedure, several other indications were found for this therapeutic modality, namely, in the female the presence of endometriosis which does not respond to the commonly used treatment protocols, severe cervical factors that cannot be overcome by intrauterine insemination, the presence of systemic or local antisperm antibodies as the only detectable factor for infertility, and the female who has no identifiable factors for her reproductive problem and who has a normal husband, but who nevertheless cannot achieve pregnancy (infertile normal couple). Soon it was realized that IVF needed a small amount of sperm (as low as perhaps 12,000) for fertilization to occur. Therefore, it was immediately inferred that this procedure may also be indicated in infertility due to male factor. Several groups started working with this type of patient, trying to correct the fertility problem in males in whom the commonly accepted treatment protocols had already failed. Other forms of assisted reproduction have been developed as variants of the classic type of IVF with embryo replacement (gamete intrafallopian transfer, gamete donation from male

Hepatocellular carcinoma (HCC) is a highly aggressive malignancy. Nanosecond pulsed electric field (nsPEF) is a new technology destroying tumor cells with a non-thermal high voltage electric field using ultra-short pulses. The study’s aim was to evaluate the ablation efficacy of nsPEFs with human HCC cell lines and a highly metastatic potential HCC xenograft model on BALB/c nude mice. The in vivo study showed nsPEFs induced HCC cell death in a dose dependent manner. On the high metastatic hepatocellular carcinoma cell line (HCCLM3) xenograft mice model, tumor growth was inhibited significantly in nsPEF-treated- groups (single dose and multi-fractionated dose). Besides a local effect, the nsPEF treatment reduced pulmonary metastases. The nsPEFs also enhanced HCC cell phagocytosis by human macrophage cell (THP1) in vitro. The nsPEF is efficient in controlling HCC progression and reducing its metastasis. NsPEF treatment may elicit a host immune response against tumor cells. This study suggests nsPEF therapy could be used as a potential locoregional therapy for hepatocellular carcinoma.

Thirty-three patients from the in vitro fertilization (IVF) program at Norfolk are critically reviewed. A battery of tests was designed and an endocrine investigation was carried out on these patients. The fertilization rate for preovulatory oocytes was lower than in the normal male population (39.6% versus 88.6%). When total concentration of sperm with rapidly progressive motility was less than 6 X 10(5), to fertilize several eggs together the fertilization rate was zero. No fertilization was obtained when the number of sperm with rapidly progressive motility recovered after the separation was less than 1.5 X 10(6). The hamster zona-free oocyte penetration test correlated well with the human IVF system. The other parameters investigated did not show good correlation. When fertilization was achieved, the results of the IVF procedure in the series reviewed rendered a 30.8% pregnancy rate per transfer in 26 transfers. Fifty percent of the pregnancies were normal (either ongoing or delivered). Thirty-seven percent were preclinical miscarriages, and 12.5% were clinical abortions. In the abnormal male population, higher concentrations of sperm per egg should be used for insemination for achievement of optimum fertilization rates. Once fertilization is obtained, the results do not differ substantially from the IVF population at large.