腹腔镜联合GnRH-a治疗Ⅰ期子宫内膜异位症不孕的临床研究

目的:探讨腹腔镜联合促性腺激素释放激素类似物治疗Ⅰ期子宫内膜异位症合并不孕患者的临床疗效。方法:将2014年1月至2015年1月收治的60例Ⅰ期子宫内膜异位症合并不孕患者按照随机数字表法平均分为治疗组与对照组,每组30例,对照组行腹腔镜手术治疗,治疗组在对照组治疗基础上加用促性腺激素释放激素类似物治疗,对比两组患者的治疗效果。结果:治疗组患者血清卵泡刺激素、雌二醇及促黄体生成素水平均较对照组显著降低(P0.05);术后1年内妊娠率治疗组为70.00%,高于对照组的43.33%,差异有统计学意义(P0.05);治疗组术后1年复发率为6.67%,对照组为26.67%,组间相比差异有统计学意义(P0.05)。结论:对于Ⅰ期子宫内膜异位症合并不孕患者,在腹腔镜手术治疗后加用促性腺激素释放激素类似物治疗,可有效改善性激素水平,提高1年内妊娠率,降低子宫内膜异位症复发率。     

腹腔镜手术联合GnRH-a对子宫内膜异位症患者性激素水平及预后的影响

目的探讨腹腔镜手术联合促性腺激素释放激素激动剂(GnRH-a)对子宫内膜异位症(EMT)患者性激素水平及预后的影响。方法选择2017-04—2018-04间获嘉县人民医院收治的84例EMT患者,随机分为2组,各42例。对照组行腹腔镜手术,观察组行腹腔镜手术联合GnRH-a治疗。结果观察组的血清促黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_2)水平以及盆腔肿块大小、子宫内膜厚度、复发率低于对照组,妊娠率高于对照组,差异均有统计学意义(P0.05)。结论腹腔镜手术联合GnRH-a治疗EMT,能有效降低患者的性激素水平,缩小盆腔肿块和子宫内膜厚度,减少术后复发率,提高患者术后妊娠率。     

雌激素是新疆女性胆石病人的危险因素

目的:探讨雌激素水平是新疆女性胆石病人的危险因素。方法:比较204例女性胆石组病人与204例对照组病人的雌二醇、促黄体生成素、卵泡刺激素、睾酮、孕酮、催乳素水平,以研究胆石形成的危险因素。结果:胆石组病人与对照组比较,促黄体生成素、卵泡刺激素、睾酮、孕酮、催乳素水平,差异均无统计学意义。与对照组比较,胆石组病人雌二醇育龄期和绝经后水平均升高,差异有统计学意义。胆石病人多发结石与单发结石比较,促黄体生成素、卵泡刺激素、睾酮、孕酮、催乳素水平差异均无统计学意义,雌二醇水平升高,差异有统计学意义。结论:育龄期和绝经后女性病人血清雌激素含量升高,多发胆石组女性病人血清雌激素含量高于单发结石病人。研究提示,血清雌激素升高是胆石的危险因素,为胆石形成机制之一。     

卵泡抽吸获得未成熟卵母细胞经体外成熟后成功分娩一例报道

病例 患者,女,30岁,继发不孕4年,诊断为多囊卵巢综合征(PCOS),两次人工授精失败.基础内分泌检测卵泡刺激素(FSH)5.96 IU/L,黄体生成素(LH)14.82 IU/L,雌二醇(E2)106 pmol/L,泌乳素(PRL)9.44 nmol/L,睾酮0.63 nmol/L.达英35治疗一周期后检查LH为8.61 IU/L.男方精液常规示中度弱精子症,形态学检查示中度畸精子症.     

垂体泌乳素大腺瘤患者术后内分泌的变化及临床疗效分析

目的:探讨手术治疗垂体泌乳素大腺瘤的临床疗效,以及对机体内分泌的影响。方法:收集符合标准的患者45例,观察手术前后血清泌乳素(PRL)、雌二醇(E2)、促卵泡素(FSH)、黄体生成素(LH)、孕酮(P)和睾酮(T)等水平变化以及对应各种激素刺激后FSH、LH和睾酮(T)的变化,并对患者临床疗效进行评定。结果:患者术后3个月、6个月和1年进行临床疗效评价,有效率分别为37.78%、60.00%和75.56%;患者术后1年血清PRL水平与术前比较,显著下降。术前促卵泡素(FSH)、黄体生成素(LH)的水平分别为(10.52±8.17)和(6.28±4.74)mIU/mL,GnRH激素刺激后,LH水的峰值达到(12.34±1.78)(P<0.05),而FSH的最高峰值为(11.28±2.30)(P>0.05);术后LH和FSH与手术之前相比显著升高。睾酮(T)术前与术后的水平有统计学意义,但是hCG反应的峰值没有显著区别。结论:泌乳素大腺瘤通过下丘脑-垂体-性腺轴影响一系列促性腺激素的释放进而影响生殖器官的功能,手术治疗垂体泌乳素大腺瘤临床疗效确切,可以显著改善患者内分泌激素水平。     

腹腔镜改良锐性剥离术治疗子宫内膜异位症的疗效分析

目的研究分析对子宫内膜异位症患者行腹腔镜不同剥离术治疗后效果以及哪种方法对卵巢功能具有更好的保护作用。方法选取2014年4月至2019年4月本院收治的子宫内膜异位症患者共62例,治疗医师按照数字表法将62例患者平分为两组,其中改良组31例,行腹腔镜改良锐性剥离术治疗,常规组31例。行腹腔镜钝性剥离术治疗,记录并比较改良组和常规组患者剥除卵巢皮质的厚度、剥除囊肿病灶的厚度,统计卵巢皮质的剥除率;术后半年患者月经的第2天检测卵泡刺激素、雌二醇、黄体生成素水平;应用彩超检测卵巢体积、卵泡数值,记录并计算患者术后的妊娠比率。结果剥除卵巢皮质厚度方面,改良组卵巢门、卵巢中间处均明显小于常规组(P0.05);剥除率方面,改良组卵巢门处的剥离率显著低于常规组(P0.05);剥离囊肿病灶的厚度方面,改良组卵巢门、卵巢中间处均明显小于常规组(P0.05);改良组患者在手术治疗前、手术治疗后半年月经第2天的雌二醇、黄体生成素及卵泡刺激素指标水平与常规组无明显差异(P0.05);组间比较,手术治疗后半年,改良组患者的卵巢体积、卵泡数明显大于常规组(P0.05);组内比较,手术治疗后所有患者的卵巢体积、卵泡数均明显小于手术治疗前(P0.05);改良组术后半年妊娠率明显大于常规组(χ~2=9.4136,P0.05)。结论腹腔镜改良剥离术治疗卵巢子宫内膜异位症可以获得更好的临床疗效,可以有效保留卵巢正常组织、减少卵泡丢失量、妊娠率相对增加,适合临床医师选择应用。     

腹腔镜卵巢子宫内膜异位症囊肿剥除术缝合止血法对卵巢储备功能的影响

目的探讨腹腔镜卵巢子宫内膜异位症囊肿剥除术缝合止血法对卵巢储备功能的影响。方法回顾性分析2017-04—2019-10间安阳市第六人民医院妇产科行腹腔镜卵巢子宫内膜异位症囊肿剥除术的68例患者的临床资料。根据止血方法分为电凝组(32例)和缝合组(36例)。比较2组患者的基线资料,统计术前、术后患者的卵巢储备功能指标,包括血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E 2)水平,以及采用阴道超声检测的窦状卵泡数目(AFC)。结果2组患者的基线资料,以及术前FSH、LH、E 2、AFC水平差异无统计学意义(P>0.05)。术后1个月、3个月、6个月及12个月时缝合组的FSH水平明显低于电凝组,AFC水平均明显高于电凝组,差异有统计学意义(P<0.05);2组术后各时间点的LH水平,以及术后1个月、3个月、6个月时的E 2水平差异均无统计学意义(P>0.05);术后12个月缝合组的E 2水平高于电凝组,差异有统计学意义(P<0.05)。结论与双极电凝止血法比较,腹腔镜卵巢子宫内膜异位症囊肿剥除术中应用缝合止血法对创面进行止血,对患者卵巢储备功能的影响较小。     

比较宫腔镜子宫内膜电切除术与腹腔镜保留双侧卵巢的子宫全切除术治疗功能失调性子宫出血的效果

目的比较宫腔镜子宫内膜电切除术与腹腔镜保留双侧卵巢的子宫全切除术治疗功能失调性子宫出血的效果。方法根据不同手术方案将82例功能失调性子宫出血患者分为2组,各41例。腹腔镜组采取子宫全切除术,宫腔镜组采取宫腔镜子宫内膜电切除术。结果宫腔镜组患者术后肛门排气时间、下床活动时间及住院时间短于腹腔镜组;术后3个月的血清孕激素(P)、雌二醇(E_2)水平高于腹腔镜组,黄体生成素(LH)、卵泡刺激素(FSH)水平低于腹腔镜组。差异均有统计学意义(P0.05)。结论宫腔镜子宫内膜电切除术治疗功能失调性子宫出血,对卵巢功能影响小,有利于患者术后恢复。     

超长方案体外受精胚胎移植失败后重复促排卵妊娠结果分析

目的:了解中、重度盆腔子宫内膜异位症或子宫腺肌症患者,经超长方案体外受精胚胎移植(IVFET)失败后,重复采用超促排卵治疗的IVF-ET结果。方法:回顾2009~2013年我中心因子宫腺肌症或中、重度盆腔子宫内膜异位症,采用3.75 mg促性腺激素释放激素拮抗剂(GnRH-a)2~6针超长治疗方案进行IVF-ET的患者,选择移植后14 d血绒毛膜促性腺激素(h CG)阴性,月经来潮的3~7 d,血促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇(E2)水平,窦卵泡直径、子宫内膜厚度,仍在降调满意水平(抽血检查FSH、LH10 m IU/ml,E230 pg/ml;B超监测窦卵泡直径10 mm)的37例患者,随即给予促性腺激素(Gn)促排卵,再次进行IVF-ET。自身比较重复促排卵前、后不同周期及妊娠结果。结果:重复周期较前一周期相比,启动日窦卵泡(AFC)的数目[(7.55±1.86)个vs(6.45±2.5)个]、注射h CG日直径≥14 mm以上卵泡数[(7.81±3.6)个vs(5.56±3.68)个]、E2水平[(2362.15±1210.49)pg/ml vs(1749.22±1139.44)pg/ml]、获卵数[(7.51±3.23)个vs(4.78±3.41)个]以及移植胚胎数[(2.00±0.33)个vs(1.50±0.67)个]明显增加,有统计学差异(P0.05)。重复周期Gn用量明显减少[(1 791.65±1 889.41)IU vs(3 439.56±1 836.53)IU],有统计学差异(P0.05)。临床妊娠率达到62.16%。结论:子宫腺肌症或中、重度盆腔子宫内膜异位症患者,经超长方案IVF-ET失败后,若FSH、LH、E2水平以及B超检测窦卵泡在降调满意范围,重复进行促排卵IVF-ET,可以改善卵巢反应性,提高妊娠结果。     

孕三烯酮预处理对子宫内膜异位症患者体外受精-胚胎移植结局的影响

目的探讨孕三烯酮预处理对子宫内膜异位症患者体外受精-胚胎移植(IVF-ET)结局的影响。方法选择珠海市妇幼保健院生殖中心2015年1~12月接受IVF-ET治疗的子宫内膜异位症患者208个新鲜周期进行回顾性分析。按降调节方案分为3组:孕三烯酮预处理后长方案降调节为A组,共60个周期;超长方案降调节为B组,共56个周期;常规长方案降调节C组,92个周期。分析和比较A组与B组、C组在年龄、不育年限、Gn天数、Gn剂量、血清基础卵泡刺激素(FSH)、黄体生成素(LH)、雌激素(E2)水平、HCG日子宫内膜厚度、获卵数、可移植胚胎数、优质胚胎率、种植率、临床妊娠率、流产率等差异。结果 A组与B组、C组比较,年龄、不育年限、Gn剂量、血清基础FSH、LH、E2水平、HCG日子宫内膜厚度、获卵数、可移植胚胎数、种植率、临床妊娠率、流产率等均无统计学差异(P0.05);A组的Gn天数[(11.4±2.0)d]和优质胚胎率(48.9%)均显著高于B组[分别为(10.6±1.8)d,37.6%]和C组[分别为(10.7±1.6)d,39.5%](P0.05)。结论孕三烯酮预处理可以提高子宫内膜异位症患者助孕的优质胚胎率,但未明显改善临床结局。     

前列腺癌患者血清睾酮水平与前列腺穿刺活检阳性的相关性

目的探讨血清总睾酮水平与前列腺穿刺活检阳性之间的相关性,为临床个体化治疗方案的选择提供理论依据。方法 2015年9月至2019年3月期间在汉中市人民医院泌尿外科接受前列腺穿刺活检的患者,收集患者的年龄、血清总前列腺特异性抗原(tPSA)及性激素等相关资料,观察这些指标对前列腺穿刺活检阳性率的影响。结果在113例患者中,前列腺癌(PCa)患者检出率共89例,穿刺阳性率为78.76%。与穿刺阴性组比较,患者血清tPSA[(12.42±4.64)vs.(5.35±1.66)ng/mL,P<0.001]和催乳素水平[(8.55±2.48)vs.(6.91±1.92)ng/L,P=0.003]升高与前列腺穿刺活检阳性有关,而总睾酮激素水平下降与前列腺穿刺活检阳性有关[(12.64±3.28)vs.(16.85±3.37)nmol/L,P<0.001]。多变量分析证实tPSA[P<0.001,OR=3.383(1.924~5.342)]和血清睾酮[P=0.038,OR=1.361(1.124~1.927)]是预测前列腺穿刺活检阳性的独立预测因子。受试者工作曲线(ROC)显示tPSA水平与前列腺穿刺阳性风险呈正相关,曲线下面积(AUC)为0.989,最佳截断值为8.022,敏感度和特异度分别为87.5%和98.88%;总睾酮激素水平与前列腺穿刺阳性风险呈负相关,AUC为0.786,最佳截断值为17.85,敏感度和特异度分别为66.67%和78.65%,差异具有统计学意义(P<0.001)。结论低血清睾酮激素与前列腺穿刺检测PCa的风险有关,这些结果可能揭示了PCa与睾酮两者关系的潜在机制。     

Varicocele ligation on free testosterone levels in infertile men with varicocele

We have analyzed the effects of varicocele ligation on free testosterone levels, and investigated the interrelationships between free testosterone and fertility. The records were retrospectively evaluated for 42 infertile patients who underwent varicocele ligation, with serum free testosterone levels, follicle stimulating hormone (FSH), lutenizing hormone (LH), testosterone, estradiol, prolactin, ejaculated volume, sperm concentration and motility before and after surgery. Serum free testosterone levels increased from 12.97+/-4.16 to 13.59+/-3.93 pg/mL, but the difference was insignificant. The differences before and after surgery of patients in sperm concentration and motility were also insignificant. However, in free testosterone increasing group, the sperm concentration and motility increased significantly, from 4.05+/-4.35 to 7.90+/-8.19 million/mL (P=0.01) and from 30.64+/-21.87% to 41.00+/-22.00%, respectively (P=0.03). The increase in serum free testosterone level by varicocele ligation results in a significant improvement in sperm concentration and motility.     

Bromocriptine therapy in oligozoospermic infertile men

A prospective, randomized double-blind study with crossover using bromocriptine and placebo was performed on a group of 17 infertile males with idiopathic oligozoospermia. Twelve patients completed the duration of this study of eight months by receiving 5 mg of bromocriptine per day for four months followed by four months of placebo or vice versa. Prior to treatment, the sperm count was 8.76 +/- 1.32 (10(6)/ml). The hormonal profile was performed prior to treatment and included estimation of prolactin, T3, T4, thyroid stimulating hormone (TSH), testosterone, follicle stimulating hormone (FSH), and plasma LH. Stimulation studies using LHRH and TRH were also performed. All hormonal estimations were within normal limits. Compared to placebo, bromocriptine had no significant effect on sperm analysis, or basic hormonal profile. The stimulation test with luteinizing hormone releasing hormone (LHRH) was unchanged except for the basic plasma testosterone, which increased. The prolactin decreased following the thyrotropin releasing hormone (TRH) stimulation. Two pregnancies were noted four to six weeks following the end of treatment. Bromocriptine did not seem to be more effective than placebo in the treatment of idiopathic oligozoospermia.     

Bromocriptine for infertile males with mild hyperprolactinemia: hormonal and spermatogenic effects

To clarify the influence of hyperprolactinemia on spermatogenesis and steroidogenesis in infertile male patients, the serum prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and estradiol concentrations were and the effect of bromocriptine treatment on spermatogenesis was examined. A total of 1234 patients were evaluated and 147 men had hyperprolactinemia. Of these, only 30 had PRL concentrations more than twice the upper limit of normal and most of them had a little excess over the upper limit. For 10 of these 30, serum hormone concentrations were measured and semen was analyzed before and after bromocriptine administration. No relationship between the PRL and other hormone concentrations was found. No changes were noted in the LH, FSH, testosterone, or estradiol concentrations, or in the sperm density and motility after treatment. The mean PRL decreased from 26.5 +/- 4.5 to 1.4 +/- 1.8 ng/mL. In infertile men who are mildly hyperprolactinemic, bromocriptine administration does not improve semen analysis, although it does normalize the PRL.     

Evidence for a stimulatory role of high doses of recombinant human follicle‐stimulating hormone in the treatment of male‐factor infertility

The efficacy of recombinant human follicle‐stimulating hormone (rhFSH) in the treatment of normogonadotropic patients with male‐factor infertility was assessed. Forty‐five infertile men with moderate/severe oligoasthenozoospermia and normal FSH, luteinizing hormone (LH) and testosterone (T) levels were treated with high rhFSH dose (300 IU) on alternate days for ≥4 months. In all, the seminal parameters, endocrine profile (FSH, LH, prolactin (PRL), total and free T and estradiol) and pregnancy rate were evaluated before, during and after rhFSH treatment. Fifteen infertile men were treated with placebo and studied in the same way, as control group. rhFSH treatment induced a marked increase in sperm count and no change in sperm motility, morphology and viability. No changes in seminal parameters were observed in the placebo group. FSH levels increased during treatment with rhFSH and not with placebo. No variations in LH, PRL, free and total T and estradiol were evidenced during treatment. A significant pregnancy rate in rhFSH versus placebo patients was also highlighted. Prolonged treatment with high rhFSH doses leads to increase sperm count and improve the spontaneous pregnancy rate in normogonadotropic infertile patients with oligoasthenozoospermia. rhFSH may represent a rational and useful tool in the treatment of male‐factor infertility.     

肿胀吸脂加乳晕下缘小切口腺体部分切除术治疗男性乳房肥大

目的总结肿胀吸脂加乳晕下缘小切口腺体部分切除术治疗男性乳房肥大的方法及临床效果。方法2004年6月-2006年6月,收治40例男性乳房肥大患者。年龄11～41岁。单侧3例,双侧37例。脂肪型10例,乳房区明显凸出,无腺体增生;脂肪腺体混合型30例,其中22例乳房区明显凸出并伴有肿块,8例呈女性乳房形态并伴有结节增生。38例血清催乳素、黄体生成素、血清卵泡刺激素、雌二醇、睾酮、皮质醇水平均正常;2例血清催乳素、黄体生成素、血清卵泡刺激素、雌二醇水平增高,睾酮水平降低。10例单纯采用肿胀吸脂术,30例联合乳晕下缘小切口腺体部分切除术。结果2例分别于术后第1、2天出现皮下血肿和少量积液,经对症处理后达Ⅰ期愈合;其他患者切口均Ⅰ期愈合。3例术后第1天即出现乳头麻木,未予特殊处理,随访6个月乳头感觉部分减退。其余患者无乳头、乳晕坏死及乳头感觉减退等并发症发生。40例患者均获随访,随访时间6～24个月,平均13个月。乳房区外形良好,无复发。结论肿胀吸脂加乳晕下缘小切口腺体部分切除术具有安全、瘢痕小、外观自然、患者满意度高等优点,是治疗男性乳房肥大有效方法之一。     

Function of the ovaries in female kidney transplant recipients

OBJECTIVES: One of the effects of an improved general health state after successful kidney transplantation in women of reproductive age is recurrence of regular menstrual function. MATERIALS AND METHODS: Sixty-three ovarian cycles in female kidney transplant recipient, aged from 18 to 44 years, at 1.5 to 15 years after transplantation, were compared with 50 cycles of healthy women. We monitored the menstrual cycle duration as well as follicle stimulation hormone (FSH), leutinizing hormone (LH), estradiol, progesterone, prolactin, creatinine, and testosterone serum concentrations as well as hematocrit and obtained sonographic observations of ovarian follicle growth and ovulation. RESULTS: Of the recipients, 68.1% had regular menstrual cycles. Ovulatory cycles were observed in 45% of patients. Estradiol concentration established in the first phase of the cycle was significantly higher among the transplanted group (mean value 226.86 +/- 97.45 pg/mL vs 140.00 +/- 61.00 in the controls). A significantly lower level of progesterone (15.05 +/- 17.34 ng/mL vs 30.79 +/- 18.48 ng/mL in the controls) and of testosterone were observed in kidney recipients. Other hormonal parameters did not differ significantly between the groups. CONCLUSIONS: Similar serum FSH, LH, and prolactin concentrations as well as increased levels of estrogens were observed in kidney transplant recipients compared with healthy nonrecipients. The rate of ovulatory cycles in regularly menstruated kidney graft recipients was similar to that of healthy women. Stabilization of graft function resulted in restoration of normal ovarian hormone metabolism and ovulatory cycles in female kidney transplanted recipients.     

Hypophyseal-Gonadal Dysfunction in Men with Non-Alcoholic Liver Cirrhosis

Seven males with liver cirrhosis associated with hepatitis and one with schistosomal liver fibrosis were studied for hypophyseal gonadal dysfunction and compared to six age matched controls. Cirrhotics as a group had higher serum 17 beta estradiol levels (22.1 +/- 6.3 vs 7.8 +/- 0.8 pg/ml, p less than 0.05) which did not rise after four days of human chorionic gonadotropin (hCG) stimulation. Conversely, there was an adequate rise in serum testosterone level after hCG stimulation (332.8 +/- 99.7 ng/dl baseline to 887.6 +/- 67.1 ng/dl, p less than 0.01). Compared to the controls, cirrhotics had lower baseline serum follicle stimulating hormone (FSH) (3.6 +/- 1.7 vs. 10.2 +/- 1.5 mIu/ml, p less than 0.02) and higher serum prolactin (13.5 +/- 2.5 vs. 6.8 +/- 1.0 ng/ml, p less than 0.05). Pituitary dynamic function testing in cirrhotics revealed blunted response of luteinizing hormone (LH) and FSH, to luteinizing hormone releasing hormone (LHRH) in four out of eight subjects tested. We conclude that the mechanism of hypogonadism in non-alcoholic cirrhosis is mostly hypogonadotropic in origin rather than primary gonadal injury which is common in alcoholic cirrhosis.     

Changes in serum levels of LH, FSH, prolactin, testosterone, and cortisol associated with season and mating in male pygmy goats

Four male pygmy goats were used in a study designed to determine the effects of season on serum hormone (luteinizing hormone, follicle stimulating hormone, prolactin, testosterone, and cortisol) levels, testis size and libido, and the effects of mating on serum hormone profiles. Seasonal peaks were observed for prolactin in July, luteinizing hormone and follicle stimulating hormone in September, and testosterone in October. Luteinizing hormone peak frequency was greatest in September and was increased by mating activity in the months immediately preceding the breeding season. Scrotal circumference did not vary with season and libido showed no consistent seasonal pattern. Mating appeared to raise all hormone levels except during the months when these hormones were seasonally elevated. When episodic releases of luteinizing hormone occurred, they were associated with subsequent rises in serum testosterone levels. On some mating days, when episodic releases of luteinizing hormone were absent, changes in testosterone levels were highly correlated with changes in cortisol levels. It was concluded that both season and mating influence reproductive hormone levels in male pygmy goats.     

Hormonal profile of infertile Makkans

Male factor infertility, being a complex and heterogeneous disorder, precludes any reliance on a single laboratory test and requires broad spectrum assessment. Sociobiological factors also influence the parameters. In this context we examined serum concentrations of nine hormones in infertile and fertile male Makkans. Infertility was implicated in 21% of the population with correlated abnormalities of gonadotrophins, thyroid, thyroid stimulating hormone (TSH), and testosterone. Hypothyroidism was established in 35% and hyperthyroidism in 14% of the infertile population, where 28% of thyroid abnormality constituted an independent infertile group. Hyperprolactinaemia associated with low levels of luteinizing hormone (LH) and testosterone signifies a cluster of 28%, while 14% of testosterone deficiency alone was causal for infertility. However, infertility in 9%, of the patients examined might have been psychogenic in nature. We present a responder panel based on cluster analysis.