Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varicocele

OBJECTIVE: To study the effects of varicocele on testicular function in adolescents. DESIGN: A prospective controlled study in 88 randomly selected adolescents. SETTING: All participants were referred to the fertility outpatient clinic of our University Hospital. PARTICIPANTS: All participants with a grade II varicocele (group 2) or a grade III varicocele (group 3) were selected at a district military medical council, whereas a similar group of healthy volunteers without a varicocele served as controls (group 3). INTERVENTIONS: Testis volumes were measured using an orchiometer. Semen analysis was performed according to standard procedures, and serum hormone levels were determined using a radioimmunoassay. MAIN OUTCOME MEASURE(S): Testis volumes, semen quality, and hormonal parameters in adolescents with and without a varicocele were compared. RESULTS: In group 1 (n = 21), the mean left testis volume (24.5 mL; 95% confidence interval [CI]: 22.8 to 26.2) was significantly (P less than 0.05) different from group 2 (n = 15) (20.9 mL: 95% CI: 18.5 to 23.4) and group 3 (n = 52) (20.7 mL; 95% CI: 19.2 to 22.2) (P less than 0.01) adolescents. In adolescents with a pronounced varicocele-associated left testicular growth failure, the total sperm number was reduced. However, sperm concentration, motility, and morphology were not altered. Luteinizing hormone, follicle-stimulating hormone, testosterone, and prolactin levels were all within the normal ranges in the three groups. CONCLUSIONS: Left testicular growth failure in adolescents with a varicocele is only associated with a decrease in total sperm number.     

Improvement in the fertility rate after placement of microsurgical shunts in men with recurrent varicocele

OBJECTIVE: To evaluate the effectiveness of microsurgical shunts for secondary varicocele repair after ligation-like procedures, focusing on long-term functional outcomes. DESIGN: Long-term survey (mean follow-up, 8.5 years) of infertile men after secondary microsurgical reconstructive varicocelectomy. SETTING: University-based medical center. PATIENT(S): Thirty-four infertile men (group A, <30 years of age; and group B, >30 years) with recurrent palpable varicocele after varicocelectomy, according to Ivanissevich (n = 28), or after angiographic vein occlusion (n = 6). Ten patients presented bilateral recurrence. INTERVENTION(S): Microsurgical shunts between spermatic vein and inferior epigastric vein. MAIN OUTCOME MEASURE(S): Sperm count, pregnancy rate, and ultrasound evaluation of varicosity. RESULT(S): Complete disappearance of varicosity was achieved in 97.06% of patients, while in 2.94%, a consistent reduction in size was observed. In patients with severe infertility, a significant postoperative increase in seminal parameters was observed. Pregnancy rates were 43.75% in group A and 22.22% in group B. CONCLUSION(S): Microsurgical drainage in patients with recurrent varicocele after ligation-like procedures was shown to be an effective minimally invasive treatment, with immediate hemodynamic recovery of testicular venous outflow and excellent long-term results in patients with left or bilateral recurrences.     

Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system

Varicocele is considered a predominantly unilateral left-sided disease. However, since male fertility is preserved with only one healthy testis, infertility perforce represents bilateral testicular dysfunction. It was hypothesized that: (i) right varicocele cannot be diagnosed by palpation and therefore has not been treated in the past by the traditional treatment, and (ii) right varicocele causes impaired oxygen supply in the right testicular microcirculation, leading to germ cell degeneration. This study performed venographies of both right and left internal spermatic veins during the treatment of 840 infertile men with varicocele and analysed the results using tools of fluid mechanics. Histopathology of the right testis revealed stagnation of blood flow and degenerative changes attributed to lack of adequate oxygenation in all testicular cell types. Right varicocele was found in the vast majority of the patients. We found that due to the destruction of one-way valves, pathologic hydrostatic pressure is produced in the testicular venous microcirculatory system about five times higher than normal, exceeding arteriolar pressure. The pressure gradient between the arterioles and venules in the testicular tissue is therefore reversed, leading to persistent hypoxia. Right varicocele, although undetected, is prevalent in infertile men with varicocele, hence only bilateral occlusion of the internal spermatic veins, including the associated bypasses, eliminating the pathologic hydrostatic pressure will lead to resumption of arterial blood flow in the testicular microcirculation.     

大鼠精索静脉曲张对睾丸氧自由基和LPO浓度的影响

应用成年Ｗｉｓｔａｒ大鼠制作精索静脉曲张动物模型，术后３月，处死动物取出睾丸。以电子自旋共振（ＥＳＲ）法测试睾丸组织的氧自由基相对自旋浓度，ＴＢＡ法和化学发光法分别检测过氧化脂质（ＬＰＯ）含量、超氧化物歧化酶（ＳＯＤ）水平。实验结果表明，精索静脉曲张组（ＶＧ）左、右睾丸氧自由基自旋浓度明显高于假手术对照组（ＣＧ）（Ｐ＜Ｏ．０５）；ＶＧ双睾ＬＰＯ含量显著高于ＣＧ（Ｐ＜０．０１）；睾丸氧自由基相对自旋浓度和ＬＰＯ含量呈明显正相关（ｒ＝０．５４，Ｐ＜０．０５）；．ＶＧ双睾ＳＯＤ水平均显著低于ＣＧ（Ｐ＜０．０１）；睾丸ＳＯＤ水平与氧自由基自旋浓度呈显著负相关（ｒ＝－０．９１，Ｐ＜０．０１）。上述结果提示：精索静脉曲张大鼠睾丸组织中含有大量的氧自由基和ＬＰＯ，损伤睾丸细胞及其各级生物膜，会导致睾丸生精功能紊乱造成不育，而睾丸氧自由基清除障碍可能是氧自由基浓度增高继之ＬＰＯ含量增多的重要机制之一。     

Testicular growth, sperm concentration, percent motility, and pregnancy outcome after varicocelectomy based on testicular histology

OBJECTIVE: To evaluate the outcome following surgery in two different patterns of testicular histology in patients with varicocele. DESIGN: Prospective study. SETTING: Academic medical center. PATIENT(S): Sixty patients underwent varicocelectomy and had a testicular histology diagnosis of germ-cell aplasia (group I, n = 28) or maturation arrest (group II, n = 32). INTERVENTION(S): Varicocelectomy. MAIN OUTCOME MEASURE(S): Preoperative hormone levels, testicular size, and sperm parameters. After varicocelectomy, variations in testicular size, semen parameters, and pregnancy rates were evaluated. RESULT(S): The mean volume of the right and left testicle was smaller in group I patients than in group II. In addition, the mean sperm concentration before treatment was lower in group I than in group II. The mean volume of the left and right testicle increased in group I after the intervention. The mean postoperative sperm concentration and motility in group II showed no increase, whereas the mean sperm concentration in group I did increase. The pregnancy rate was higher in group II (14/26, 53.8%) than in group I (4/16, 25%) (P=.02). CONCLUSION(S): Patients with germ-cell aplasia present a postoperative increase in testicular size but the pregnancy rate is higher in patients with maturation arrest following surgery.     

Tissue testosterone and dihydrotestosterone from bilateral testis biopsies in males with varicocele.

Nine males with varying degrees of subfertility with left varicocele underwent bilateral testicular biopsy for determination of testicular testosterone (T) and dihydrotestosterone (DHT) content. Testicular tissue T and DHT levels varied greatly, and there was no significant difference when the group T and DHT content of the left testis was compared with that of the right testis. When the respective mean preoperative sperm count was compared with the bilateral tissue T and DHT content, no consistent relationship was found.     

Second trimester folate status and preterm birth

OBJECTIVE: The purpose of this study was to show that maternal folate status during pregnancy may be related to preterm birth. STUDY DESIGN: Women were recruited at 24 to 29 weeks' gestation from 1995 to 2000 into the Pregnancy, Infection, and Nutrition Study. Those who completed an interview and a food frequency questionnaire, or provided a blood sample for radioassay of serum (n = 2026) and red blood cell (n = 1034) folate were included. RESULTS: Mean daily dietary folate intake was 463 microg (SD +/- 248). Intake 相似文献   

Risk of adverse pregnancy outcomes in young adolescent parturients in an inner-city hospital

OBJECTIVE: Our purpose was to determine the relationship between adolescence and pregnancy-related outcomes. STUDY DESIGN: A retrospective cohort study was conducted in a population of adolescents delivered in a large inner-city hospital. The study population consisted of 14,718 adolescents and 11,830 nonadolescent controls. Pregnancy outcomes were compared in young adolescents (n = 2930) and mature adolescents (n = 11,788) versus controls. RESULTS: Adolescents were significantly more likely than controls to be African American, single, diagnosed with a sexually transmitted disease during pregnancy, and reside with others (P <.001). Adolescents were significantly more likely than controls to have eclampsia (relative risk [RR] 2.23, 95% CI 1.37-3.66) and preterm delivery (RR 1.12, 95% CI 1.04-1.21). Young adolescents were significantly more likely than controls to have preeclampsia (RR 1.33, 95% CI 1.15-1.54), eclampsia (RR 3.24, 95% CI 1.70-6.14), preterm delivery (RR 1.47, 95% CI 1.31-1.64), low-birth-weight delivery (RR 1.47, 95% CI 1.31-1.64), and very-low-birth-weight delivery (RR 1.25, 95% CI 1.01-1.56). Finally, mature adolescents were significantly more likely than controls to have eclampsia (RR 1.99, 95% CI 1.19-3.34). CONCLUSION: Young adolescents are at increased risk for adverse pregnancy outcomes.     

Serum inhibin B and anti-Müllerian hormone are not superior to follicle-stimulating hormone as predictors of the presence of sperm in testicular fine-needle aspiration in men with azoospermia

OBJECTIVE: To compare FSH, inhibin B (INHB), and anti-Müllerian hormone (AMH) as predictors of the recovery of sperm in testicular fine-needle aspiration biopsy (FNA) performed in men with azoospermia. DESIGN: Cross-sectional, clinical study. SETTING: Academic Unit of Reproductive Endocrinology. PATIENT(S): Fifty-one men with azoospermia and 31 controls. INTERVENTION(S): Testicular FNA. MAIN OUTCOME MEASURE(S): Serum FSH, INHB, and AMH levels. RESULT(S): Clinical diagnoses in men with azoospermia were idiopathic nonobstructive azoospermia (n = 34, 67%), cryptorchidism (n = 4, 8%), varicocele (n = 3, 6%), and other diagnoses (n = 10, 16%). In pairwise comparison of receiver operating characteristic curves, none of FSH (area under curve 0.716), INHB (0.610), AMH (0.565), or volume of the larger testis (0.693) was proved to be superior to the others as predictor of sperm retrieval during an FNA procedure. Similarly, in a logistic regression analysis, none of FSH, AMH, INHB, or volume of the larger testis could predict presence of sperm in FNA. CONCLUSION(S): Serum INHB and AMH, as well as their combination, are not superior to FSH as predictors of the presence of sperm in testicular FNA in men with azoospermia and should not be used for this purpose.     

精索静脉曲张大鼠睾丸LPO与SOD含量及ACE活力的变化

成熟雄性Wistar大鼠48只,随机分为精索静脉曲张组(VG)和假手术组(SOG),观察3个月。实验结果表明,左睾重量VG明显低于SOG(P<0.05)。VG双侧睾丸血管紧张素转换酶(ACE)活力显著低于SOG(P<0.001)。相关检验显示睾丸重量与ACE活性呈正相关(r=0.464,P<0.005)。VG左睾脂质过氧化物(LPO)含量显著高于SOG(P<0.001),LPO含量和睾丸ACE活力呈负相关关系(r=-0.477,P<0.005)。睾丸超氧化物歧化酶(SOD)含量两组间无明显差异(P>0.05)。     

Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study.

OBJECTIVE: To evaluate the effect of applied relaxation and electro-acupuncture on vasomotor symptoms in women treated for breast cancer. METHODS: Thirty-eight postmenopausal women with breast cancer and vasomotor symptoms were randomized to treatment with electro-acupuncture (n = 19) or applied relaxation (n = 19) during 12 weeks. The number of hot flushes was registered daily in a logbook before and during treatment and after 3 and 6 months of follow-up. RESULTS: Thirty-one women completed 12 weeks of treatment and 6 months of follow-up. After 12 weeks of applied relaxation, the number of flushes/24 h had decreased from 9.2 (95% confidence interval (CI) 6.6-11.9) at baseline to 4.5 (95% CI 3.2-5.8) and to 3.9 (95% CI 1.8-6.0) at 6 months follow-up (n = 14). The flushes/24 h were reduced from 8.4 (95% CI 6.6-10.2) to 4.1 (95% CI 3.0-5.2) after 12 weeks of treatment with electro-acupuncture and to 3.5 (95% CI 1.7-5.3) after 6 months follow-up (n = 17). In both groups, the mean Kupperman Index score was significantly reduced after treatment and remained unchanged 6 months after end of treatment. CONCLUSION: We suggest that applied relaxation and electro-acupuncture should be further evaluated as possible treatments for vasomotor symptoms in postmenopausal women with breast cancer.     

How long should urinary bladder catheterisation be continued after vaginal prolapse surgery? A randomised controlled trial comparing short term versus long term catheterisation after vaginal prolapse surgery

OBJECTIVE: To determine whether prolonged urinary bladder catheterisation after vaginal prolapse surgery is advantageous. DESIGN: Randomised controlled trial. SETTING: A large training hospital in the Netherlands. POPULATION: Patients undergoing anterior colporrhaphy. METHODS: One hundred patients were included. Patients were randomised into two groups. In one group (n= 50), a transurethral catheter was in place for four days post-operatively and removed on the fifth post-operative day. In the other group (n= 50), catheterisation was not prolonged and the catheter was removed the morning after surgery. Residual volumes after removal of the catheter were measured by ultrasound scanning. Where residual volumes of >200 mL were found the patient was recatheterised for three more days. Urinary cultures were taken before removal of the catheter. Six patients were excluded: four in the standard prolonged catheterisation group and two in the not prolonged catheterisation group. MAIN OUTCOME MEASURES: Need for recatheterisation, urinary tract infection, mean duration of catheterisation and hospital stay. RESULTS: Residual volumes exceeding 200 mL and need for recatheterisation occurred in 9% in the standard prolonged catheterisation group versus 40% of patients in the not prolonged catheterisation group (OR 0.15, 95% CI 0.045-0.47). Positive urine cultures were found in 40% of cases in the standard prolonged catheterisation group compared with 4% in the not prolonged catheterisation group (OR 15, 95% CI 3.2-68.6). Mean duration of catheterisation was 5.3 days in the standard prolonged catheterisation group and 2.3 days in the not prolonged catheterisation group (P < 0.001). Mean duration of hospitalisation was 7 days in the standard prolonged catheterisation group and 5.7 days in the not prolonged group (P < 0.001). CONCLUSION: The disadvantages of prolonged catheterisation outweigh the advantages, therefore, removal of the catheter on the morning after surgery may be preferable and longer term catheterisation should only be undertaken where there are specific indications.     

Short cervix: a cause of preterm delivery in young adolescents?

OBJECTIVE: To test the hypothesis that at midgestation younger adolescents (<16 years of age at conception) have shorter cervices than older adolescents (16-19 years of age at conception). METHODS: At midgestation (22.9 +/- 2.4 weeks) we measured cervical length by transvaginal ultrasound in a group of 46 13-19-year-old participants in an intensive, adolescent-oriented, antenatal program. Subjects were also comprehensively screened and treated for other recognized physiologic, microbiologic, obstetric, behavioral, and psychosocial factors associated with preterm delivery. Univariate, bivariate, and logistic regression analyses were used. RESULTS: The 18 younger adolescents had significantly shorter cervices than the 28 older adolescents (30 +/- 11 mm vs. 39 +/- 8 mm; P = 0.002). The younger adolescents' cervices were also more likely to be < or =25 mm long (33% and 4%, respectively; P = 0.02) and to exhibit funneling (39% vs. 4%; P = 0.01). Teenagers with cervices < or =25 mm long were younger, thinner, more apt to report vaginal bleeding and substance abuse, and to be treated for preterm labor (71% vs. 21%; P = 0.005). Logistic regression analyses revealed that age <16 years at conception (odds ratio = 13.7; 95% CI: 1.3-151.4) and substance abuse (odds ratio = 8.5; 95% CI: 1.2-62.8) were associated with cervical length < or =25 mm. Cervical length < or =25 mm was the only significant predictor of preterm delivery (odds ratio = 26.2; 95% CI: 2.1-333.6; P = 0.01) in this population of adolescents who were routinely treated for other recognized causes of preterm delivery. CONCLUSIONS: Cervical length < or =25 mm and cervical funneling may be complications of conception prior to 16 years of age. Randomized trials are needed to determine if younger adolescents benefit preferentially from ultrasound screening for short cervix at midgestation.     

Quantitative evaluation of biopty gun testis needle biopsy. Correlation between biopsy score of varicocele-bearing testis and sperm count.

OBJECTIVE: To investigate the applicability of quantitative evaluation of needle biopsy of the testis and any correlation between biopsy score and sperm parameters in infertile or subfertile men with varicocele. STUDY DESIGN: A total of 45 infertile men with clinical left varicocele were included in the study. All patients underwent left varicocelectomy and bilateral biopty gun needle biopsy of both testes. Spermiograms were obtained before and three months after the operation. The biopsy specimens were evaluated for Johnsen and Agger score, Leydig cell score, germ cell/Sertoli cell ratio, mean tubular diameter, peritubular fibrosis, and tubular and basement membrane hyalinization. RESULTS: Mean sperm count, motility and normally configured motile sperm counts increased 20%, 25% and 60% by month 3, respectively (P < .05). We did not observe any significant change in normally configured sperm counts. A mean of 14 tubuli per testis were obtained with single-pass needle biopsy. Johnsen and Agger scores, Leydig cell scores, mean tubular diameter and germ cell/Sertoli cell ratios of both testes were comparable. However, there was significantly less peritubular fibrosis, tubular hyalinization and basal membrane hyalinization in the right testis when compared to the varicocele-bearing left testis (P < .05). We found positive correlations between Johnsen and Agger score of varicocele-bearing left testis and preoperative normally configured motile sperm counts (Pearson's r = .34 and P < .05 and Pearson's r = .41 and P < .05, respectively). The Leydig cell score of varicocele-bearing testis correlated inversely with sperm counts (Pearson's r = -0.37, P < .05). CONCLUSION: These observations may prove of prognostic value in infertile or subfertile men with varicocele.     

Microsurgical treatment of persistent or recurrent varicocele

OBJECTIVE: To examine the effectiveness of subinguinal microsurgical varicocelectomy in the treatment of persistent or recurrent varicocele. DESIGN: Retrospective chart review. SETTING: Urban, tertiary care, academic teaching hospital. PATIENT(S): Fifty-four men who presented for treatment of persistent or recurrent varicocele. INTERVENTION(S): A single surgeon using an artery and lymphatic sparing subinguinal microsurgical technique with delivery of the testis repaired all varicocele. MAIN OUTCOME MEASURE(S): Preoperative to postoperative changes in semen parameters (volume of ejaculate, sperm concentration, percent motility, percent morphologically normal sperm, total motile sperm concentration), serum hormone levels, and testicular volume. Pregnancy rates and surgical complications were documented. RESULT(S): Postoperative mean serum T and mean testicular volume increased significantly from prevaricocelectomy levels. Median sperm concentration, percent motility, and total motile sperm per ejaculate improved significantly following recurrent varicocelectomy. Among patients with follow-up over 24 weeks (65%, 35 out of 54), the overall pregnancy rate was 40% (14 out of 35), including 23% (8 out of 35) of pregnancies achieved through natural intercourse, 9% (3 out of 35) with IVF/intracytoplasmic sperm injection, and 9% (3 out of 35) with IUI. Complications such as hydrocele, hematoma, wound infection, and testicular atrophy were not observed during the follow-up period. CONCLUSION(S): Treatment of persistent or recurrent varicocele using an artery and lymphatic sparing subinguinal microsurgical technique with delivery of the testis improves semen parameters, serum T levels, and testicular volume from preoperative levels without a significant risk of postoperative complications.     

Predictive indicators of successful varicocele repair in men with infertility

OBJECTIVE: We sought predictive indicators of functionally successful repair in 168 infertile Japanese males who underwent high ligation of a varicocele via a retroperitoneal approach. METHODS: Possible indicators evaluated included age at marriage, duration of infertility, testicular volume, varicocele grade, seminal analysis findings, and serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone. All patients had palpable or visible unilateral left varicoceles. Success in conception was evaluated in all subjects 1 year after varicocele repair. RESULTS: No associations were observed between outcome and mean age at marriage, infertility duration, varicocele grade, seminal volume, or serum PRL and testosterone concentrations, but testicular volume, sperm count, percentage of motile sperm, and serum FSH and LH concentrations were significantly associated with outcome. Multiple regression analysis of dependence of outcome revealed testicular volume and serum FSH concentrations to be independent predictors. CONCLUSIONS: Varicocele repair is likely to accomplish fertility in patients with a combined testicular volume of at least 30 mL or serum FSH concentrations lower than 11.7 mIU/mL.     

精索静脉曲张大鼠附睾功能变化的观察

目的:探讨实验性精索静脉曲张导致大鼠附睾功能降低的病理生理机制。方法:雄性Wister大鼠建立左侧精索静脉曲张模型,为实验组(n=11)并以假手术为对照组(n=9),免疫组化法检测附睾上皮p53的表达,DTNB法检测附睾中肉毒碱的含量,以5-甲基苯二酚法检测附睾中唾液酸的含量。结果:大鼠精索静脉曲张模型建立后的d28,实验组左侧附睾上皮p53表达显著高于对照组(P<0.05);实验组附睾中唾液酸、肉毒碱含量显著低于对照组(P<0.05)。结论:p53在精索静脉曲张后附睾功能降低的过程中起重要作用。     

Nicotine patches for pregnant smokers: a randomized controlled study

OBJECTIVE: To assess the effect of nicotine patches on continine-validated smoking cessation in pregnant women and the effect of nicotine on birth weight and preterm delivery. METHODS: Pregnant women who smoked ten or more cigarettes after the first trimester (N = 250) were randomly assigned to receive nicotine patches (n = 124) or placebo patches (n = 126). Women randomized to nicotine were treated with 15-mg patches (16 hours/day) for 8 weeks, and 10-mg patches (16 hours/day) for 3 weeks. RESULTS: Overall, 26% stopped smoking and 14% were nonsmokers 1 year after delivery. There was no difference between nicotine and placebo groups. At the end of the intervention, the mean value of cotinine in saliva in women assigned to nicotine was 120 ng/mL and placebo 153 ng/mL (mean difference -33; 95% CI -72, 6 ng/mL). Mean birth weight difference was 186 g (95% CI 35, 336 g) higher in the nicotine than placebo group, and there was an insignificantly lower rate of low birth weight (under 2500 g) in the former group. There was no difference in the rate of preterm delivery between the two groups. CONCLUSION: Nicotine patches had no influence on smoking cessation during pregnancy, although they might increase birth weight in comparison with placebo.     

Short Cervix: A cause of preterm delivery in young adolescents?

Objective: To test the hypothesis that at midgestation younger adolescents (> 16 years of age at conception) have shorter cervices than older adolescents (16–19 years of age at conception).

Methods: At midgestation (22.9 ± 2.4 weeks) we measured cervical length by transvaginal ultrasound in a group of 46 13–19-year-old participants in an intensive, adolescent-oriented, antenatal program. Subjects were also comprehensively screened and treated for other recognized physiologic, microbiologic, obstetric, behavioral, and psychosocial factors associated with preterm delivery. Univariate, bivariate, and logistic regression analyses were used.

Results: The 18 younger adolescents had significantly shorter cervices than the 28 older adolescents (30 ± 11 mm vs. 39 ± 8 mm; P = 0.002). The younger adolescents' cervices were also more likely to be ≤25 mm long (33% and 4%, respectively; P = 0.02) and to exhibit funneling (39% vs. 4%; P = 0.01). Teenagers with cervices ≤25 mm long were younger, thinner, more apt to report vaginal bleeding and substance abuse, and to be treated for preterm labor (71% vs. 21%; P = 0.005). Logistic regression analyses revealed that age < 16 years at conception (odds ratio = 13.7; 95% CI: 1.3–151.4) and substance abuse (odds ratio = 8.5; 95% CI: 1.2–62.8) were associated with cervical length ≤25 mm. Cervical length ≤25 mm was the only significant predictor of preterm delivery (odds ratio = 26.2; 95% CI: 2.1–333.6; P = 0.01) in this population of adolescents who were routinely treated for other recognized causes of preterm delivery.

Conclusions: Cervical length ≤25 mm and cervical funneling may be complications of conception prior to 16 years of age. Randomized trials are needed to determine if younger adolescents benefit preferentially from ultrasound screening for short cervix at midgestation.