The Unit on Reproductive Endocrinology and Infertility, led by James Segars, investigates underlying causes and effectiveness of treatments for a variety of clinical reproductive disorders. The studies are conducted as an integral facet of the clinical training program in Reproductive Endocrinology and Infertility; the objective is to provide clinician-scientists with a foundation of expertise in basic and clinical research related to reproduction. In the past year, we have continued to examine and refine assessment of several states of infertility. We have reported a simplified method of determining ovarian size by ultrasound, which may assist in the assessment of women with subtly impaired ovarian function. We have also shown that pregnancy outcome in women with subtly impaired ovarian function (also known as a reduced number of oocytes in the ovary) is poor. In addition, we have noted that development of fluid in the womb (endometrial cavity fluid) during treatment with medications to stimulate the ovaries is predictive of poor reproductive outcome and may indicate subtle impairment of ovarian function. The assessment of subtle impairments of ovarian function in women is important in the United States because many women are postponing childbearing until their late 30s and early 40s, a time when, despite normal menstrual cycles, ovarian function may not be normal and fertility may be greatly impaired.

In the past year, we have also initiated a collaboration with Dr. Lynnette Nieman (PREB), Dr. Pamela Stratton (PREB), and Dr. Craig Winkel (Department of Obstetrics and Gynecology, Georgetown University) to study the reproductive disease endometriosis. To complement the clinical initiative in the branch, the Unit on Reproductive Endocrinology and Infertility has assisted in basic studies on surgically obtained samples, which suggest that lesions of endometriosis are not simply composed of "normal" endometrial tissue present in the wrong location but rather have undergone significant qualitative changes. Further studies are in progress in this collaborative initiative. Endometriosis is a common disease that affects up to 10 percent of women of reproductive age in the United States and may cause infertility or pelvic pain.