Treatment validation of ultrasound-defined abnormal follicular dynamics as a cause of infertility.
From March 1984 to February 1987, 109 patients with otherwise normal infertility evaluations (semen analysis, postcoital test, endometrial biopsy, hysterosalpingogram and/or hysteroscopy, and laparoscopy) underwent serial ultrasound (US) for follicular dynamics. Twenty-five patients were found to have repetitive abnormal follicular growth and/or rupture patterns. These patients were treated by ovulation induction protocols from clomiphene citrate (CC) to human menopausal gonadotropin (hMG). Of the 84 normal US patients, 47 elected no interventional therapy (control A). Twenty elected empiric treatment with hMG/hMG-intrauterine insemination (IUI) (control B). Seventeen were lost to follow-up or elected in vitro procedures within 1 year of diagnosis. Viable fecundibility (fv) was calculated for each group. Long-term viable conception was compared between groups by chi-square-Yates coefficient. Nineteen of 25 patients treated for abnormal US conceived on treatment (fv = 0.25) (chi-square to control A P less than 0.005, chi-square to control B P less than 0.05). Six of 20 control B patients conceived during treatment (fv = 0.11). Two control B patients conceived in nontreatment cycles (fv = 0.016). When nontreated and treated cycles are considered, the fv = 0.042, not significantly different from control A (fv = 0.035). There was no increase in control B pregnancies over the course of the study compared with control A (chi-square = 0). The authors concluded: (1) Abnormal follicular dynamics on US is a correctable cause of infertility. (2) Empiric treatment of unexplained infertility patients with hMG/hMG-IUI does not appear to improve long-term conception rates; rather, it tends to advance pregnancies into the treatment cycles.(ABSTRACT TRUNCATED AT 250 WORDS)
Daly
D C
DC
Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester.
D000328:Adult; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007315:Insemination, Artificial; D006080:Ovarian Follicle / Q000503:physiopathology*; D010062:Ovulation Induction / Q000379:methods; D014463:Ultrasonography