Ovarian Stimulation for Disordered Ovulatory Cycles

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Abstract
A total of 391 “ovulatory” women with unexplained infertility had 1,071 treatment cycles (2.74 treatments per patient) with clomiphene citrate (C), human menopausal gonadotrophin (hMG) or a combination of C/hMG; each regimen combined with human chorionic gonadotrophin in the luteal phase. Pre‐treatment monitoring of serum hormones, cervical mucus and ovarian follicle dimensions by ultrasound delineated a relatively narrow range of measurements for “conception” cycles and the term “disordered ovulatory cycles” with follicular or luteal phase defects was applied for those outside the range. At least 70% of treatment cycles responded appropriately and 119 patients conceived (31%) during treatment, showing that “ovulatory” women can benefit by ovarian stimulation. The data also implies that treatment is more likely to be effective for defined ovulatory disorders rather than when given empirically (p>0.05 for clomiphene treatment of follicular phase disorders). However, cervical mucus scores were adversely affected in 22%, of clomiphene treated patients (p> 0.001). This was improved in the C/hMG group and virtually resolved by treatment with hMG alone.