Cycle abnormalities in infertile women with regular menstrual cycles: effects of clomiphene citrate treatment

Abstract

Objective: To investigate the incidence and nature of cycle abnormalities and the effect of clomiphene citrate (CC) treatment in women with apparently ovulatory cycles and unexplained infertility.

Design: Nonrandomized, open study of patients before and during treatment.

Setting: The Reproductive Medicine Clinic of a District General Hospital.

Patients: Thirty-five women with regular, apparently ovulatory menstrual cycles and unexplained infertility.

Interventions: Detailed ultrasound and hormonal cycle tracking was performed before and during treatment with CC.

Main outcome measures: Serial ultrasound scans and measurements of serum LH, FSH, E2, and P.

Results: Before treatment, 54% of cycles were uniovulatory, 40% were characterized by cyst formation, and 6% were characterized by poor follicular growth. Fifty-one percent of pretreatment cycles had normal hormone profiles, 31% had defective luteal phases, 14% had increased early follicular phase serum FSH levels, and 9% had increased early follicular phase serum LH levels. Treatment with CC reduced the incidence of cyst formation to 9% and the incidence of luteal phase defects to 3%. However, 28% of CC-treated cycles showed ultrasound features of overstimulation and 51% had high follicular phase E2 peaks so that only 34% of CC-treated cycles had normal hormone profiles.

Conclusions: Cycle abnormalities are common in unexplained infertility. The incidence of cyst formation and luteal phase defects, the most common abnormalities in this group, is reduced by CC treatment.