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An accurate home test for prediction of ovulation can be useful in the treatment of infertility. An enzyme immunoassay for luteinizing hormone determination was compared with other ovulation-monitoring methods. The accuracy and convenience of this method suggest that such a test merits consideration for many infertility applications.
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The endocervix undergoes cyclic changes in every menstrual cycle, as reflected by the rheologic properties of the cervical mucus. A study was therefore undertaken to establish whether there were any morphologic changes in the endocervical columnar cells, as seen in the endocervical smears, that could be correlated with ovulation and anovulation. An endocervical smear was collected in the luteal phase of the cycle from patients in whom an endometrial biopsy or D & C was being done as a part of an infertility investigation. A significant correlation was observed between the endocervical smear interpretation and the endometrial histology as to whether the cycle was ovulatory or anovulatory.
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We are investigating the most practical parameters i.e. reliable and with a rapid response, which allow the time of insemination to be determined in women undergoing stimulation because of anovulation. We have already shown the advantage of rapid radio-immunological determinations of 17 beta-oestradiol (E2) to induce the releasing action of chorionic gonadotrophic hormone (hCG). We have carried out our investigations directed towards the rapid-immunological determination of luteotrophic hormone (LH), and have recorded a good temporal correlation between E2 and LH, the rise of E2 preceding by some hours that of LH, and the two summits succeeding each other. Inseminations are followed by fertilization in women who present with the following: a mean oestradiolaemia of about 500 pg/ml in the second part of the follicular phase, maintained after interruption of HMG administration (alone or after clomiphene citrate), which decreases only slowly after administration of hCG; a level of LH increasing from 9-14 ng/ml (mean) in the last two days preceding the summit of LH; the level of LH multiplied at least by 2 after the administration of hCG, whatever the mode of stimulation. Clomiphene citrate, not provoking a constant ovulatory discharge, does not dispense with the administration of hCG in the majority of cases. These considerations result from the study of a group of 22 anovulatory women, in whom stimulation followed by determination of E2 and LH, under echographic control, have allowed 12 pregnancies to be obtained (7 by clomiphene citrate + HMG + hCG; 5 by HMG + hCG), decreasing the mean number of inseminated cycles to 3 per woman thus studied.
The concentration of progesterone in peritoneal fluid, aspirated from the pouch of Douglas by laparoscopy, 72 hours after the peak of the luteinizing hormone in serum is believed to indicate whether the ovarian follicle has ruptured or not. Twenty six patients were studied. The volume of peritoneal fluid 72 hours after the peak of the luteinizing hormone was markedly decreased when bilateral ovarian adhesions were present. Progesterone concentrations, assayed during the early luteal phase in peritoneal fluid of women with bilateral ovarian adhesions, were significantly lower than in women with a corpus luteum presenting an ovulation stigma and even significantly lower than in those without ovulation stigma (luteinized unruptured follicle syndrome). The assay of progesterone in peritoneal fluid during the early luteal phase may be of value in women with ovarian adhesions.
The different causes of infertility and evaluation of the infertile couple are reviewed in this paper. Forty to 50 percent of cases are due to male factors, and special emphasis is placed in describing techniques to diagnosis this type of infertility. Five to ten percent of infertile couples have infertility of unknown etiology even after a complete, appropriate evaluation. Special instruction in how to diagnose and treat these types of patients is described. A step by step evaluation of peritoneal factors, ovulation factors, and male and cervical mucus interaction is presented for the clinicians' use.
Nine normal cycling subjects were monitored for mid-cycle LH surge and a subsequent rise in serum progesterone levels. Frequent samples were then taken for progesterone measurement during 8 h sessions in the early, mid and late luteal phases. These data showed: that progesterone secretion is pulsatile throughout the human luteal phase, with maximum frequency in the mid-luteal phase; that during the mid-luteal phase most subjects had progesterone levels both above and below currently accepted ovulatory thresholds; the use of a single measurement of progesterone in the mid-luteal phase is not always a reliable indicator of ovulation; a threshold greater than 20 nmol/l may yield an unacceptable number of false negative results.
A prospective six-year study (1975-1980) of 273 patients, monitored in the use of natural family planning (NFP), has shown that those with previously irregular menstrual cycles are disadvantaged in the subsequent use of the ovulation method after pregnancy in that they have fewer recognizable safe days and/or are more likely to have unplanned pregnancies than women who had regular cycles prior to pregnancy. Eight patients, seven nursing and one non-nursing mother, conceived during postpartum amenorrhoea. The reliability of memory in the recall of previous menstrual histories is discussed in relation to the results of an international study of menstrual cycles by the World Health Organization (WHO 1983). The relevance of prediction of menstrual events in natural family planning is also considered.
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