Chapter 20: Disorders of Human Ovulation: Sonographic Classification System

Hilgers TW

Diagnostics Ultrasound

Chapter 20: Disorders of Human Ovulation: Sonographic Classification System

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 259-268, 2004

RRM Academy Synopsis

Ultrasound found abnormal ovulation in over half of infertility cycles

Ultrasound found abnormal ovulation in more than 5 out of 10 cycles from women seen at one center for infertility. The 2004 book chapter reports 460 spontaneous cycles from a prospective series. The authors use them to build a working classification.

Key Findings

Of 460 consecutive spontaneous cycles, 200 (43.5%) showed anatomically normal ovulation by ultrasound and 260 (56.5%) showed an anatomically abnormal ovulation pattern.
As shares of all 460 cycles: mature follicle with a negative or retained cumulus oophorus 23.5% (n=108), luteinized unruptured follicle 13.9% (n=64), immature follicle 10.2% (n=47).
Partial rupture made up 5.2% (n=24) of the 460 cycles, delayed rupture 3.0% (n=14), and afollicular cycles 0.7% (n=3).
Across the 460 cycles, the cumulus oophorus showed as negative in 36.3% (n=167) and retained in 3.9% (n=18). The other 59.8% (n=275) were positive.
Two earlier ultrasound series in infertility patients found abnormal ovulation patterns in 58% of 136 cycles and in 54% of cycles. The authors call this similar to their 56.5%.

RRM Context

The chapter belongs to the NaProTechnology literature. Its scans were timed from the Peak Day on Creighton Model charts. The authors argue that the aim should be identifying which specific ovulation disorder is present. They state that four common checks cannot identify these disorders: one mid-luteal progesterone level, a urinary LH kit, a temperature curve and an endometrial biopsy. They write that most luteinized unruptured follicles occur in women with regular, normal-appearing cycles.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter presents a working sonographic classification of disorders of human ovulation, built from serial follicular ultrasound in the non-medicated, spontaneous cycles of women with primary or secondary infertility who were charting with the CREIGHTON MODEL FertilityCare System (CrMS). The classification sets an anatomically normal ovulation, a mature follicle with a cumulus oophorus followed by complete rupture, against six abnormal patterns: a mature follicle with an absent or retained cumulus, the luteinized unruptured follicle, the immature follicle, partial rupture, delayed rupture and afollicularism. In a subgroup of 460 consecutive spontaneous cycles, anatomically abnormal ovulation patterns were observed in 56.5 percent of cycles. Hilgers states that these disorders cannot be determined by a midluteal phase progesterone level, a urinary LH test kit, a basal body temperature curve or an endometrial biopsy, and argues that what is needed is a search for the various disorders of ovulation that goes beyond simple ovulation detection.

Topics

Diagnostics › Ultrasound › Follicular Monitoring · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Clinical Guidelines and Standards › Diagnostic Criteria and Classification › Staging and Classification Systems

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 20: Disorders of Human Ovulation: Sonographic Classification System

Ultrasound found abnormal ovulation in over half of infertility cycles

Key Findings

RRM Context

Abstract

Topics

By this author

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