Chapter 22: Disorders of Human Ovulation: Clinical Validation of the Sonographic Classification System

Hilgers TW

Menstrual Cycle · Cycle Disorders

Chapter 22: Disorders of Human Ovulation: Clinical Validation of the Sonographic Classification System

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 275-279, 2004

RRM Academy Synopsis

Ovulation defects on ultrasound tied to infertility and complications

No pregnancy occurred in luteinized unruptured follicle or afollicular cycles. The review used 1,818 ultrasound series. A pregnancy with an immature follicle had an abnormal outcome about 6 times in 10, against about 2 in 10 with a mature follicle. One institute supplied the data.

Key Findings

The review covered 1,818 diagnostic follicular ultrasound series. Pregnancy happened in 70 cycles (3.8%): 35 in spontaneous cycles and 35 in cycles using ovulation-induction protocols.
No pregnancies occurred in cycles with a luteinized unruptured follicle or in afollicular cycles.
With an immature follicle, 8 of 13 pregnancies (61.5%) had an abnormal outcome: spontaneous abortion (3), premature birth (3) and ectopic pregnancy (2). With a mature follicle the rate was 19.6%.
All 3 pregnancies in cycles where the follicle only partially ruptured had abnormal outcomes (100.0%), against 16 of 65 (24.6%) in complete rupture cycles.
Among 1,250 cycles, pregnancy rates were 2.6% when the cumulus oophorus was missing on ultrasound and 5.9% when it was seen (p=.0158).

RRM Context

The chapter argues that evaluation should look for disorders of ovulation, beyond asking whether ovulation occurred. The author adds that treatment begins with a diagnosis found by objective testing. The order matches the restorative principle of evaluation before treatment. Dr. Thomas W. Hilgers developed the classification within NaProTechnology. A named ovulation defect gives a cycle a diagnosable cause. That fits the view that unexplained infertility is undiagnosed.

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

Abstract

This chapter reviews 16 years of follicular ultrasound series at the Pope Paul VI Institute and relates the cycles in which pregnancy did or did not occur to the sonographic classification of ovulation disorders. No pregnancies occurred in cycles with a luteinized unruptured follicle or in afollicular cycles, and the chapter treats both as disorders associated with absolute infertility. Immature follicles and partial ruptures were associated with abnormal pregnancy outcomes, including spontaneous abortion, ectopic pregnancy and pre-term birth, and cycles in which no cumulus oophorus was observed had a significantly lower pregnancy rate. The chapter states that the ultrasound series were diagnostic, so the pregnancies observed do not reflect a success rate in the treatment of infertility.

Topics

Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Fertility Awareness › Biomarkers › Cervical Mucus · Diagnostics › Cycle Biomarkers › Cervical Mucus Monitoring

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 22: Disorders of Human Ovulation: Clinical Validation of the Sonographic Classification System

Ovulation defects on ultrasound tied to infertility and complications

Key Findings

RRM Context

Abstract

Topics

By this author

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