Soto-Albors, C., Daly, D. C., & Ying, Y. K. (1989). Efficacy of human menopausal gonadotropins as therapy for abnormal cervical mucus. Fertility and Sterility, 51(1), 58-62. https://doi.org/10.1016/s0015-0282(16)60428-4
Soto-Albors C, Daly DC, Ying YK. Efficacy of human menopausal gonadotropins as therapy for abnormal cervical mucus. Fertil Steril. 1989;51(1):58-62. doi:10.1016/s0015-0282(16)60428-4
Soto-Albors, Carlos, et al. "Efficacy of human menopausal gonadotropins as therapy for abnormal cervical mucus." Fertility and Sterility, vol. 51, no. 1, 1989, pp. 58-62.
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University of Connecticut Health Center, Farmington.
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RRM Academy Synopsis
14 of 17 women with estrogen-responsive poor mucus conceived on hMG
A 1989 case series from two US university centers treated women with abnormal cervical mucus and an estrogen-responsive cervix with human menopausal gonadotropin (hMG). About 82 out of 100 of these women conceived viable pregnancies during treatment.35 out of 100 cycles with corrected mucus produced a viable pregnancy, against an expected 9 out of 100 or fewer untreated.
Key Findings
Of 17 women whose cervix responded to a conjugated equine estrogen screen, 14 conceived viable pregnancies during hMG treatment.
Eight women conceived on the low-dose regimen. Nine moved to standard doses, and six of them conceived viable pregnancies within four cycles at most.
Viable fecundibility (viable pregnancies per cycle) was 0.35 in cycles with corrected mucus and 0.29 across all treatment cycles, above the 0.09 upper limit expected untreated (P < 0.01).
Twins resulted in one pregnancy. Ultrasound showed mild ovarian hyperstimulation in two cases, and no woman developed hyperstimulation syndrome.
Five women at the two centers did not respond to the estrogen screen. Three of those five had been exposed to diethylstilbestrol in utero.
Interpretation
The study is a treatment series of 17 women at two centers. The entered patients ovulated and had in-phase late luteal biopsies, normal tubal evaluation, and partners with normal semen analysis. Abnormal mucus was their only apparent reason for infertility, and the cervix had to respond to the estrogen screen. The 0.09 comparison value is a calculated 99% upper limit for untreated fertility, based on the group's 50 months of average infertility. The authors note that abnormal mucus affects 2 to 8% of infertile couples, which keeps studies small.
RRM Context
Fertility awareness charting records cervical mucus, a sign of estrogen activity. The authors confirmed ovulation, semen, tubes and luteal phase first, then tested the cervix with estrogen. This cause-first order matches restorative reproductive medicine. The authors note that IVF and GIFT have been used to bypass abnormal mucus, while their hMG protocol corrected the mucus and let couples conceive with intercourse.
Our editorial summary of this paper, not the article's abstract.
Abstract
Traditional therapies for abnormal cervical mucus, other than timed intrauterine insemination, are noteworthy for being ineffectual. Patients (n = 27) with documented abnormal Insler scores in repetitive cycles and failure to conceive with traditional treatments were screened with conjugated equine estrogens (CEE) for estrogen responsiveness of the cervix. Only 5 patients were found unresponsive. Seventeen patients with CEE-responsive cervices then were treated with human gonadotropins (hMG), initially 1 ampule days 5 to 11. If the mucus failed to improve, the hMG was increased to standard doses. Eight patients responded to 1 ampule hMG with improved mucus and conception. The remainder required 2 ampules hMG. In patient cycles with corrected cervical mucus, the viable fecundibility (fv) was 0.35. This is significantly higher than predicted for this population (fv = 0.09; P less than 0.01). In all, 14 of 17 patients conceived viable pregnancies during hMG treatment. It is concluded that graduated hMG is efficacious in treating patients with abnormal cervical mucus responsive to CEE. It is preferable to either in vitro fertilization or gamete intrafallopian transfer, based on both cost and efficacy for most patients.
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