Hamilton, C. J., Wetzels, L. C., Evers, J. L., Hoogland, H. J., Muijtjens, A., & de Haan, J. (1985). Follicle growth curves and hormonal patterns in patients with the luteinized unruptured follicle syndrome. Fertility and Sterility, 43(4), 541-548. https://doi.org/10.1016/s0015-0282(16)48494-3
Hamilton CJ, Wetzels LC, Evers JL, Hoogland HJ, Muijtjens A, de Haan J. Follicle growth curves and hormonal patterns in patients with the luteinized unruptured follicle syndrome. Fertil Steril. 1985;43(4):541-548. doi:10.1016/s0015-0282(16)48494-3
Hamilton, Carl J. C. M., et al. "Follicle growth curves and hormonal patterns in patients with the luteinized unruptured follicle syndrome." Fertility and Sterility, vol. 43, no. 4, 1985, pp. 541-548.
For EndNote, Zotero or Mendeley:
Open access
Free to read
No reuse license
Free to read at the publisher (reported by Unpaywall and OpenAlex, not verified by RRM Academy)
Author affiliations
2 institutions
Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
Luteinized unruptured follicles grow rapidly after the LH peak
A prospective ultrasound study of 270 infertility patients found that luteinized unruptured follicles (LUF) grow rapidly after the luteinizing hormone peak and do not rupture. Growth before the peak matched ovulatory cycles. The study compared 20 LUF cycles with 45 ovulatory control cycles.
1 in 10 infertility patients had a luteinized unruptured follicle cycle. Source: Hamilton CJ et al., 1985, PMID 3921410.Study at a glance, prospective longitudinal design of 270 infertility patients: Luteinized unruptured follicles grow fast after the luteinizing hormone peak. Source: Hamilton CJ et al., 1985, PMID 3921410.
Key Findings
Among 600 monitored cycles in 270 infertility patients, LUF occurred in 40 cycles (6.7%) in 27 patients (10%), with luteinization signs on basal body temperature recordings and progesterone determinations.
Each LUF cycle showed two-step follicle growth. Growth matched control cycles until the luteinizing hormone peak, then rose rapidly and leveled off at 35.5 mm mean diameter (range, 29 to 70 mm).
LUF cycles had significantly lower luteinizing hormone peaks and midluteal progesterone than control cycles (both P < 0.01). The peak came 2.3 days later on average. Luteal phase duration was the same.
Repeated LUF cycles occurred only in patients receiving ovulation induction and in patients with a history of pelvic inflammatory disease.
Interpretation
The study followed a prospective longitudinal design with standardized serial ultrasound and a blood sample at each scan. The LUF cycles arose in three groups of patients: unexplained infertility with spontaneous cycles, ovulation induction, and a history of pelvic inflammatory disease. Control cycles came from 20 healthy volunteers of proven fertility and 25 patients with male factor infertility only. The authors note that hormone results were incomplete in seven patients, which left 20 LUF cycles for comparison. They conclude that central and local factors can each explain the lack of rupture.
RRM Context
Restorative reproductive medicine relies on cycle charting and treats ovulation as the central event of the cycle. The paper describes cycles with temperature and progesterone evidence of luteinization in which the follicle does not rupture. A chart rise reflects luteinization, and ultrasound shows whether the follicle ruptured. Evaluation before treatment asks why a cycle with these signs has not led to conception.
Our editorial summary of this paper, not the article's abstract.
Abstract
A prospective longitudinal and standardized study is presented, dealing with ultrasonographic and hormonal characteristics of the luteinized unruptured follicle (LUF) syndrome. Among 600 cycles monitored in 270 infertility patients, 40 cycles in 27 patients showed no evidence of follicle rupture, in spite of signs of luteinization, as reflected by basal body temperature recordings and progesterone determinations. In this study, 20 LUF cycles in 20 infertile patients were compared with 45 ovulatory cycles in 45 control women. During the follicular phase, no substantial difference in follicle growth was found, but after the luteinizing hormone peak, LUF follicles, instead of rupturing, showed a typical accelerated growth pattern. Both mean luteinizing hormone peak levels and midluteal progesterone levels were significantly lower in LUF cycles than in the control cycles. However, the duration of the luteal phase was not affected. Both central and local factors can be held responsible for the lack of follicle rupture. Ultrasound offers new possibilities as a noninvasive method in diagnosing the LUF syndrome.
05f0rzm15 
