Follicle size by ultrasound versus cervical mucus quality: normal and abnormal patterns in spontaneous cycles

Douglas C. Daly; Karen. Reuter; Stephen. Cohen; Jennie. Mastroianni

doi:10.1016/s0015-0282(16)60606-4

Diagnostics · Ultrasound

Follicle size by ultrasound versus cervical mucus quality: normal and abnormal patterns in spontaneous cycles

Daly DC, Reuter K, Cohen S, Mastroianni J

Published April 1989 Fertility and Sterility, 51(4), 598-603

DOI 10.1016/s0015-0282(16)60606-4 PMID 2522397

RRM Academy Synopsis

Cervical mucus quality tracks follicle growth in infertility patients

In 50 infertility patients, mucus quality rose predictably as the follicle grew. The prospective study used serial ultrasound and postcoital testing of cervical mucus. Among 19 patients with abnormal mucus, 11 had normal follicle growth. Four of the 19 had abnormal follicle growth. Four had a narrow mucus window.

Key Findings

In the normal group, mucus scored low on the Insler scale at a follicle diameter of 13 mm and reached ovulatory quality by 16 mm.
In the normal patients, normal mucus appeared by the third day before physical ovulation.
Of 19 patients with abnormal mucus (15 referred, 4 from controls), 11 (58%) had normal follicular growth, which the authors read as implicating a hyporesponsive cervix.
Four of the 19 (21%) had abnormal follicular dynamics. Another four (21%) reached normal mucus only within a narrow window of 24 hours or less.
Ultrasound workup yielded 16 diagnoses against 12 without it. Estimated cost per diagnosis was $2,100 with ultrasound versus $2,000 when ultrasound is not used.

Interpretation

The study was prospective and ran at one medical school. The authors built the standard curves from 34 of the 50 control patients. All 50 control patients had normal temperature charts, normal semen analyses, and no history suggesting tubal disease. Eighteen patients came by referral for abnormal mucus. The findings describe an association between follicle size and mucus quality in these patients. The paper reports no pregnancy results for the three mucus patterns. The authors call cost-effectiveness estimates imprecise even in a randomized comparison, and this comparison was not randomized.

RRM Context

Cycle-charting methods teach couples to record cervical mucus. The paper ties that sign to follicle growth seen on ultrasound. The authors sort abnormal mucus into three patterns the authors link to different problems. Seventeen of the 50 control patients still had unexplained infertility after this workup. The restorative reproductive medicine view is that unexplained means undiagnosed.

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

Abstract

Ultrasound (US) has been demonstrated to be the method of choice for diagnosing luteinized unruptured follicle syndrome and to be a valuable adjuvant in the assessment of luteal phase defect. In this prospective study, the use of US with postcoital testing (PCT) is evaluated. Fifty control infertility patients were examined with serial US for follicle dynamics in conjunction with PCT. Standard curves for follicle dynamics versus cervical mucus quality (Insler score) were calculated. Eighteen patients referred for abnormal mucus underwent similar evaluation. Their follicle dynamics versus mucus quality were compared with those of the controls. The findings were: (1) there is a predictable relationship between follicle size and mucus quality, (2) the majority of patients with abnormal mucus have normal follicular dynamics, and (3) a minority of patients with abnormal mucus have either a narrow mucus window or abnormal follicular dynamics. In addition, US was found to be cost-effective in the overall fertility evaluation.

Topics

Diagnostics › Ultrasound › Follicular Monitoring · Menstrual Cycle › Cycle Biomarkers › Cervical Mucus · Infertility › Cervical Factor › Mucus Deficiency

Douglas C. Daly, Karen. Reuter, Stephen. Cohen, Jennie. Mastroianni

Doug Daly, D Daly, K Reuter, Steve Cohen, S Cohen, J Mastroianni

PMID 2522397 2522397 DOI 10.1016/s0015-0282(16)60606-4 10.1016/s0015-0282(16)60606-4 Daly et al. 1989, Daly 1989

Keywords

Cervix Mucus/cytology, Cost-Benefit Analysis, Female, Humans, Infertility, Female/diagnosis, Laparoscopy, Luteal Phase, Ovarian Follicle/pathology, Ultrasonography

Follicle size by ultrasound versus cervical mucus quality: normal and abnormal patterns in spontaneous cycles

Cervical mucus quality tracks follicle growth in infertility patients

Key Findings

Interpretation

RRM Context

Abstract

Topics

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