Hamilton, M. P., Fleming, R., Coutts, J. R., Macnaughton, M. C., & Whitfield, C. R. (1990). Luteal cysts and unexplained infertility: biochemical and ultrasonic evaluation. Fertility and Sterility, 54(1), 32-37. https://doi.org/10.1016/s0015-0282(16)53632-2
Hamilton MP, Fleming R, Coutts JR, Macnaughton MC, Whitfield CR. Luteal cysts and unexplained infertility: biochemical and ultrasonic evaluation. Fertil Steril. 1990;54(1):32-37. doi:10.1016/s0015-0282(16)53632-2
Hamilton, Mark P. R., et al. "Luteal cysts and unexplained infertility: biochemical and ultrasonic evaluation." Fertility and Sterility, vol. 54, no. 1, 1990, pp. 32-37.
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RRM Academy Synopsis
Luteal cysts occurred in 23.4% of women with unexplained infertility
A prospective, controlled study of 175 women with unexplained infertility found luteal cysts in 41 women (23.4%) and in none of 43 control cycles. The 20 luteinized unruptured follicle cycles had significantly reduced early luteal progesterone. In these cycles the follicle did not shrink after the LH peak.
Key Findings
Luteal cysts formed in 41 of 175 women with unexplained infertility (23.4%), and none of the 43 control cycles produced one (P < 0.0001).
After the LH peak, the dominant follicle reduced in size in 21 cycles (cystic corpus luteum cycles) and showed no shrinkage in 20 cycles (luteinized unruptured follicles).
Progesterone in the early luteal phase was significantly lower in luteinized unruptured follicle cycles than in controls or in cystic corpus luteum cycles (P < 0.001).
A normal progesterone index appeared in 2 of 20 luteinized unruptured follicle cycles and in 17 of 21 cystic corpus luteum cycles (P < 0.0001).
Plasma FSH was elevated during the early follicular and luteal phases in both cyst-forming groups, while estradiol and LH profiles resembled those of the controls.
Interpretation
This prospective, controlled study combined ovarian ultrasound with daily hormone tests. The 175 women had unexplained infertility for over 3 years, normal laparoscopy and a normal male partner. A group of 43 volunteers served as controls. The results link ultrasound findings to hormone patterns, and the authors suggest that two distinct mechanisms may be involved in luteal cyst formation. The authors note the groups may overlap, since a brief shrinkage could fall between scans and egg release may not follow every shrinkage.
RRM Context
RRM sees unexplained infertility as undiagnosed and looks for the cause in each case. RRM clinicians tell an ovulatory event apart from confirmed egg release, and a follicle that stays whole after the LH peak illustrates that gap.
Our editorial summary of this paper, not the article's abstract.
Abstract
A prospective, controlled study of ovarian function using ovarian ultrasound and daily plasma hormone estimations (estradiol, progesterone [P], follicle-stimulating hormone [FSH], luteinizing hormone [LH]) was carried out on 175 spontaneously cycling patients with unexplained infertility. Forty-one (23.4%) demonstrated luteal phase cyst formation. In 21 cycles the dominant follicle reduced in size after the LH peak (cystic corpus luteum cycles), and in 20 no shrinkage was seen (luteinized unruptured follicles). Progesterone concentrations in the early luteal phase were significantly reduced in the luteinized unruptured follicle cycles. Elevation in plasma FSH was seen in the early follicular and luteal phases of both cyst forming groups and may be due to disturbances in ovarian metabolism. Follicular rupture is important for efficient P release by the corpus luteum.
