Marik, J., & Hulka, J. (1978). Luteinized unruptured follicle syndrome: a subtle cause of infertility. Fertility and Sterility, 29(3), 270-274. https://doi.org/10.1016/s0015-0282(16)43151-1
Marik J, Hulka J. Luteinized unruptured follicle syndrome: a subtle cause of infertility. Fertil Steril. 1978;29(3):270-274. doi:10.1016/s0015-0282(16)43151-1
Marik, Jaroslav, and Jaroslav Hulka. "Luteinized unruptured follicle syndrome: a subtle cause of infertility." Fertility and Sterility, vol. 29, no. 3, 1978, pp. 270-274.
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RRM Academy Synopsis
Unruptured follicles found in 62 of 102 women with ovulation signs
A 1978 clinic series of 102 infertile women with normal signs of ovulation found 62 out of 102 had a follicle that had not ruptured. The findings pointed to no egg being released. Of 28 women given ovarian stimulation, 15 became pregnant.
Key Findings
The Tyler Clinic reviewed 205 consecutive infertility laparoscopies. Secretory endometrium and fully visible ovaries were found in 102 women.
Of those 102 women, 40 had a corpus hemorrhagicum with a stigma (the normal finding), 32 had a corpus hemorrhagicum with no stigma, and 30 had no corpus hemorrhagicum.
Among the 30 women with no corpus hemorrhagicum, 11 (37%) had endometriosis.
Of 28 previously infertile women with no other obvious infertility factor who received ovarian stimulation, 15 became pregnant.
Eight of 12 women given direct follicular stimulation with human menopausal gonadotropin became pregnant.
Interpretation
This case series studied 102 women. Each had a secretory lining and fully visible ovaries, found among 205 infertility laparoscopies done 3 to 5 days after ovulation. Among 28 women with no other clear cause of infertility, the authors find a causal link between ovarian stimulation and pregnancy hard to deny. The authors note that one look may not reflect every cycle. The findings support larger studies of this approach.
RRM Context
RRM clinicians separate an ovulatory event from confirmed ovulation. A temperature rise and rising progesterone mark the event. Serial ultrasound or a pregnancy confirms that an egg left the ovary. Marik and Hulka show the gap: a normal-looking chart can sit beside an unruptured follicle.
Our editorial summary of this paper, not the article's abstract.
Abstract
A clinical description of luteinized unruptured follicles is presented. This abnormality in ovulation is characterized by normal endocrinologic presumptive signs of ovulation: biphasic basal body temperature curves, secretory endometrium, and laboratory evidence of progesterone production by elevated urinary pregnanediol or plasma progesterone levels. In a group of 102 such infertile women, laparoscopy performed 3 to 5 days after apparent ovulation revealed the absence of a corpus hemorrhagicum in 30 women, and the absence of a sigma on a corpus hemorrhagicum in an additional 32 women. These findings were evidence that a follicle had not ruptured and an ovum had not escaped. Of 28 patients undergoing follicular stimulation with clomiphene citrate or human menopausal gonadotropin after this diagnosis, 15 conceived.
