Subtle abnormalities in follicular development and hormonal profile in women with unexplained infertility

Dan Lewinthal; Anchel Furman; Josef Blankstein; Bernard Corenblum; Josef Shalev; Bruno Lunenfeld

doi:10.1016/s0015-0282(16)49821-3

Reproductive Endocrinology Ovulation Physiology

Subtle abnormalities in follicular development and hormonal profile in women with unexplained infertility

Lewinthal D, Furman A, Blankstein J, Corenblum B, Shalev J, Lunenfeld B

Published November 1986 Fertility and Sterility, 46(5), 833-839

DOI 10.1016/s0015-0282(16)49821-3 PMID 3781002

RRM Academy Synopsis

Follicle problems found in 3 of 6 women with unexplained infertility

Three out of six women with unexplained infertility had follicle abnormalities. This 1986 case series from an Israeli hospital tracked six couples through a menstrual cycle with serial ultrasound and blood tests. The three women had poor follicle growth, an early LH surge, or a follicle that stayed unruptured. Each pattern repeated in later cycles.

Key Findings

Six consecutive couples met the criteria for unexplained infertility. In three of the six women, ultrasound and hormone tracking showed nothing that could explain the infertility.
One woman had poor follicular growth, a premature small rise of LH, low estradiol in the late follicular phase, an unusually wide LH peak, and low progesterone in the luteal phase.
A second woman's follicle growth was cut short. An early estradiol rise triggered the LH surge while the follicle was still small, and the follicle disappeared 24 hours after the surge.
The authors judged that a third woman fit luteinized unruptured follicle syndrome: her follicle kept growing after the LH/FSH surge, and no fluid appeared in the cul-de-sac.
Progesterone rose later than expected after the LH surge in all three women. The authors report that the abnormalities repeated in later cycles.

Interpretation

This case series followed six couples with unexplained infertility through a full menstrual cycle, tracking follicle growth and hormones directly. Three of the six women showed follicle or hormone abnormalities, and the authors report these patterns repeated in later cycles. The authors note that their account of the late progesterone rise is speculative. The findings support larger studies of direct follicle and hormone tracking in unexplained infertility.

RRM Context

Each couple had a biphasic temperature chart, three or more normal semen analyses, and normal hysterosalpingography and laparoscopy results. Three women still had a finding once follicles were watched directly. RRM treats unexplained infertility as undiagnosed. Here the findings came from following follicle growth and hormones together across the cycle.

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

Abstract

A prospective study of six unselected couples diagnosed as having unexplained infertility was done. In three of six patients, subtle abnormalities in follicular development were detected. In the first case poor follicular growth was observed. There was a premature small rise of luteinizing hormone (LH) with subsequent low levels of estradiol (E2) in the late follicular phase and unusual wide LH peak. This was followed by low progesterone levels in the luteal phase. In the second case follicular growth was abrupted by premature LH surge. This surge was triggered by early rise of E2 level while the follicle was still small in size. In the third case luteinized unruptured follicle syndrome was diagnosed, on ultrasound examination. All of the abnormalities were repetitive.

Topics

Reproductive Endocrinology › Ovulation Physiology › Follicular Development · Diagnostics › Hormone Testing › Serum Panels · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances

Dan Lewinthal, Anchel Furman, Josef Blankstein, Bernard Corenblum, Josef Shalev, Bruno Lunenfeld

Daniel Lewinthal, D Lewinthal, A Furman, J Blankstein, B Corenblum, J Shalev, B Lunenfeld

PMID 3781002 3781002 DOI 10.1016/s0015-0282(16)49821-3 10.1016/s0015-0282(16)49821-3 Lewinthal et al. 1986, Lewinthal 1986

Keywords

Adult, Estradiol/metabolism, Female, Humans, Infertility, Female/etiology/physiopathology, Luteinizing Hormone/metabolism, Ovarian Diseases/complications, Ovarian Follicle/physiopathology, Estradiol, Luteinizing Hormone

Subtle abnormalities in follicular development and hormonal profile in women with unexplained infertility

Follicle problems found in 3 of 6 women with unexplained infertility

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords