The Use of Ovarian Ultrasound and Biochemistry in the Investigation and Management of the Female Partner in Couples With Unexplained Infertility

Hamilton, Mark Patrick Rogers (1988) The Use of Ovarian Ultrasound and Biochemistry in the Investigation and Management of the Female Partner in Couples With Unexplained Infertility. MD thesis, University of Glasgow.

Abstract

Fertility assessment is founded firstly on the documentation of egg and sperm availability and secondly on a determination that the gametes can meet. If these criteria are met, then continued infertility is deemed to be unexplained, a situation found in 20-30% of the couples attending most infertility clinics. Conventional tests of ovulation are, in the absence of pregnancy, indirect barometers of ovarian function, and tell us little of the dynamics of follicular growth, oocyte release and corpus luteum function. Since gonadotrophin and ovarian steroid secretion is dynamic, and the endometrium is sensitive to hormonal fluctuations during the cycle, it is clear that if reproductive function is to. be assessed satisfactorily then the maximum information possible must be obtained. The concept of luteal phase deficiency (LPD) has aroused considerable debate over the years, and disagreements over the nature, definition, diagnosis and clinical implications of the condition abound in the literature. A number of studies on patients with unexplained infertility have demonstrated subtle deviations from normal in the plasma concentrations of gonadotrophins and ovarian steroids, but none have, in substantial numbers, related these features to ultrasonically observed follicular growth patterns. The present study was designed to explore ovarian function in women with unexplained infertility using the combined resources of ovarian ultrasound and simultaneous daily plasma biochemistry to elaborate follicular growth patterns and gonadotrophin and ovarian steroid hormone profiles in blood. These ultrasonic and endocrine profiles were then related to those obtained from normally cycling, presumably fertile, volunteers and from spontaneous conception cycles . Daily blood samples were taken throughout complete menstrual cycles and frequent ultrasound scans were performed during the periovulatory and luteal phases. The normal cycle data (43 cycles) were compared with that from 11 spontaneous conception cycles, and in terms of follicular growth and corpus luteum function, showed no differences, thus justifying the use of the control data as the yardstick of normality. 175 cycles from patients with unexplained infertility were studied in detail. 98 (56%) of these cycles demonstrated apparently abnormal ovarian function. The analysis of these "abnormal" cycles provides the core of the thesis. Luteal cyst formation was seen in 41 cycles (23. 4%); reference to the U/S and biochemical data discriminated two distinct subgroups - those where the dominant follicle was seen to shrink prior to luteal cyst formation, often associated with normal ovarian steroid profiles, and those cycles where no shrinkage of the follicle was seen following the LH peak, very often associated with markedly deficient luteal phase plasma P concentrations. The former, it is hypothesised, represent cystic corpora lutea and the latter, may be luteinised unruptured follicles (LUF's). Cyst size alone was not a sensitive indicator of the nature of the luteal cysts seen. 51 cycles (29. 1%) were found to exhibit abnormal patterns of P production in the early luteal phase. Many such PPS cycles exhibited mid-luteal P concentrations in excess of "normal ovulatory" criteria, indicating that infrequent sampling will miss a high proportion of abnormal cycles. 45. 1% of the PPS cycles also demonstrated luteal cyst formation, the majority of which were LUF's. Thus in these cycles it is likely that impairment of oocyte release and sub-optimal endometrial receptivity render the cycle infertile. (Abstract shortened by ProQuest.).

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Keywords: Obstetrics
• Date of Award: 1988
• Depositing User: Enlighten Team
• Unique ID: glathesis:1988-77791
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 14 Jan 2020 11:53
• Last Modified: 14 Jan 2020 11:53
• URI: https://theses.gla.ac.uk/id/eprint/77791