AND SummaryThree hundred and twenty-eight infertile women were selected for treatment with clomiphene citrate because the sole cause of their infertility was absent or infrequent ovulation ; this was induced in 66 -4 per cent with an overall pregnancy rate of 52 per cent. Six types of cytological response to clomiphene are described together with the effect on cervical mucus. Improved results were obtained by a more careful selection of patients and with greater use of combined therapy with human chorionic gonadotrophin, when the ovulatory response rose to 74 per cent with pregnancy rate of 63 per cent.IN 1968 we reported a clinical trial of clomiphene citrate (Clomid, Merrell-National) for the induction of ovulation in unselected women with anovulatory endocrine disorders (Osmond-Clarke, Murray and Bishop, 1968). In this study we found that the biological methods of assessment gave more information about the individual patient's response to clomiphene than any of the biochemical estimations, and theiefore since 1966 we have only used serial endocrine cytology, basal body temperatures and examinations of cervical mucus. We are now reporting the results of treatment of a selected group of women with clomiphene between 1962 and March 1971.

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The number of dyskaryotic cells on ThinPrep slides showing mild cervical dyskaryosis has predictive value. The number of dyskaryotic cells may be used to select women suitable for cytological rather than colposcopic follow-up.

During a recent discussion on classification of cervical cytology, the introduction of a 'Borderline Nuclear Change - High Grade Dyskaryosis Not Excluded' (BNCH) category was proposed. BNCH cases diagnosed prospectively were retrieved from laboratory records. Questionnaires were sent to referring practitioners regarding clinicopathological outcome. Cytopathological features resulting in the BNCH classification were recorded on slide review. A total of 103 reports on conventional cervical smears diagnosed as BNCH from 1999 to 2002 were retrieved, comprising 0.096% of 107 634 smears. Of 86/103 cases with clinical follow-up, CIN2 or worse was present in 30 (35%); 15 (17%) showed a borderline/low-grade abnormality and 41 (48%) were negative. No individual cytopathological feature was predictive of high-grade disease on follow-up. The yield of high-grade abnormalities on follow-up of BNCH supports the introduction of this terminology.

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