Ultrasonic assessment of subsequent unexplained infertility after ovulation induction

Abstract

Summary. The development of ovarian follicles was studied ultra‐sonographically in 21 cycles in eight infertile patients with the diagnosis of ovulatory dysfunction in whom conception did not occur after the defect had apparently been corrected. Pelvic ultrasound demonstrated three patterns in 20 of the 21 cycles studied: ovarian hyperstimulation in seven cycles; follicular atresia before ovulation in three cycles; persistent unruptured follicular cysts in 10 cycles. Recognition of these patterns has been helpful in modifying therapy in infertile patients.

Infertility: Metastatic ovarian strumosis in an in-vitro fertilization patient

“…Ultrasonic assessments demonstrate two different patterns of persistent ovarian cysts (Coulam et al, 1983): unruptured follicle cysts and hyperstimulation of the multiloculated cystic variety such as the one despicted in our patient ( Figure 1). Neither simple nor complex baseline ovarian cysts appear to have a negative impact on ovulation induction or pregnancy rates in an IVF programme (Tummon et al, 1988;Hornstein et al, 1988;Rizk et al, 1990;Stewart et al, 1992).…”

“…It is now well established that cystic ovarian structures may persist into subsequent cycles after ovulation induction or ovarian stimulation for IVF (Coulam et al, 1983;Tummon et al ,1988;Ron-El et al, 1989). Ultrasonic assessments demonstrate two different patterns of persistent ovarian cysts (Coulam et al, 1983): unruptured follicle cysts and hyperstimulation of the multiloculated cystic variety such as the one despicted in our patient ( Figure 1).…”

“…Ovarian cyst formation has been reported after the administration of both human menopausal and chorionic gonadotrophins (Coulam et al, 1983;Tummon et al, 1988) and the gonadotrophin-releasing hormone agonists (GnRH-a) (Ron-El et al, 1989). These simple ovarian cysts are usually accepted as an attenuated form of ovarian hyperstimulation syndrome (OHSS), and are not considered as a contraindication to repeated stimulation whether for in-vitro fertilization (TVF) and embryo transfer or not, and may not adversely affect the prognosis for conception (Tummon et al, 1988;Rizk et al, 1990).…”

Urinary luteinizing hormone testing and prediction of ovulation in spontaneous, clomiphene citrate and human menopausal gonadotropin-stimulated cycles. A clinical evaluation

“…Subsequent spontaneous secondary follicular development was initiated, cul¬ minating in a single ovulation about 2 weeks later. Coulam et al (13), performing ultrasound on pa¬ tients who had failed to conceive after ovulation induction, also reported the same phenomenon in 3 of 21 investigated cycles. While in our series this picture was often observed during hMG stimula¬ tion, its occurrence in clomiphene citrate-induced as well as in spontaneous cycles excludes this to be only a stimulation-related effect.…”

“…Overall, the urinary LH surge was seen to occur after 3 to 4 days of testing, with a cumulative percentage of detection above 98% after seven test days. The first positive decoloured test appeared on mean cycle day 14 in normal and cloniphene citrate-stimulated cycles, and on cycle 13 in the hMG group. The differences among the latter group and the other 2 modalities was statistically significant (p<0.0001, ANOVA).…”