INTENSIVE HORMONE MONITORING IN WOMEN WITH UNEXPLAINED INFERTILITY - EVIDENCE FOR SUBTLE ABNORMALITIES SUGGESTIVE OF DIMINISHED OVARIAN RESERVE

Objective: To determine hormone levels across the menstrual cycle in w omen with rigorously defined unexplained infertility. Design: Prospect ive study. Setting: National Center for Infertility Research at Michig an. Patient(s): Evaluation of 1,885 women with infertility identified 12 women who met the following rigorously defined criteria for unexpla ined infertility: [1] infertility of greater than or equal to 24 month s' duration, with no male factor, anatomic or functional disorders of the reproductive tract, or immunologic infertility; [2] normal body ma ss index (BMI); (3) ovulatory cycles ranging from 26 to 32 days; [4] n ormal luteal phase determined by endometrial biopsy; and [5] normal ba seline hormonal profile. Controls (n = 12) were healthy, parous women with normal ovulatory cycles and normal hormonal screens, and were mat ched for age and BMI with patients. Main Outcome Measure(s): Daily gon adotropin and steroid hormone levels across the menstrual cycle. Resul t(s): Basal FSH and LH levels in the early, middle and late follicular phases were increased significantly in the group with unexplained fer tility compared with the normal controls. The mean (+/-SD) early folli cular FSH levels were 7.0 +/- 0.57 mIU/mL in the unexplained-infertili ty group and 4.7 +/- 0.37 mIU/mL (conversion factor to SI units, 1.00) in the normal controls, respectively. There was no difference between groups over the periovulatory or luteal phase. Midluteal mean (+/-SD) P levels were lower in the unexplained-infertility group than in the normal controls (13.7 +/- 1.6 versus 24.0 +/- 3.2 ng/mL [conversion fa ctor to SI units, 3.180]). Mean E-2 concentrations were elevated in th e group with unexplained infertility versus normal controls in the ear ly through the late follicular phase but reached significance only in the midfollicular phase. Mean prolactin levels were elevated consisten tly across the menstrual cycle in the unexplained-infertility group co mpared with those in normal controls but reached significance only in the early and late follicular and midluteal phases of the cycle. Corti sol concentrations were similar between the two groups. Conclusion(s): These data indicate that there are subtle alterations in various horm ones measured across the menstrual cycle in women with unexplained inf ertility compared with those in normal controls, suggesting a diminish ed ovarian reserve. (C) 1997 by American Society for Reproductive Medi cine.