CYCLE ABNORMALITIES IN INFERTILE WOMEN WITH REGULAR MENSTRUAL CYCLES - EFFECTS OF CLOMIPHENE CITRATE TREATMENT

Objective: To investigate the incidence and nature of cycle abnormalit ies and the effect of clomiphene citrate (CC) treatment in women with apparently ovulatory cycles and unexplained infertility. Design: Nonra ndomized, open study of patients before and during treatment. Setting: The Reproductive Medicine Clinic of a District General Hospital. Pati ents: Thirty-five women with regular, apparently ovulatory menstrual c ycles and unexplained infertility. Interventions: Detailed ultrasound and hormonal cycle tracking was performed before and during treatment with CC. Main Outcome Measures: Serial ultrasound scans and measuremen ts of serum LH, FSH, E(2), and P. Results: Before treatment, 54% of cy cles were uniovulatory, 40% were characterized by cyst formation, and 6% were characterized by poor follicular growth. Fifty-one percent of pretreatment cycles had normal hormone profiles, 31% had defective lut eal phases, 14% had increased early follicular phase serum FSH levels, and 9% had increased early follicular phase serum LH levels. Treatmen t with CC reduced the incidence of cyst formation to 9% and the incide nce of luteal phase defects to 3%. However, 28% of CC-treated cycles s howed ultrasound features of overstimulation and 51% had high follicul ar phase E(2) peaks so that only 34% of CC-treated cycles had normal h ormone profiles. Conclusions: Cycle abnormalities are common in unexpl ained infertility. The incidence of cyst formation and luteal phase de fects, the most common abnormalities in this group, is reduced by CC t reatment.