Minimal requirements for a successful outcome in anovulatory patients treated with human menopausal gonadotropins

Objective-To determine the minimal requirements for achieving a full-term s ingleton pregnancy in hMG-treated patients. Methods-One hundred and ninety- two pregnancy cycles resulting from hMG therapy in infertile patients were retrospectively studied to determine the minimal requirements for the occur rence of a pregnancy in those women. The cycles were divided into five grou ps: pregnancies ending in miscarriage, ectopic pregnancies, pregnancies end ing in preterm delivery, full-term singleton pregnancies, and full-term mul tiple pregnancies. The number of hMG ampules, the number of preovulatory fo llicles reaching 18 mm or more in diameter, the cervical mucus score (Insle r), the number of living spermatozoa per high-power field (HPF) observed in the cervical mucus on the day of hCG administration, and the midluteal pla sma progesterone concentration were determined and correlated with the outc ome of the pregnancy in the five groups studied. The minimal requirements f or the occurrence of a full-term singleton pregnancy were also determined. Results-In this cohort of 192 women, the mean number of hMG ampules adminis tered was 25.38 (1903.5 IU), the mean number of preovulatory follicles reac hing 18 mm was 2.1, the mean cervical mucus score (Insler) was 9.48, and th e mean number of motile spermatozoa per HPF in the cervical mucus on the da y of hCG administration was 19.3. There were no statistically significant d ifferences between the five groups studied regarding these four variables. The mean midluteal plasma progesterone concentration was 29.07 ng/mL and th ere was no statistically significant difference in midluteal plasma progest erone concentration between the cycles resulting in full-term deliveries an d those ending in miscarriage. However, a statistically significant differe nce in midluteal plasma progesterone concentration was found between the cy cles resulting in full-term singleton pregnancies and those resulting in fu ll-term multiple pregnancies. Conclusions-The minimal requirements for achi eving a full-term singleton pregnancy were 9 ampules of hMG (675 IU), one 1 8-mm follicle, a cervical mucus score (Insler) of 6 on the day of hCG admin istration, and a midluteal plasma progesterone concentration of 10.83 ng/mL . The presence of motile spermatozoa in the cervical mucus was a reassuring sign in 92.7% of instances but was not an absolute necessity for a success ful outcome.