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Unexplained Infertility and Folliculo-Luteal Function

  • György Siklósi
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Abstract

Hormonal stimulation therapies increase spontaneous pregnancy rates by several times (from 1–3 % up to 10–15 %) in unexplained infertility (UI) (normospermia, intact female anatomical features, verified ovulation). In light of this, we presumed that the cause of UI is the hormonal insufficiency of ovulatory cycles: low preovulatory oestradiol (E2), based on which insufficient luteal P and E2 levels can lead to the formation of a deficient secretory endometrium, which is inappropriate for implantation and placentation (folliculo-luteal insufficiency, FLI). The luteal P level is significantly (p < 0.001) lower in UI than the physiological value (11.3 ± 3.3 and 29.2 ± 3.1 ng/ml).

In 658 UI patients (aged between 20 and 45 years, 30.3 years on average; 2–17-year infertility period, 4.4 years on average), we normalised folliculo-luteal function (FLF) (P > 23 ng/ml) using clomiphene citrate and/or dexamethasone treatment and investigated its effect on the patients’ fertility.

The monthly pregnancy rate (MPR) was an average of 28.9 % during the first three cycles, and the 12-month average was 26.6 %.

The cumulative pregnancy rate (CPR) was 64.1 %, 82.5 %, 90.3 % and 93.5 % over 3, 6, 9 and 12 months, respectively. In patients who continued treatment for 12 months (N = 625), the 12-month CPR was 98.4 % during the first treatments.

Time to pregnancy (TTP) with physiological FLF was 3.14 ± 2.4 cycles during the first treatments (N = 625).

In the untreated control group (N = 147, age of 20–45 years, average of 30.3 years; infertility period of 2–14 years, average of 4.2 years), 102 pregnancies occurred in 72 patients (49 %) over 8 years. CPR over 6 and 12 months were 8.8 and 13.6 % in this group.

According to our results, the main cause of UI is folliculo-luteal insufficiency, which remains unrecognised by the currently used diagnostic methods: the normalisation of FLF – based on the diagnostic parameters we developed – resulted in physiological fertility.

Keywords

Pregnancy Rate Preterm Birth Pregnancy Outcome Clomiphene Citrate Untreated Control Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • György Siklósi
    • 1
  1. 1.Semmelweis University Second Department of Obstetrics and GynecologyBudapestHungary

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