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- Title
Az „ismeretlen eredetű meddőség” oka folliculo-luteális elégtelenség: sikeres kezelése.
- Authors
György, Siklósi
- Abstract
The aim of our study was to investigate the role of folliculo-luteal insufficienty (FLI) in unexplained infertility (UI) (normospermia, intact female anatomical features and verified ovulation) on the basis of new diagnostic criteria elaborated by us. The luteal progesterone 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). Patients and methods: Progesterone (P) mean values measured during the luteal phase of pregnancies resulting in singular, mature and eutrophic newborn can be considered physiological in the aspect of reproduction. In such cycles, the luteal mean P value is: 29.2±3.1 ng/ml (physiological minimum 23 ng/ml) and the luteal average of oestradiol (E2) is 420 pg/ml (physiological minimum 350 pg/ml). We normalized FLF by controlled clomiphene citrate and/or dexamethasone treatment before conception. In 658 UI patients (aged between 20–45 years, 30.3 years on average; 2–17 year infertility period, 4.4 years on average), we normalized folliculo-luteal function (FLF) (P >23ng/ml) using clomiphene citrate and/or dexamethasone treatment and investigated its effect on the patients’ fertility. Results: The monthly pregnancy rate (MPR) was an average of 28.9% during the first three cycles, and the 12-month average was 26.6%, during the second treatment an average of 38.4% (n=212). 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-months 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) and 2.56±2.0. In the untreated control group (N=147, age: 20–45 years, average: 30.3 years; infertility period: 2–14 years, average: 4.2 years), 102 pregnancies occurred in 72 patients (49%) over eight years. CPR over 6 and 12 months were 8.8% and 13.6% in this group. Conclusions: According to our results, the main cause of UI is folliculo-luteal insufficiency, which remains unrecognised by the currently used diagnostic methods: the normalization of FLF –based on the diagnostic parameters we developed – resulted in physiological fertility. Compared to the IVF our treatment method is simpler, more successful, faster, the incidence of all forms of adverse pregnancy outcome are with ten time lower and hundred time cheaper.
- Publication
Magyar Nőorvosok Lapja, 2021, Vol 84, Issue 3, p136
- ISSN
0025-021X
- Publication type
Article