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  • Title: Monitoring of ovulation induction.
    Author: Wu CH.
    Journal: Fertil Steril; 1978 Dec; 30(6):617-30. PubMed ID: 729822.
    Abstract:
    The plasma hormonal patterns of the normal menstrual cycle have been reviewed. A consistent cyclic pattern of plasma hormone levels is observed in LH, FSH, estrogens, and progestins in the menstrual cycle. Other plasma hormones, such as ACTH, growth hormone, TSH, and PRL, as well as androgens and corticosteroids, fluctuate throughout the menstrual cycle without any consistent pattern during the ovulatory cycle. FSH, LH, E2, E1, P, T, and A levels during the induced ovulatory cycle are presneted for comparison. In the gonadotropin-induced ovulatory cycle most hormones behave in a manner similar to that in the normal ovulatory cycle, except for FSH levels, which rise continuously throughout the follicular phase of the cycle. Following ovulation in the gonadotropin-induced cycle, T rises above normal levels. Early in the clomiphene-induced ovulatory cycle, unlike the normal cycle, LH is distinctly elevated. Levels of both LH and FSH in the rest of the cycle simulate those in the normal cycle. However, T and A levels rise from the very beginning of clomiphene therapy and continue to rise throughout the clomiphene-induced ovulatory cycle. Levels of E and P are higher than in the normal ovulatory cycle, but a similar pattern is preserved. Because of the potential dangers of gonadotropin therapy, monitoring by frequent examination and laboratory tests is required. E monitoring is mandatory to evaluate follicular maturation, to time hCG administration, and to minimize hyperstimulation. Cervical mucus is an unreliable parameter for monitoring gonadotropin therapy alone. In addition to cervical mucus, plasma or urinary E should be monitored regularly. Clomiphene therapy is less dangerous than gonadotropin therapy. Because of its lesser risk, monitoring is rarely performed during clomiphene use. An active monitoring approach has been described. While this approach may not necessarily improve the outcome of clomiphene therapy, it may hasten the process of selecting the appropriate dose. Although other ovulation-inducing agents are available, their use is rarely associated with serious medical complications, and monitoring would seem unnecessary. The biophysical and biochemical changes which occur during the normal menstrual cycle are explained and charted. Consistent cyclic plasma hormone levels of LH, FSH, estrogens, and progestins are described. Such other plasma hormones as ACTH, growth hormone, TSH, and PRL, as well as androgens and corticosteroids, fluctuate with no consistent pattern throughout the normal menstrual cycle. In anovulatory women, ovulation can be induced with gonadotropins or clomiphene. The blood hormone patterns occurring during such induced ovulatory cycles are charted and described. Because of the potential dangers associated with gonadotropin induction of ovulation, it is recommended for use only for patients desiring pregnancy at the time of therapy. Monitoring is essential. Cervical mucus monitoring is inadequate and should be supplemented with plasma or urinary E monitoring. Since clomiphene induction is less dangerous, monitoring is less often performed. With both methods, the pregnancies which ensure are subject to a higher rate of spontaneous abortion. Other ovulation-inducing agents are discussed.
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