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Improvement of Cervical Factor by High-Dose Estrogen and Human Menopausal Gonadotropin Therapy With Ultrasound Monitoring

From the Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, The Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania

Abstract

Conventional treatment of the cervical factor has proved unsuccessful, with fertility rates under 30% usually quoted. Low-dose estrogen has been one of the main therapies but carries the complication of ovulation interference. It is hypothesized that higher doses of estrogen would improve mucus but would have an even greater adverse effect on ovulation. However, the latter could be obviated by concomitant use of human menopausal gonadotropin (hMG). The hMG would then be monitored by pelvic ultrasound because the ingested estrogen would interfere with estrogen assays. Eighty-two percent of 34 infertile women with no motile sperm on baseline postcoital tests improved their levels after therapy with this high-dose estrogen hMG technique. To date, 56% of these women for whom therapy had previously failed have conceived. Nevertheless, simpler and less expensive techniques should be used initially.