Terrance S. Drake

Continued Clinical Experience with an Increasing Dosage Regimen of Clomiphene Citrate Administrations

Between August 1, 1975, and July 31, 1977, 60 patients with infertility and ovulatory dysfunction were evaluated at the Naval Regional Medical Center, Oakland. Of these, 15 had incomplete work-ups or were lost to follow-up. Of the remaining 45 patients, 2 (4.5%) failed to ovulate at a maximal dose of 250 mg of clomiphene for 5 days with 10,000 units of human chorionic gonadotropin. Of the 43 (95.5%) who did ovulate, 33 conceived. Of these 33 patients, 9 (27%) required greater than 100 mg of clomiphene and/or longer than three ovulatory cycles to conceive. Of the 10 patients who did not become pregnant, additional infertility factors were present in 5. When these 5 were eliminated, the corrected pregnancy rate was 87% (33 of 38). The spontaneous abortion rate was 12.2% and there were no multiple gestations. These results would further emphasize that clomiphene can be used safely and effectively at doses greater than 100 mg or for longer than three ovulatory cycles.

Comparison of the fractional postcoital test and semen analysis

Abstract This twofold investigation was designed to determine the prognostic value of the midcycle fractional postcoital test (PCT) in regard to the semen analysis (SA). The first portion of the study involved a comparison of the SA and PCT in 101 infertility couples. A significant correlation was noted between the number of motile sperm per high-power field at the internal cervical os level and the SA (p 6 sperm. Since the PCT and the SA were not collected from the same ejaculate, the second portion of the study was designed to alleviate this problem. Thirty-eight normal female subjects had midcycle cervical mucus collections after insemination of known amounts of sperm. With time held constant there was a significant correlation between the motile inseminated sperm and the number of cervical mucus sperm (p 6 per cubic centimeter produced greater than 15 motile sperm per high-power field at the internal cervical os. Also a sperm count of 9 × 10 6 per cubic centimeter resulted in 11 to 12 motile sperm per high-power field, whereas only 3 × 10 6 resulted in 5 to 6 sperm per high-power field. Thus, while more than 5 motile sperm per high-power field are considered normal for the fractional PCT, an SA is still necessary for the infertility evaluation. Only when moer than 15 motile sperm per high-power field are noted at the internal cervical os level is repeated SA probably not necessary.

Spontaneous pregnancy during the infertility evaluation.

Of 299 patients evaluated for infertility between July 1, 1974, and December 31, 1976, 21 (7.2%) became pregnant during the initial evaluation prior to any recognized therapy. A comparative analysis was made between these 21 couples and the 223 completely evaluated infertility couples. No significant difference in sexual, psychiatric, or menstrual history was found. There was a significantly increased incidence of low coital frequency in the pregnancy group (P less than 0.01). The mean duration of infertility was also significantly less (1.6 years versus 2.9 years) in the pregnancy group. It is concluded that the majority of patients who become pregnant during an evaluation for infertility do so because of prior low coital exposure. There was no evidence in this study to support the concept that psychophysiologic factors were altered in these 21 couples during the initial clinical visits.

A reassessment of the fractional postcoital test

The present investigation was designed to reassess the fractional postcoital test (PCT). Specifically, the study addressed the question of whether the internal cervical mucus sperm count is significantly different from the sperm counts at other cervical levels. By means of standardized methodology, 25 normal postcoital tests were perfoemed on 22 couples. Cervical mucus from three different levels within the endocervical canal was examined for total count, motility, and sperm morphology. No significant difference could be found in these three parameters among any of the cervical levels (p greater than 0.05). Significantly fewer abnormal sperm were found in the cervical mucus when compared to the total abnormal forms in the semen (p less than 0.001). Therefore, while the fractional PCT is a reflection of cervical sperm, this study indicates that the three different cervical levels in the fractional PCT (internal-mid-external) are equally effective in the interpretation of the postcoital test.