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PLASMA PROGESTERONE ESTIMATION IN INFERTILE WOMEN AND IN WOMEN UNDER TREATMENT WITH CLOMIPHENE AND CHORIONIC GONADOTROPHIN

Plasma progesterone levels were measured by a competitive protein‐binding method in 170 infertile women, of whom 103 were menstruating and 67 were undergoing treatment for anovulatory conditions. The group of menstruating patients was divided into two sub‐groups according to the predominant aetiological factors discovered. Thirty‐three women with obvious non‐hormonal causes of infertility (tubal occlusion or infertile husbands) had mid‐luteal plasma progesterone levels (mean 15.8 ng./ml.) which were significantly higher than those of 70 women without such non‐hormonal factors (mean 11.3 ng./ml.). Forty‐two patients with plasma progesterone levels of less than 10 ng./ml. underwent treatment with HCG or clomiphene or clomiphene and HCG. All these forms of therapy resulted in an approximate two‐fold increase of plasma progesterone concentration, but the best results, in terms of frequency of conception, were obtained by the administration of clomiphene and HCG. In the group of anovulatory patients ovulation was believed to have been induced successfully by clomiphene, or clomiphene and HCG in 57 patients. By monitoring the response to treatment and adjusting the dose, “normal” ovulation, as reflected by plasma progesterone levels, was induced in most instances. Nine pregnancies occurred in 31 patients on clomiphene (45 cycles of treatment) and 16 pregnancies in 29 patients on clomiphene and HCG (60 cycles of treatment). Analysis of the conception cycles revealed that pregnancies occur, with rare exceptions, only during cycles with normal plasma progesterone levels. Defective ovulation and luteal insufficiency as detected by plasma progesterone determination probably play a significant role in infertility and can be corrected in many cases by the preovulatory stimulation of ovarian function.