Pathophysiology of reproductive failure after clomiphene-induced ovulation

Abstract Seventy patients with infertility were evaluated after clomiphene-induced ovulation to determine the cause of the low rate of conception and subsequent viable pregnancy. Ovarian function was measured employing the usual clinical techniques. In a select group of four, plasma luteotropic hormone, follicle-stimulating hormone, progesterone, and 17-hydroxyprogesterone were measured and ovarian biopsies were obtained. From these studies two groups could be defined. The first group was found to have normal luteal function followed by a relatively high incidence of successful pregnancy. The second group demonstrated abnormal luteal function with only one successful pregnancy. Ovarian biopsies from 2 patients in the second group showed inadequate luteinization of the granulosa cells; a finding which appeared to correlate with abnormal gonadotropin stimulation. These data would suggest that gonadotropin requirements for adequate corpus luteum function are separate from those required for ovulation.