AMENORRHEA AND INFERTILITY AFTER THE USE OF ORAL CONTRACEPTIVES

Abstract

Clinical laparoscopic and radiologic findings in 55 patients refer red because of amenorrhea and infertility following the use of oral contraceptives were compared with ovarian responses in animals which were treated with progestational steroids. Relationship was sought between the length of time the pills were taken previous menstrual history or response to treatment with a view of predicting in which patients these complications might arise. The age range of patients was 19 to 34 years. Infertilty for at least 8 months or amenorrhea for 7 months was present in all. Several combinations of oral contraceptives had been taken and several patients had taken more than 1 preparation. Sequential regimen was used by only 3. Roentgenography of the skull and chest vaginal cytology thyroid function and urinary gonadotropin leve ls were determined for all. Gynecography was performed for 46 patients. Laparoscopy with ovarian biopsy was done for 16. Menstruatio n or pregnancy occurred without treatment in 13; 2 of 4 treated for hypothyroidism menstruated and conceived after 6 months. Roetgenograms were all normal; however there were 15 enlarged smooth and 23 cystic ovaries. Of 31 patients given 50-100 mg of clomiphene daily for 5 days to a maximum of 5 courses 21 menstruated and 12 conceived within 3 months. The other 10 were treated with gonadotropins but only 2 have become pregnant. These results parallel studies in female hooded Lister rats who were treated for 4 months with either norethynodrel chlormadinone or megestrol. 3 to 4 weeks after therapy was discontinued the rats were injected intraperitoneally with 100 IU of pregnant mares serum and 54-56 hours later with 20 IU of human chorionic gonadotrophin to induce superovulation. The ovaries of rats treated with steroid contraceptives were enlarged and had numerous cystic follicles; fertility and release of ova after gonadotropin injection were impaired for at least 7 cycles after discontinuing steroids. Limited initial investigation and prescription of clomiphene is recommended for women suffering from amenorrhea and/or infertility after oral contraceptive use. Laparoscopy is considered for those who do not respond. The value of experimental studies in animals for the assessment of drug responses in humans is emphasized.