Basal Body Temperature Charts Research Articles

Luteal phase following oocyte aspiration, in vitro fertilization, and embryo transfer in clomid/HCG-stimulated cycles.

Using basal body temperature and repeated radioimmunological plasma progesterone estimations we monitored the luteal phase in seven patients after the administration of Clomid/hCG, oocyte recovery, in vitro fertilization and embryo transfer. In six of these women, the transferred embryos did not implant, and they bled 13--16 days after oocyte recovery. Neither the basal body temperature charts nor the plasma progesterone levels provided any indication of a luteal phase defect, being indistinguishable from those obtained in a control group of healthy women during the natural cycle. In the seventh woman, transfer of an eight-cell stage embryo resulted in implantation and a pregnancy which, to date (37th week) is developing normally.

Basal Body Temperature: Unreliable Method of Ovulation Detection

Basal body temperature (BBT) charts for menstrual cycles of 98 women were evaluated by six experienced physicians. The time of ovulation as estimated from the charts by a consensus of at least five of the evaluators coincided with the luteinizing hormone (LH) peak +/- 1 day in only 17 (22.1%) of the 77 cycles that were determined by endocrine profiles to be ovulatory and to have adequate luteal phases. An additional 22.1% of these cycles were thought to have monophasic patterns by a consensus of the physicians. Extreme caution in interpretation is urged when BBT is used for clinical or research evaluations of ovulation or menstrual cycle dynamics.

Urodynamic studies in the normal menstrual cycle: The relationship between hormonal changes during the menstrual cycle and the urethral pressure profile

The influence of endogenous gonadal steroids on the urethral pressure profile (UPP) was studied in 27 healthy nulliparous women with normal ovulatory cycles. The UPP and hormonal values were recorded in the follicular phase, at midcycle, and early and late in the luteal phase. Simultaneous urethrocystometry was performed by means of the microtransducer technique, according to a precise standardized methodology. The parameters of the UPP, as defined by the Standardization Committee of the intermational Continence Society, and the area under the urethral closure pressure curve (integrated pressure) were calculated. Reproducibility of the UPP measurements was evaluated. In addition to a basal body temperature (BBT) chart, serum levels of 17β-estradiol (E2), progesterone (P), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were measured at each study session in order to confirm a normal ovulatory pattern for that cycle and for comparison with the urodynamic parameters. The mean values and standard deviations of the UPP parameters in healthy nulliparous women in the supine and sitting positions are presented. Values of the pressure measurements obtained during one menstrual cycle did not change systematically with the hormonal alterations. At midcycle and early in the luteal phase, however, the anatomic and functional lengths of the urethra were consistently increased over those found in the early follicular and late luteal phases. The data suggest a causal relationship between the changes in serum E2 concentrations and the changes in urethral length.

Clinical Investigation of the Menstrual Cycle. III. Clinical, Endometrial, and Endocrine Aspects of Luteal Defect

This study was intended to correlate different clinical and biologic parameters to better define luteal insufficiency (LI) and to contribute to a better understanding of its origin. Endometrial patterns were used as the basis for classification of clinical cases. Of 328 outpatients with menstrual disorders and/or infertility, 88 were considered to have LI. Their cycles were compared with 79 normal cycles. Two different principal endometrial patterns of LI are described: pure LI, when the endometrium is more than 2days out of phase; and LI with persistent estrogenic influence, when the histologic estrogenic stigmata are excessive during the luteal phase. Basal body temperature charts demonstrated menstrual cycle disturbances: either ovulation delay or a slow increase in temperature (longer than 2days). Plasma steroid concentrations also demonstrated a perturbation of the entire menstrual cycle: progesterone levels were statistically significantly lower in LI than in normal cycles and this defect was worse when the estrogenic influence was persistent; the preovulatory estradiol peak was disturbed in all circumstances, as was the concentration of endometrial steroid receptors. These simultaneous abnormalities strongly suggest a central origin of LI.

Sonographic monitoring of ovarian follicular development

Serial sonographic examinations were performed on 15 volunteers five days during the expected midcycle. The 75 sonographic studies were evaluated in a nonbiased manner, and the following features were assessed: 1) the presence or absence of a follicle within the ovary; 2) if present, the average dimension of the follicle; 3) the ability to delineate both ovaries; and 4) the presence of associated changes, such as involution of the follicle, echogenic texture within the follicle, or fluid in the cul-de-sac. The sonographic findings were correlated with serial leutinizing hormone (LH) assays as well as basal body temperature charts. As defined in the study, the correlation between the sonographic findings and hormonal determination were considered excellent in 70% of the cases, good in 20%, and poor in 10%. Both ovaries were delineated in 73% of the examinations performed, thus substantiating the ability of sonography to detect maturing ovarian follicles.

The Diagnostic and Therapeutic Potential of the Postcoital Test

An analysis was made of postcoital tests carried out on 423 couples attending the Rotunda and St. James Hospitals in Dublin. Initially 66.6% of tests were abnormal, but 21.3% of these were invalid because of the presence of seminal or cervical abnormalities, leaving 57.7% of couples with initially valid negative tests. Retesting showed 30.3% of couples to have persistently negative tests, 24.5% of whom achieved pregnancy. Three per cent of abnormalities were immunologic in origin. The most common cause why a subsequently positive test was initially negative was failure to observe correct clinical procedures, but unadmitted psychosexual problems were present in 17.6% of cases. Of the best postcoital tests, 78.5% correlated well with semen analyses and 90.9% with basal body temperature charts. In total, 6.2% of all pregnancies achieved in the clinics followed postcoital testing.

Clinical Investigation of the Menstrual Cycle. III. Clinical, Endometrial, and Endocrine Aspects of Luteal Defect

This study was intended to correlate different clinical and biologic parameters to better define luteal insufficiency (LI) and to contribute to a better understanding of its origin. Endometrial patterns were used as the basis for classification of clinical cases. Of 328 outpatients with menstrual disorders and/or infertility, 88 were considered to have LI. Their cycles were compared with 79 normal cycles. Two different principal endometrial patterns of LI are described: pure LI, when the endometrium is more than 2 days out of phase; and LI with persistent estrogenic influence, when the histologic estrogenic stigmata are excessive during the luteal phase. Basal body temperature charts demonstrated menstrual cycle disturbances: either ovulation delay or a slow increase in temperature (longer than 2 days). Plasma steroid concentrations also demonstrated a perturbation of the entire menstrual cycle: progesterone levels were statistically significantly lower in LI than in normal cycles and this defect was worse when the estrogenic influence was persistent; the preovulatory estradiol peak was disturbed in all circumstances, as was the concentration of endometrial steroid receptors. These simultaneous abnormalities strongly suggest a central origin of LI.

The infertile patient. Guidelines for successful workup.

The key to a successful infertility workup is to follow a protocol carefully and completely. After preliminary history taking and physical examination, tests are carried out systematically to investigate all possible ovulatory, cervical, tubal, and endometrial factors. A basal body temperature chart is essential for proper timing of tests, and a flow sheet helps keep track of results. Thorough evaluation of the man is also needed to identify possible causative factors.

Endometrial Biopsy During a Cycle of Conception

Endometrial biopsies obtained from 18 infertile women during early intrauterine pregnancy were examined histologically. The cycle date on which the biopsies were obtained was determined from the day of ovulation by basal body temperature charts and prior menstrual history. The average cycle dates of the biopsies were similar for the women who delivered at term or who had first-trimester spontaneous abortions. Among the women who delivered at term, the average histologic date assigned to the specimens was significantly earlier than the average cycle date. In contrast, among the women who had early pregnancy loss, the specimens had an average histologic date significantly later than the average cycle date. A histologic date of later than 25 days or later than the cycle date of the biopsy was associated with a poor prognosis for the pregnancy.

The adjustment of basal body temperature measurements to allow for time of waking.

During one menstrual cycle, each of eleven volunteer student nurses at Northwick Park Hospital recorded their vaginal temperature on waking and noted the clock time. Waking times varied between 0530 hours and 1100 hours. Regression analysis revealed significant linear relation between temperature and time of waking, with a slope of 0.086 degrees C/hour (SE, 0.009 degrees C/hr) in the postmenstrual (hypothermal) phase. A rounded adjustment factor of 0.1 degrees C/hour is shown to improve the interpretability of basal body temperature (BBT) charts in a group of seven women regularly using natural family planning methods. The adjustment factor is simple to apply and only involves counting one square on a BBT chart for each hour that the waking time differs from normal.

DIAGNOSIS OF THE LUTEINIZED UNRUPTURED FOLLICLE SYNDROME BY STEROID HORMONE ASSAYS ON PERITONEAL FLUID

The luteinized unruptured follicle syndrome is a frequent phenomenon, occurring in half of our women with regular cycles and infertility. Progesterone concentrations and 17 beta-oestradiol concentrations were assayed in peritoneal fluid of women during the luteal phase. Up to day 20 of the cycle, the concentrations were significantly higher in women with an ovulation stigma than in women without an ovulation stigma on their corpus luteum. The range of concentrations was sufficiently different in the early luteal phase to be used diagnostically, the only limitation being the presence of a cystic corpus luteum. We suggest that the assay of progesterone and 17 beta-oestradiol in peritoneal fluid should be done in all women with infertility and biphasic basal body temperature charts in order to diagnose the luteinized unruptured follicle syndrome.

An Objective Method for Detecting the Shift in Basal Body Temperature in Women

The upward shift in basal body temperature (BBT) observed in women of child-bearing age is often used as an indicator that ovulation has occurred and that a period of infertility has begun. In natural family planning programmes it is important to detect the BBT shift reliably and with a minimum of user uncertainty, against a background of physiologically induced temperature variations. The cumulative sum (CUSUM) test is adapted to the problem of detecting BBT shift and applied to 137 BBT charts obtained from 21 women using natural family planning. Results show successful detection of the shift in all cases. Shifts occurred at gynaecologically appropriate times in the menstrual cycle.

Induction of Ovulation in Women with Hyperprolactinemic Amenorrhea Using Clomiphene and Human Chorionic Gonadotropin or Bromocriptine

RADWANSKA, EWA; McGARRIGLE, HUGH H. G.; LITTLE, VALERIE; LAWRENCE, DAPHNE; SARRIS, SPIROS; SWYER, GERALD I. M. Author Information

Induction of Ovulation in Women with Hyperprolactinemic Amenorrhea Using Clomiphene and Human Chorionic Gonadotropin or Bromocriptine

Clomiphene citrate (Clomid), when given alone, is generally considered ineffective in inducing ovulation in women with hyperprolactinemia. This study reports the treatment of 29 infertile women with hyperprolactinemic amenorrhea. Twenty-one patients (eighteen of whom had previously had no ovulation response to Clomid alone) were treated with a combined regimen of Clomid (100 to 200 mg/day for 5 days) and two injections of 5000 IU of human chorionic gonadotropin (HCG), the first 8 to 10 days after Clomid withdrawal and a second injection 1 week later. Basal body temperature charts, conception, and/or plasma progesterone measurements showed that 19 patients ovulated (90%). There were 17 pregnancies in 12 of 21 patients (57% pregnancy rate) with 15 single live births and two abortions. When bromocriptine (Parlodel) became available, a total of 22 patients (including 14 patients previously treated with Clomid/HCG, six of them successfully) with amenorrhea associated with hyperprolactinemia were treated with this drug with dosages varying from 2.5 mg to 15 mg/day. Ovulation was confirmed in 20 patients (90%). There were 17 pregnancies in 15 patients (68% pregnancy rate) with 15 single live births and two first-trimester abortions. In all, 21 of 29 patients (73%) achieved one or more pregnancies resulting in live births with one or both of the above treatments. It is concluded that a combined Clomid/HCG regimen can often be used as an effective alternative to bromocriptine therapy in the treatment of infertility associated with hyperprolactinemic amenorrhea.

THE DIAGNOSIS AND THERAPY OF LUTEAL PHASE DEFICIENCY

Soules, Michael R.; Wiebe, R. Herbert; Aksel, Sezer; Hammond, Charles B. Author Information

Clinical Investigation of the Menstrual Cycle. I. Diagram of the Normal Menstrual Cycle

The clinical definition of normal menstrual cycles has been attempted by using the basal body temperature charts of patients without gynecologic dysfunction who conceived in the following cycle. A second-species linear regression method has been used for statistical comparison of lengths of both follicular and luteal phases. A graphic representation of the equation of the tolerance limit about 46 normal cycles is proposed which can be considered a nomogram of the menstrual cycle.

The Diagnosis and Therapy of Luteal Phase Deficiency

Between 1973 and 1975, 16 patients evaluated for infertility at Duke University Medical Center were diagnosed as having luteal phase deficiency. A majority had had prior infertility surveys, and the average duration of their infertility exceeded 2 years. The diagnosis was suspected after study of basal body temperature charts and menstrual patterns in more than 80% of the patients. This diagnosis was established by timed endometrial biopsy. The primary method of therapy was supplementation of the luteal phase with progesterone vaginal suppositories. The pregnancy rate after therapy was 50% and pregnancy occurred after a mean of five treatment cycles. The minimal follow-up of patients who failed to conceive was 8 months. To date, the majority of these pregnancies have been completed without complication and the remainder are progressing satisfactorily. Two additional patients developed luteal phase deficiency while taking clomiphene citrate and became pregnant with progesterone supplementation.

Artificial Insemination Donor: Clinical and Psychologic Aspects

Forty-four sterile sterile couples in whom the main cause of infertility was the male factor were investigated. Artificial insemination donor (AID) was performed, timed according to the basal body temperature chart. It was found that it is important to match not only the physical appearance of the couple to that of the donor but also the blood group of at least one of the future parents. Patients were interviewed by a psychologist in order to define their marital relationship, their attitude toward the infertility, their feelings about AID in comparison to adoption, their attitude toward the donor and pregnancy, and their attitude toward their physician. The role of the psycholgist in AID treatment was found to be important for careful selection of cases. He can also guide and prepare these couples to face family life in the future.

Spontaneous abortion and aging of human ova and spermatozoa.

To test the hypothesis that aging of human gametes within the genital tract increases the chance of abortion, we measured the probabilities of abortion after insemination on a given day of the menstrual cycle in relation to the day of the shift in the basal body temperature in 965 patients. Cases came from family-planning and sterility clinics where basal body temperature and coital records are kept routinely. The probability of abortion diminished significantly (P less than 0.001) as the shift in temperature was approached and the increased to its highest point (24 per cent) three days later. Animal experiments have shown that aging of both spermatozoa and ova before fertilization is accompanied by higher probabilities of abortion. Present evidence indicates that this higher prevalence is also true for human beings.

Urinary hormone excretion patterns during low-dose progestogen administration.

The effects on pituitary-ovarian function of long-term administration of 0·5 mg of lynestrenol and 0·35 mg of norethisterone in continuous daily doses were investigated in 9 female subjects. The parameters employed were the basal body temperature charts and urinary assays of LH, total oestrogen and pregnanediol. At the start of administration, ovulation was usually inhibited, but as a rule this effect disappeared as administration continued. Corpus luteum function appeared to be reduced.