Basal Ovarian Cysts and Clomiphene Citrate Ovulation Induction Cycles

John M. Csokmay, John L. Frattarelli
In: Obstetrics & Gynecology · 2006 · vol. 107(6) , pp. 1292–1296 · doi:10.1097/01.aog.0000217695.95139.1e · PMID:16738154 · W2334736889
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Basal ovarian cysts significantly reduced ovulation rates in patients undergoing clomiphene citrate treatment, although pregnancy rates did not differ significantly from patients without cysts.

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This prospective cohort trial evaluated the impact of basal ovarian cysts on infertility patients undergoing ovulation induction with clomiphene citrate. The study compared 42 patients with cysts measuring 10 mm or greater against 42 patients without cysts, assessing ovulation rates via progesterone levels and monitoring cyst persistence through ultrasound. Results indicated that while patients with baseline cysts had significantly lower ovulation rates, their pregnancy rates did not differ significantly from those without cysts, and initial cyst size failed to predict whether a cyst would persist. This paper is centrally about endometriosis — specifically regarding the management of ovarian cysts often associated with the condition during fertility treatments.

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Abstract

OBJECTIVE: To evaluate the effect of simple basal ovarian cysts in patients undergoing infertility treatment with clomiphene citrate. To evaluate the effect of clomiphene citrate on pretreatment simple ovarian cysts. METHODS: Prospective cohort trial of 84 infertility patients undergoing ovulation induction with clomiphene citrate. Patients with basal ovarian cysts of 10 mm or greater (n = 42) were compared with patients without ovarian cysts (n = 42). The main outcome measure was ovulation determined by menstrual cycle day 21 progesterone level. Each patients with an ovarian cyst was also evaluated for persistence or resolution of the cyst in association with ovulation and cyst size. Pretreatment and posttreatment transvaginal ultrasound examinations were performed on all patients. RESULTS: Demographic data were similar among the groups. The mean ovarian cyst size was 17.4 +/- 5.8 mm. Patients in the ovarian cyst group were significantly less likely to ovulate (80.9% versus 97.6%, P < .05), but did not differ in pregnancy rate compared with patients without baseline ovarian cysts (4.8% versus 11.9%, P = .43). Persistent ovarian cysts occurred in 36.7% of the patients. The initial size of the cyst did not predict cyst persistence. CONCLUSION: According to these data, basal ovarian cysts significantly reduce ovulatory events in patients treated with clomiphene citrate. LEVEL OF EVIDENCE: II-2.
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Objective

To evaluate the effect of simple basal ovarian cysts in patients undergoing infertility treatment with clomiphene citrate. To evaluate the effect of clomiphene citrate on pretreatment simple ovarian cysts.

Methods

Prospective cohort trial of 84 infertility patients undergoing ovulation induction with clomiphene citrate. Patients with basal ovarian cysts of 10 mm or greater (n = 42) were compared with patients without ovarian cysts (n = 42). The main outcome measure was ovulation determined by menstrual cycle day 21 progesterone level. Each patients with an ovarian cyst was also evaluated for persistence or resolution of the cyst in association with ovulation and cyst size. Pretreatment and posttreatment transvaginal ultrasound examinations were performed on all patients.

Results

Demographic data were similar among the groups. The mean ovarian cyst size was 17.4 ± 5.8 mm. Patients in the ovarian cyst group were significantly less likely to ovulate (80.9% versus 97.6%, P < .05), but did not differ in pregnancy rate compared with patients without baseline ovarian cysts (4.8% versus 11.9%, P = .43). Persistent ovarian cysts occurred in 36.7% of the patients. The initial size of the cyst did not predict cyst persistence.

Conclusion

According to these data, basal ovarian cysts significantly reduce ovulatory events in patients treated with clomiphene citrate. LEVEL OF EVIDENCE: II-2

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