Friday, August 27, 2010

LUF syndrome and infertility

Ovarian follicleIn normal healthy fertile females, ovulation with rupture of the mature ovarian follicle and release of the eggs occurs within 38 hours of the surge in luteinizing hormone (LH). However, in a small percentage of women, the dominant follicle will undergo the luteinization process but will not rupture following the midcycle LH surge. This is called LUF (luteinized unruptured follicle syndrome). As a result of the increased progesterone secretion, the endometrium undergoes the secretory changes, but, obviously, without the release of the oocyte , pregnancy cannot occur. This means that the cycles are regular; and hormonal studies ( Day 21 progesterone level) , the basal body temperature curve, and the findings in an endometrial biopsy will all be consistent with ovulation.

This is obviously a difficult diagnosis to make; and can only be made by serial vaginal ultrasound scans to track ovulation. These scans show that the follicle matures; but the dominant follicle fails to rupture. The lack of follicle rupture and the lack of free peritoneal fluid around the time of ovulation are used to establish the diagnosis of LUF. This condition is also called “trapped egg syndrome”.

LUF is more commonly seen in women with endometriosis; and PCOD. Often the diagnosis is made only when patients are being monitored for follicle tracking with serial ultrasound scans. LUF is a “silent” problem; and because it does not cause any symptoms or signs, it’s very easy to miss the diagnosis as well ! Since LH is responsible for inducing follicular rupture, LUF can be treated by giving an injection of Human Chorionic Gonadotropin (hCG) in a dose of 10,000 IU intramuscularly, when the lead follicle reaches 18-20 mm in diameter. Ultrasound can be used to document ovulation. It takes about 36 to 40 hours for the oocyte to be released after the injection. Intercourse or insemination should be timed accordingly. If it still does not take place, the dose of the hCG injection can be increased. If ovulation still cannot be achieved even with an increased dose of 20000 IU , then IVF is the best solution.

In our clinic, we really do not bother to make a diagnosis of LUF ! This is because this diagnosis does not really change your treatment options . After all, if you are infertile, this means the eggs and sperm are not meeting. The next step logically is to then do an IUI – and since an HCG injection is routinely given during IUI treatment to induce ovulation, the IUI automatically helps to treat patients who have LUF !



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11 comments:

  1. Anonymous10:40 AM

    Wow! quite a jump at the end about how if you have LUFS you should have IUI. LUFS has to do with the egg not releasing, so IUI has no effect on that whatsoever. Maybe IUI increases you odds 5% of conceiving that cycle, but only first if you are certain that the follicle is releasing, which can be confirmed through ultrasounds before and after ovulation.

    ReplyDelete
  2. The advantage of doing an IUI is that in an IUI cycle, ovulation is usually induced using HCG, thus treating the LUF also effectively, and increasing the chances of conceiving quickly in that cycle.

    If you are going for ultrasound scanning in any case, then doing an IUI in that cycle makes sense ( at least in India, where an IUI is very inexpensive !) I agree this may not be true in the USA, where IUI can be very expensive !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  3. IUI's do not always work. I had IUI's for two months straight. After the second month I requested an ultrasound after my HCG trigger shot, this showed the follicle DID NOT RUPTURE. Having an IUI has nothing to do with.

    ReplyDelete
  4. Yes, IUIs have a success rate of only 10% per cycle.

    My point is that they are logical next step in treating LUF before consider IVF !

    Dr Malpani

    ReplyDelete
  5. Anonymous5:58 PM

    Dear sir,
    My wife is dignosed with LUF. Even with 10,000 HCG follicle do not rupture. Her AMH is only 0.39. What should we do now?

    ReplyDelete
  6. Please share this with her

    Your low AMH level ( www.drmalpani.com/amh.htm)
    suggests you have poor ovarian reserve .

    You can read more about this at www.drmalpani.com/oopause.htm.

    Dr Malpani

    ReplyDelete
  7. ILMAS9:27 PM

    DEAR SIR,
    WHAT ABOUT TREATMENT OF LUF THROUGH THE IMPLEMENTATION OF NAPRO TECHNOLOGY. AND ALSO ABOUT USE OF LUPRON AND NEUPOGEN AS TRIGGERS.

    ReplyDelete
  8. Neupogen is not a trigger. Lupron can be used as a trigger because it causes an LH surge, but HCG is far more effective because it induces follicular rupture directly. I do not think Napro Technology has any role to play in treating LUF at all

    ReplyDelete
  9. Anonymous10:58 PM

    Dear Sir,
    After doing lot of research on treating LUFS on net i got info that many doctors in many parts of europe, usa and canada are using napro technology to terat patients with LUFS so that IVF can be avoided. Could you please suggest any other than IVF to treat LUFS??

    ReplyDelete
  10. Dear doctor...
    My wife is diagnosed with tubal blockage after myomectomy
    We had a surgery for adhenolysis and tubes are open now but we get to know her follicles does not rupture even after hcg 10000
    Our doctor gave her lupride
    Hmg
    Fsh
    And hcg 10000
    But her follicles does not rupture
    We had a failed cycle of ivf coz her 12 eggs does not get fertilised...plz guide us

    ReplyDelete
  11. Anonymous2:48 PM

    Everything is very open with a clear clarification of the challenges.
    It was truly informative. Your website is very
    useful. Many thanks for sharing!

    ReplyDelete

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