Failure to Induce Ovulation with Clomiphene Citrate and Bromocriptine in Luteal Deficient Women Athletes

Abstract

This study was designed with a three-fold aim: to assess ovarian function of women athletes with menstrual irregularities (AMI); to evaluate the potentiality of clomiphene citrate and bromocriptine for the induction of ovulation in these women; and to show that ultrasound scanning offers a suitable technique for ovarian screening in healthy and high-performance athletes. Our small test group consisted of 11 women, mainly track athletes, with AMI. There was no significant difference in age at menarche (13.2 yrs ± 0.2), percent of ideal body weight (92% ± 4), or percent of body fat (12.3% ± 2.8) among the subjects. Plasma estradiol values were low (mean: 22 pg/ml ± 0.8), as were those of plasma progesterone (2.85 ng/ml ± 2.10), LH (5.6 mIU/ml ± 0.8), and prolactin (10.89 ng/ml ± 5.56). The mean distance run per week (35 km ± 15) was relatively high considering the presence of 4 non-runners. All menstrual irregularities were attributed to exercise. A short luteal phase (7 days ± 1.5 for a cycle with a mean duration of 25 days ± 1.8) was found in all subjects. We failed to observe the presence of a corpus luteum in 9 out of 11 women. A two-month administration of clomiphene citrate (150 mg/d for 5 days) or bromocriptine (2.5 mg/d) did not succeed in provoking ovulation in any of these women. Ultrasonographic observations showed a continuously hypo-estrogenic endometrium with a consecutively developing and regressive follicle. Our data emphasize the difficulties inherent in the restoration of menstrual function in women athletes with AMI. In addition, the usefulness of ultrasound in screening ovarian function was confirmed.

Key words

Amenorrhea - anovulation - bromocriptine - clomiphene citrate - luteal phase deficiency - ovulation induction