FERTILITY AND STERILITY Copyright ~ 1976 The American Fertility Society
Vol. 27, No.1, January 1976 Printed in U.S.A.
METHYLTESTOSTERONE TREATMENT OF INFERTILITY ASSOCIATED WITH PELVIC ENDOMETRIOSIS K. PAUL KATAYAMA, M.D., PH.D.,* MAY MANUEL, M.D.,t HOWARD W. JONES, JR., M.D., AND GEORGEANNA S. JONES, M.D.
Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
Endometriosis is sometimes associated with infertility. Various endocrine products have been used to aid fertility. This report describes the results of methyltestosterone treatment for the infertility associated with this disease. MATERIALS AND METHODS
Our experience with the primary use of methyltestosterone for treatment of infertility is based on 64 patients. All of them went through our routine infertility work-up, which included semen analysis, Huhner test, timed endometrial biopsy for luteal phase evaluation, hysterosalpingography, and endoscopic examination. When a difficulty was found in the course of the work-up, such as infected cervical mucus, an effort was made to treat it. The diagnosis of endometriosis was usually made by endoscopic observation. The patients with large adnexal masses were usually excluded from primary medical treatment and submitted to primary surgical treatment, because we did not want to overlook any ovarian neoplasms and because the treatment of large masses of endometriosis by endocrine therapy is generally not satisfactory. The average age of the patients in this series was 29 and the mean duration of the infertility was 4 years and 4 months (Table 1). Received April 4, 1975. *Present address: Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wis. 53226. tPresent address: 2 Village Road, Madras 34, S. India.
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As a rule, a 5-mg methyltestosterone (Metandren) Linguet was given every day continuously for a period of 6 months. During this time a record of the basal body temperature was maintained; if a pregnancy was suspected, the medication was discontinued so that the possibility of masculinizing a female conceptus could be avoided, although, theoretically, a 5-mg dose is too small to do this. RESULTS
Of the 64 patients treated with methyltestosterone, 12 patients became pregnant: 3 during treatment, 6 1 month after termination of treatment, and 3 thereafter. There was one ectopic pregnancy; the rest resulted in live births. The average length of treatment with testosterone was 4.8 months for the pregnant group and 5.6 months for the nonpregnant group. The mean duration of infertility for the former group was 3 years and 4 months and for the latter group 4 years and 7 months. On the average, the patients became pregnant within 6.4 months. When the patient did not become pregnant within a reasonable time after initiation of the testosterone treatment, she was usually offered conservative surgery, thus terminating the follow-up for testosterone therapy. The mean follow-up period for this group was only 12.4 months. The rate of pregnancy was clearly dependent upon the length of follow-up: the shorter the follow-up period, the lower the
84
January 1976
KATAYAMA ET AL.
TABLE 1. Infertile Patients with Endometriosis Treated with Methyltestosterone (64 Cases)" Age of patients
Duration of infertility
Cycles treated
yr
mo
rna
Patients achieving pregnancy Patients failing pregnancy
28.4 ± 4.6 28.7 ± 4.0
39.6 ± 23.4 54.9 ± 38.9
4.8 ± 2.3 5.6 ± 2.4
6.4 ± 4.0b 12.4 ± 13.7
Vol. 27, No.1, January 1976 Printed in U.S.A.
METHYLTESTOSTERONE TREATMENT OF INFERTILITY ASSOCIATED WITH PELVIC ENDOMETRIOSIS K. PAUL KATAYAMA, M.D., PH.D.,* MAY MANUEL, M.D.,t HOWARD W. JONES, JR., M.D., AND GEORGEANNA S. JONES, M.D.
Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
Endometriosis is sometimes associated with infertility. Various endocrine products have been used to aid fertility. This report describes the results of methyltestosterone treatment for the infertility associated with this disease. MATERIALS AND METHODS
Our experience with the primary use of methyltestosterone for treatment of infertility is based on 64 patients. All of them went through our routine infertility work-up, which included semen analysis, Huhner test, timed endometrial biopsy for luteal phase evaluation, hysterosalpingography, and endoscopic examination. When a difficulty was found in the course of the work-up, such as infected cervical mucus, an effort was made to treat it. The diagnosis of endometriosis was usually made by endoscopic observation. The patients with large adnexal masses were usually excluded from primary medical treatment and submitted to primary surgical treatment, because we did not want to overlook any ovarian neoplasms and because the treatment of large masses of endometriosis by endocrine therapy is generally not satisfactory. The average age of the patients in this series was 29 and the mean duration of the infertility was 4 years and 4 months (Table 1). Received April 4, 1975. *Present address: Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wis. 53226. tPresent address: 2 Village Road, Madras 34, S. India.
83
As a rule, a 5-mg methyltestosterone (Metandren) Linguet was given every day continuously for a period of 6 months. During this time a record of the basal body temperature was maintained; if a pregnancy was suspected, the medication was discontinued so that the possibility of masculinizing a female conceptus could be avoided, although, theoretically, a 5-mg dose is too small to do this. RESULTS
Of the 64 patients treated with methyltestosterone, 12 patients became pregnant: 3 during treatment, 6 1 month after termination of treatment, and 3 thereafter. There was one ectopic pregnancy; the rest resulted in live births. The average length of treatment with testosterone was 4.8 months for the pregnant group and 5.6 months for the nonpregnant group. The mean duration of infertility for the former group was 3 years and 4 months and for the latter group 4 years and 7 months. On the average, the patients became pregnant within 6.4 months. When the patient did not become pregnant within a reasonable time after initiation of the testosterone treatment, she was usually offered conservative surgery, thus terminating the follow-up for testosterone therapy. The mean follow-up period for this group was only 12.4 months. The rate of pregnancy was clearly dependent upon the length of follow-up: the shorter the follow-up period, the lower the
84
January 1976
KATAYAMA ET AL.
TABLE 1. Infertile Patients with Endometriosis Treated with Methyltestosterone (64 Cases)" Age of patients
Duration of infertility
Cycles treated
yr
mo
rna
Patients achieving pregnancy Patients failing pregnancy
28.4 ± 4.6 28.7 ± 4.0
39.6 ± 23.4 54.9 ± 38.9
4.8 ± 2.3 5.6 ± 2.4
6.4 ± 4.0b 12.4 ± 13.7
