The Treatment of Luteinised Unruptured Follicle Syndrome With Chinese Medicine

Headnote

Abstract

Luteinised unruptured follicle syndrome (LUFS) is a dysfunction of ovulation that is common amongst women being treated for infertility, although relatively few practitioners are aware of its significance. This article describes the aetiology, pathology and diagnosis of LUFS according to both Chinese medicine and conventional biomedicine, and presents a comprehensive approach to the treatment of LUFS with Chinese herbal medicine and acupuncture. A case study is included from the clinic of Dr Yuning Wu in order to illustrate how the theory translates into actual clinical practice.

Keywords: Luteinised unruptured follicle syndrome, LUFS, infertility, Chinese medicine, herbal medicine, acupuncture, anovulation.

Introduction

Luteinised unruptured follicle syndrome (LUFS) is a dysfunction of ovulation where, despite manifesting the clinical signs and symptoms of ovulation, a woman's cycle remains anovulatory - the follicle does not rupture and an egg is not released. An ultrasound examination performed a few days after ovulation will confirm the diagnosis of LUFS by showing the presence of an intact follicle.

LUFS is commonly seen in fertility clinics, and can occur in up to 23 per cent of normal menstrual cycles.1-2 The condition appears to be more frequent in infertile women with endometriosis or pelvic inflammatory disease (PID), as well as in women with 'unexplained' infertility.3-4-5 In women receiving treatment with Clomid (clomiphene citrate) the incidence of LUFS can be as high as 25 per cent, and the rate of recurrence during subsequent cycles can be as high as 90 per cent,5 making conception very difficult.

Two distinct types of LUFS have been identified: mature and immature LUFS. In mature LUFS a follicle reaches maturity normally, growing to a size of 18 to 20 millimetres, but then fails to rupture. In immature LUFS, despite the normal signs and symptoms of ovulation, an ultrasound scan will show that the follicles have not matured, with only one small follicle (<15 millimetres) or multiple small follicles (<15 millimetres) detectable.6

The cause of LUFS is not yet known. However, because ovulation is a prostaglandin-dependent event, medicines that interfere with prostaglandin synthesis - such as non-steroidal anti-inflammatory drugs (for example aspirin or ibuprofen) - may play a role. Cessation of these drugs can result in a return to normal ovulation.7

The most successful biomedical treatment for LUFS is...