May 22, 2015

Luteal Phase Deficiency

Luteal Phase Deficiency | Missing Piece| Unexplained Infertility

Countless hours, blogs and forums have been dedicated to infertility and the potential source as a luteal phase deficiency.  Luteal phase deficiency (LPD), or a lack of progesterone has been described in menstruating women.  It’s association has been with other medical conditions (rapid weight loss, post partum, renal transplantation, and even in random, normal cycles).  However, it has not been a source of infertility.  The time contemplating its existence far exceeds the data generated to support even a casual role in the generation of infertility.

There are medical conditions that can impact the luteal phase (part of the menstrual cycle after ovulation) function.  Ultimately this impaction affects the development of the endometrium, the soil for embryo implantation.  Initially a LPD is defined as a luteal phase of 8 days or less from the onset of the LH surge (the start of ovulation) to the start of the menstrual period.  This abbreviated time has most been associated with either lower FSH levels (ovarian stimulation) or an alteration in how the brain produces the two hormones of ovarian stimulation, FSH and LH.  As a result of these hormonal alterations, less estrogen and progesterone is present at the level of the endometrium.  Therefore, the body cannot hold onto the endometrium and it is shed—the period.

There are no clear diagnostic tests that can clearly define LPD in the setting of fertility – recall, it can be completely normal to have a shortened luteal phase in a healthy young woman.  Therefore if diagnosis is not possible, is it feasible to afford treatment.  Of course, treatment suggests there is a deficit to be corrected.  Treatment then becomes empiric.  It becomes providing for adequate endometrial maturation and development and to support early pregnancy as well as solidifying follicular development.

With advanced ART (assisted reproductive technologies), luteal support is afforded.  However, it remains uncertain as to whether LPD is an independent entity responsible for infertility.

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Danielle Vitiello, Ph.D., M.D.

Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility