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Luteal Phase Defect
Abnormalities in endometrial development – luteal phase defect (LPD) – are associated with infertility and early miscarriage.
Diagnosis
The appearance of consistent and cyclic menstruation is generally considered to be an indication that all components of the female reproductive system are functioning optimally. However, significant alterations in hormonal secretion and ovulatory capacity may occur without disturbing menstrual cycles; these changes can significantly impair fertility.
Luteal phase defect occurs when the endometrium is inadequately prepared, either because the secretion of Progesterone by the ovary is below normal or because the endometrium isn’t responding to the normal stimulation by Progesterone.
Assessment of endometrial development can be done by performing an endometrial biopsy after cycle day 21 or one to two days prior to the expected onset of menstruation. The appearance of the endometrium when examined under the microscope can determine the quality of the endometrium. Results are reported as a day of the menstrual cycle, i.e., if the biopsy is done on day 26 and a woman has her period two days after the biopsy, her endometrial biopsy is “in phase” with her menstrual dates. In contrast, if the difference between the dating of the biopsy and the menstrual date differs by more than two days, the endometrium is said to be “out of phase;” in other words, a luteal phase defect is present.
Because sporadic cycles with luteal phase defect can occur in any woman, a definitive diagnosis is made by two out-of-phase biopsies. The optimal time to obtain a biopsy is two days prior to the expected onset of menstruation.
Treatment
Three methods of therapy have been utilized to treat LPD. Your doctor will decide which treatment to use:
- clomiphene citrate or human menopausal gonadotropins (hMG) to stimulate follicular growth
- supplemental hCG to improve corpus luteum secretion of progesterone
- additional progesterone after ovulation given by injection, orally or by vaginal suppositories or gel is often used.