Luteal Phase Defect (LPD)

Infertility topics explained by Brian Acacio, M.D..   www.AcacioFertility.com 
Acacio Fertility Center, southern California.  (949)249-9200 begin_of_the_skype_highlighting (949)249-9200 end_of_the_skype_highlighting

The luteal phase of a woman's menstrual cycle is the latter half which begins from ovulation and ends the day before the next period. In a 28-day cycle, the luteal phase begins on Day 14 (when ovulation occurs) and ends on Day 28 (the day before bleeding begins). While the average luteal phase lasts for 14 days, a range from 10 to 16 days is considered normal.

Corpus Luteum

During the luteal phase and once ovulation has occurred, a structure called the corpus luteum continues where the egg was released. The corpus luteum releases the hormone progesterone, which is necessary to prepare the endometrium, or the uterine lining, for pregnancy as well as sustain the pregnancy until the placenta takes over.

Luteal Phase Defect

Luteal Phase Defect (LPD) occurs when the endometrium is inadequately prepared for an embryo. If there is an insufficient level of progesterone or non-responsiveness to the hormone, implantation may not happen or may result in a miscarriage.

LPD Causes

LPD can occur as the result of inadequate endometrium preparation or response to progesterone. Low levels of progesterone production may be the result of several conditions: poor follicle production, shorter than average luteal phase (10 or fewer days), an ineffective corpus luteum, or a combination of any of these conditions.

LPD Assessment

To determine whether or not a woman has LPD, an endometrial biopsy can be performed after Day 21 of her cycle or a day or two before the start of her next cycle. The appearance and dating of the endometrium Nope's Criteria is recorded along with the onset of the next period. If the onset of the next menstrual cycle differs by more than two days (based on biopsy readings), the endometrium is considered “out of phase” and LPD is diagnosed. This is almost never performed as the results are not uniform and the test can be painful.

LPD Treatment

Methods of treating LPD include:

• augmenting progesterone (after ovulation) through injection vaginal suppositories
• stimulation of follicular growth through use of clomiphene citrate or human gonadotropins (hMG)

While LPD is a common diagnosis given for Recurrent Pregnancy Loss, it is rarely the actual cause (<1%). Rather, a low progesterone level is most likely a sign of an abnormal pregnancy.