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Infertility Cubby

Luteal Phase Defect
by Geoffrey Sher, M.D.

Q. I have been charting for 8 months now and my luteal phase is never any longer than 10 days. That is the average. What can I do to lengthen this in order to sustain a pregnancy?

A. You could have luteal phase defect.

Following ovulation, the remainder of the dominant follicle transforms itself into a structure called the Corpus Luteum (CL) which produces progesterone. The purpose of progesterone is to prepare the uterus to accept and support an early pregnancy until it is able to sustain itself at around 8-10 weeks of gestation.

The life span of the CL is predetermined to be 12-13 days, unless rescued by a signal from the early pregnancy. If no pregnancy occurs, the CL stops making progesterone and menses ensue 1-2 days later. For most women the length of the second half of the menstrual cycle (the luteal phase) is constant at 14 days. A small percentage of infertile women (3-4%) have a shortened luteal phase. This may result in the loss of pregnancy support before the budding pregnancy has a chance to signal the ovary that it is there.

The lining of the uterus (the endometrium) has a specific appearance that changes throughout the menstrual cycle, such that a biopsy of the lining a few days prior to expected menstruation, can accurately date endometrial development. A three or more day difference between endometrial dating by biopsy and cycle day as determined by the start of the next menstrual period is indicative of a luteal phase defect (LPD). Sequential mid luteal progesterone levels < 10 ng/dl can also be used to diagnose a LPD.

Luteal phase defect can be treated with Clomiphene Citrate, Progesterone supplementation or hCG injections.

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