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Wednesday, July 26, 2006

Diagnosis: Luteal Phase Defect

Diagnosis: Luteal Phase Defect
by Melissa

What a Luteal Phase Defect (LPD) Means and Its Impact on Fertility

In order to talk about the important things like progesterone levels, you need to know something about your cycle. Simply put, your cycle is broken down into two parts. Pre-ovulation, it's called the follicular phase. As it sounds, this is the part of the cycle where the follicle is growing and preparing to release an egg. After ovulation, the second part of your cycle is called the luteal phase. This is the time where the embryo implants and (hopefully) gets cozy for the next nine months. If the embryo fails to implant--or going even more basic, the egg fails to fertilize--the cycle ends and begins anew with your period.

Follicular phases can vary in length. Sometimes, they fit the average 28 day cycle and the person has a 14 day follicular phase and a 14 day luteal phase. But the length of time is determined by the follicle's rate of growth because the follicular phase will continue until the egg is released. That could happen earlier than 14 days or much later than 14 days.

The luteal phase isn't really supposed to vary in length like the follicular phase. The length of the luteal phase is determined by the corpus luteum (the "yellow body" that is left after the egg is released from the follicle). The breaking down of the corpus luteum and the end of the cycle usually happens around 12--14 days after ovulation (unless the embryo implants).

But in some women, it happens much sooner. Or the corpus luteum doesn't secrete enough progesterone. Or the progesterone it does secrete doesn't build up the endometrial lining for implantation. Which means that the person either cannot become pregnant or maintain a pregnancy.

Diagnostic Process

There are several tests that are used to determine a luteal phase defect. The least invasive is what is called a "day 21 progesterone test." It actually needs to be drawn around 7 days post ovulation (7 dpo). Therefore, it would only occur on the 21st day of your cycle if your cycle was 28 days long and you ovulated on the 14th day. Most doctors want to see at least 10 ng/mLs of progesterone and some give a diagnosis of low progesterone for anything under 20 ng/mLs.

Some doctors will treat a LPD with progesterone supplements and follicular-stimulating hormones without conducting more tests. But those who have normal progesterone levels and adequate follicles may have an endometrial biopsy performed if a day-21 sonogram (again, 7 dpo) reveals endometrial lining that is too thin. Whether or not your doctor progresses to performing an endometrial biopsy will be determined by his comfort with diagnosing from blood work and sonograms.

Treatment Options

The corpus luteum is only as good as the follicle that creates it. Therefore, many doctors begin by attempting to nurture great follicles which will in turn become strong corpus luteums. Doctors will prescribe Clomid (oral) or an follitropin like Follistim or Gonal-F (sub-cue injectible) to stimulate follicle growth. After ovulation, vaginal suppositories of Prometrium are prescribed (there are also IM injections of progesterone).

Personal Experience

We began suspecting there was a problem once I began charting my temperature. Most months, my luteal phase was only 10 days long (or less). But on other months, my luteal phase would stretch as long as 21 days without tipping a positive home pregnancy test (though blood work showed low hcG levels). Blood work 7 dpo confirmed low progesterone. My first blood draw had a result of less than 5 ng/mL. Every subsequent test showed under 3 ng/mL.

We took Clomid (days 3--7) and then Follistim (over the course of many days based on sonograms and hormone levels). After few days after an hcG shot to trigger ovulation, I took Prometrium twice a day until I received a negative beta (or in the case of the month I got pregnant, I continued taking Prometrium until my 15th week of pregnancy).


battynurse said...

Hi in reading this section I am curious. I was told that my ovulation was borderline after having my progesterone drawn and getting a level of 9.9. I seem to have about a 13 day luteal phase although some months my temps don't clearly show an ovulation. I'm not sure if this is related though to the fact that I don't sleep well though, I wake up a lot. Also, I have tried several different opks and can usually only get Answer brand and my CBFM to work for me. Any input would be appreciated. Thanks.
battystamper at comcast dot net is my e-mail

Michelle said...

my Dr. has specifically told me not to use the answer brand tests, for whatever that's worth

Anonymous said...

I'm 37 and have been trying to get pregnant for about 10 months. I started charting my BBT 6 months ago and using an ovulation mointer. My Luteal phases have been as low as 10 and as high as 24 days with a neg preg. test. I'm going to see my Doctor. Help!
Could this be Luteal Phase defect?

rachel blog said...

thanks mel, just re-reading this old post of yours and realizing I need to address my short luteal phase. this info is helpful.

Anonymous said...

Was given progesterone to start my mentrual period, but nothing has happened. Took my last pill 3 weeks ago. Any thoughts?

Anonymous said...

The whole issue with Pergesterone boggles me on occasion. I had endometritis, was given progesterone tablets to give me back my period. Then had cysts removed from my uterus. I've had obnoctiously long cycles(31-35 days from bleed to bleed, with spotting tossed in for good measure).

My bbt temps are also low and almost unmoving when i chart. (i realy am a cold-blooded....)
How do we fix it, is estrogen domonance only cured by weight loss and if so how much will i have to shed to get pregnant. I've been on WW for a year now and i've bee gaining ad loosing the same 7.5 lbs now for a year. I'm stumped How to the MD's dx progesterone defficiency is the BBT the only way?
Also will having a low progesterone level skew the urine test kits for the ovulation monitors?

Anonymous said...

Thank you! Thank you! My doctor just tested my progesterone once I got a surge on my OPK! I knew that was wrong and couldn't understand. Now coming across your blog I know she was wrong! I should be tested on Day 21. Congrats on your pregnancy!! :)

miskami said...

Hi : ) I had LPD and was given a referal to a infertility specialist. I had a level of 4. In the meantime I did some research and talked to my NP and we agreed I would try using the bio identical progesterone. We had tried to get pregnant for over a year and after 4 months on the arm cream we were pregnant. We were not looking foward to the expense of fertility treatment. The cream cost about $35 a month and does the same thing as the clomid. My understanding is they give you clomid to produce more which in turn produces more progesterone. I encourage people to talk to their MD's and do some research and see if it could work for you as well. : )