People trying to become pregnant may hear a lot about
luteal phase deficiency or luteal phase defect. What is it? What causes luteal
phase defect? How do you test for it? What is the best way to treat it?
There are two parts to the menstrual cycle. From the time of the period until ovulation
is the first part and it is called the follicular phase. The second part is from ovulation until the
next period and is called the luteal phase. During the follicular phase, the ovaries produce estrogen
which thickens the uterine lining. During the luteal- phase, the ovaries produce a huge amount
of progesterone which transforms the uterine lining so that it can allow an embryo to implant.
A luteal phase defect is defined as some problem that occurs
during the luteal phase that reduces the chances that an embryo will implant
or increases the chance that an implanted embryo will not develop.
How do you know if you have a luteal phase defect? One method is to determine the length
of time from ovulation until the next period. Implantation of an embryo usually occurs 7
to 8 days after ovulation. If you are getting your period less than a week after you ovulate,
then you may have a luteal phase defect. Remember that your cycle can vary from one month to the
next so it is likely only a problem if the length of your luteal phase is persistently short.
Blood testing to measure progesterone levels is often recommended as a test for luteal phase
defect but this is notoriously unreliable. This is because progesterone is produced
in pulses. As a result, progesterone levels can fluctuate nearly 10 fold within 90 minutes.
In other words, what seems like a low progesterone level at the time you had your blood drawn
may have been much higher if your blood was drawn an hour later.
Check out this video to learn more about what your progesterone level could mean.
In the past, some doctors recommended doing a biopsy of the uterine lining and then looking
for certain changes under the microscope. Unfortunately, this is unreliable also.
A few studies have found that up to half of women with normal cycles will show abnormal results.
No difference was found between women with infertility or normal fertility.
There are several conditions that could cause a luteal phase defect.
Make sure to have blood tests such as a TSH to check for thyroid problems
and prolactin to look for abnormal elevations. Luteal phase defects are
also seemingly more common in older women and in women with very low weight or who are overweight.
Treatment for luteal phase defect uses medication to either add more progesterone directly
or trying to get the body to produce more progesterone. What about natural methods
for increasing progesterone like changing your diet, taking vitamins or exercising? I
actually did an entire video about this. Check it out after you are done with this episode.
Progesterone medications for fertility contain the type of progesterone that is identical to
the kind made by the ovaries. Progesterone can be given orally as a pill. However, much of the
progesterone is destroyed in the stomach and broken down in the liver. Only about 10% of the
progesterone taken orally is absorbed intact. Oral progesterone for fertility is not recommended.
Progesterone can be given as an intramuscular injection.
Injections of progesterone give very high levels on blood tests. The problem with
progesterone injections is that it is a thick oil that has to be injected into the muscle.
This is fairly painful and sometimes causes welts and rashes.
Vaginal progesterone products such as Crinone, which is an ointment
or Endometrin which is a tablet produces lower blood levels compared to injections
but more of the progesterone ends up in the uterus which is where we want it. The
biggest problem with vaginal progesterone is leakage. While this doesn't affect how well
the progesterone is absorbed, it can be messy to the point where you may need to wear a pad.
Finally, there are progesterone creams which are meant to be applied to the skin.
A few problems with these. First, since there are no commercial preparations of progesterone cream,
it has to be made from scratch. Quality control is more difficult so there is a lot of variability
in the amount of progesterone from dose to dose. This is also a problem since it is
impossible to always squeeze out the exact same amount each time. Finally, differences in the
thickness of skin will interfere with reliable absorption. Creams are therefore not recommended.
Other than giving progesterone, fertility medications like clomid have been used to increase
progesterone production by getting multiple eggs to develop. The follicle where each egg
develops is what produces progesterone so having multiple sources will raise progesterone levels.
One final point. It should be noted that if you are trying to get pregnant naturally,
there are no studies which show that treating a luteal phase defect will
improve your chances for conceiving or delivering so ultimately none of this might be very helpful