Q&A: Luteal Phase Defects and MiscarraigeApril C. Sanchez, M.D.
Q I have a short luteal phase (approx 10 days), and had a miscarriage a few months ago. I have read that a short leutal phase can make it difficult to get and stay pregnant. Any suggestions?
A An inadequate luteal phase occurs when there is a deficiency in progesterone production by the ovary after ovulation.
There can be two different presentations of this condition:
1. A short interval (less than 11 days) between ovulation and menstruation; this is the category where you appear to be
2. A normal interval (14 days) between ovulation and menstruation, but a lower than normal progesterone level.
The diagnosis of inadequate luteal phase can be made if it is found in more than 2 cycles. It may be normal for some women to have inadequate luteal phases in isolated cycles. Higher than normal prolactin (a hormone produced by the pituitary gland) can cause luteal phase deficiency. Prolactin levels should by checked using a blood test.
When using basal body temperature charts, if there is a temperature rise, it will be less than 11 days in duration. Bloodwork can be done 1 week prior to the onset of menstruation to check the progesterone level. If the level is low, there is probably an inadequate luteal phase; however, a normal progesterone level does not exlude the diagnosis of inadequate luteal phase.
The definitive diagnosis is made by taking a biopsy of the lining of the uterus (endometrium) 2 to 3 days prior to menstruation. This should only by done in a cycle in which condoms or abstinence has been used for contraception. If no contraception has been used, there is a risk of interrupting a pregnancy.
Treatment of inadequate luteal phase consists of either progesterone replacement or an ovulation induction agent such as clomiphene citrate. Progesterone supplementation is usually begun 3 days after ovulaion and may prolong the interval between ovulation and menstruation, but otherwise is not harmful. The risks of clomiphene citrate are minimal, except for an increased probability of twins.
I would suggest that you consult with your doctor for treatment before attempting pregnancy again. I wish you the best of luck.
April C. Sanchez, M.D.
Click here to Ask Dr. Sanchez your pregnancy questions.
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