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Luteal Phase Defect and Your Fertility

by Katlyn Joy | February 1, 2012 11:47 AM0 Comments

When trying to conceive you can become an expert on body processes that before were mysteries to you. One example is understanding the meaning of luteal phase defect and how it affects your fertility.

While a woman may be experiencing normal periods and believe all systems are go, a silent cause may be blocking her path to successful pregnancy. This cause can be luteal phase defect.

In a healthy menstrual cycle, follicle stimulating hormone or FSH is released approximately a week after the period has started. When FSH levels rise, an egg-producing follicle ripens on one of the ovaries. Once maturation occurs, a luteinizing hormone or LH surge happens.

The LH surge causes two different but important actions. First, the follicle on the ovary bursts which then releases the egg into the fallopian tube where it may meet the lucky sperm and fertilization will take place. Secondly, the LH surge will cause the follicle to refill after the bursting and this yellowish liquid found inside will become thicker.

After these changes the follicle is now considered a corpus luteum and it will produce the hormone progesterone. In the second half of the menstrual cycle, the lining of the uterus will thicken due to the progesterone rise. Also, blood vessels will grow during this time. This thickened, cushioned area is ideal for a growing embryo to attach and grow. Progesterone levels must stay elevated to prevent menstruation and the loss of a pregnancy. Heightened progesterone levels occur for approximately 12 days.

Three types of LPD

- Premature failure of the corpus luteum. In this type, progesterone levels are deficient or experience a sudden drop-off. This will cause a premature start of menstruation and interfere with fertility.

- Poor follicle production. With this type of LPD, low levels of FSH or ovaries that respond inadequately will result in follicle production that is not ideal for conception.

- Failure of endometrial lining response. Even if the corpus luteum develops properly and the follicles are functioning well, sometimes the lining of the uterus just doesn't respond to the correct levels of progesterone and the embryo cannot implant properly.

Is it LPD? How to Know and How to Treat

If a woman charts her basal body temp and notes that her temperature doesn't stay elevated for a full 12 days during the luteal phase, a luteal phase defect will be suspected. Shorter cycles may also indicate a LPD problem.

Serum progesterone tests is often done about a week following ovulation. If levels are inadequate, progesterone treatments will likely begin to correct the condition.

However, if follicle development is an issue, diagnosis is typically made through ultrasound viewing to insure the follicle is the right size during the middle of the cycle. Estradiol levels will additionally be checked by blood testing.

If follicle development is indeed the culprit, progesterone treatment won't be the preferred treatment. Rather fertility drugs such as Clomid will likely be taken in order to mature the follicle and produce better eggs and corpus luteum that will be healthier.

If the problem appears to be with the uterine lining not responding, an ultrasound will be done about a week following ovulation to observe whether it has thickened sufficiently. Treatment for this can include progesterone treatments and possibly HCG injections for the purpose of helping the corpus luteum.

Endometrial biopsy may be performed shortly before the start of the menstrual period. A little section or sample of the uterine lining will be sent for laboratory testing which includes observing the tissue under a microscope. The lining will be tested to see if it corresponds to the expected development for that day of the monthly cycle. Linings that are a couple days or more off from what development is expected are said to be "out of phase," which means a diagnosis of LPD.

It usually takes two out of phase endometrial biopsies to result in a definitive diagnosis of luteal phase defect. Understanding the type of defect is key to treating it. Treatment is often successful once the exact cause is detected. Knowing a woman has LPD can help her both achieve a pregnancy and maintain a healthy one and avoid miscarriage.

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