Luteal Phase Defect
The follicle surrounding the egg (released at ovulation) forms the corpus luteum after ovulation. The corpus luteum produces the hormone progesterone during the second half of your cycle and during early pregnancy.
Luteal phase deficiency (LPD) is a reproductive endocrinologic problem that is also called "inadequate corpus luteum" and "corpus luteum deficiency". It is considered to be clinically relevant if present in more than one cycle.
Luteal phase deficiency is a clinical entity in which there is a recurrent post-ovulatory deficiency in progesterone production and/or progesterone effect from the ovary leading to infertility and/or habitual miscarriages. Both thyroid disease and prolactin abnormalities need to be evaluated if you have LPD. There are several ways to diagnose this problem (e.g. pooled progesterone, endometrial biopsy, basal body temperature charts). Once luteal phase deficiency has been diagnosed then one enters the treatment phase.
Medications
There are several useful medications for the treatment of luteal phase deficiency.
If you have a persistent elevation of a blood hormone called prolactin, LPD is best treated with a medication called bromocriptine (ParlodelR). Bromocriptine is given in pill form and the cycles are monitored with basal body temperature (BBT) charts. Bromocriptine should be taken until a positive pregnancy test is obtained. At that point the bromocriptine therapy will be stopped under the direction of your doctor.
Another form of therapy for LPD is clomiphene citrate. This is the same medication that is used for ovulation induction. Clomiphene is capable of boosting the progesterone levels in the second half of the cycle. The cycles are usually monitored with a basal body temperature chart and monthly clinic visits for pelvic examinations.
Another therapy for LPD is supplementation of the second half of the cycle with progesterone. Progesterone is usually prescribed in one of two forms: (1) intramuscular shots, (2) capsules for oral ingestion (Prometrium™). The dose can be anywhere from 1-3 suppositories or capsules per day.
The progesterone therapy, when used, is started about 3 to 4 days after ovulation is confirmed by a BBT chart or a urinary LH kit (e.g. Clear Plan™). Progesterone therapy should be continued in the prescribed dose until the first day of good flow of your next menstrual period. If there is only spotting than the progesterone should be continued. If you miss your next menstrual period, you should keep using the progesterone until a pregnancy test is performed.
Success Rates
The overall pregnancy rate achieved in women with luteal phase deficiency is 25-50%. On average it takes 4-6 cycles to achieve this pregnancy rate. Obviously some patients take even longer than 6 cycles to achieve a pregnancy. Your doctor will discuss the therapeutic strategy to be used in your particular case.
