Luteal Phase Defect (LPD) is a common cause of infertility and early miscarriage. Essentially, it is a condition when the luteal phase in the menstrual cycle is too short. In fact, you can have a perfect, routine, 28-day cycle and still have an inadequate luteal phase. The easiest way to detect this condition is by maintaining a basal body temperature (BBT) chart, although it can also be detected and confirmed by other means. Other methods used to diagnose LPD are progesterone level tests, uterine lining checks and endometrial biopsies.
If you are already charting your BBT, then you may be able to detect this problem yourself. The first half of your menstrual cycle is called the follicular phase and begins the first day of blood flow and spans until ovulation. It is the period of time following ovulation until the cycle begins anew, called the luteal phase, which you will monitor. If the luteal phase is shorter than 12 days, and possibly if your temperature does not dramatically shift, there is good indication to believe you have LPD. If the body does not produce enough progesterone, the follicle is of poor quality or the uterus does not respond to adequate progesterone, it results in a truncated luteal phase and the body will not create a sufficient uterine lining to sustain a pregnancy.
The follicle stimulating hormone (FSH) causes eggs to mature, and ultimately ovulation. If there is insufficient FSH production or the ovaries fail to adequately respond, the eggs will be of poor quality and disrupt the cycle of the corpus luteum (which produces progesterone). Progesterone is required to develop a thick uterine lining, which sustains pregnancy. If this level is insufficient, the body will attempt to start the cycle over, causing you to start your period. Obviously, it is difficult for an embryo to attach to a shedding uterus, causing early miscarriage (if it was detected at all).
Treatment for this condition depends on the cause of the shortened luteal phase. If the corpus luteum simply does not produce sufficient progesterone, then a progesterone supplement may be the proper route of treatment. However, it is necessary to monitor follicle size and check estradiol levels mid-cycle to rule out poor quality follicles as the cause of insufficient progesterone levels. If this is believed to be the cause, then, like PCOS, follicle stimulants like Clomid may be the proper solution. If progesterone levels are normal but the uterine lining is insufficient, it may be treated with a combination of progesterone, follicle stimulants and hCG injections. Two drawbacks to this form of treatment is that follicle stimulants are associated with multiple births and artificial hCG will trigger a positive on a pregnancy test when there is in fact no pregnancy, which means early home pregnancy tests will not be a reliable option. If you have been monitoring your BBT and suspect you may have LPD, inform your doctor and bring your charts with you.
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