Luteal Phase Defect (LPD)

So what is Luteal Phase Defect?

Luteal phase is the phase of the menstrual cycle between ovulation and the onset of menstrual bleeding. This is an important phase of the cycle because fertilisation and embryo implantation happens during this phase. The key hormone that makes this possible is called Progesterone and it is secreted by the Corpus Luteum in the ovary. Corpus Luteum is nothing but the transformation of the follicle that has ruptured into a conglomeration of Progesterone secreting cells. So when the luteal phase is insufficient it is apparent that the implanting embryo will not receive sufficient nutrition for it to grow in the womb, leading to failed implantation or early miscarriage.

Causes of Luteal Phase Defect

Luteal phase defect can occur when either of these happen -

• When the corpus luteum is defective and secretes less Progesterone
• When there is early demise of corpus luteum due to any reason
• When the end organ (endometrium) is not responsive to Progesterone

A combination of the above phenomena is seen to occur in the following conditions leading to LPD :-

• Excessive Obesity
• Anorexia or Bulimia
• PCOS
• Thyroid conditions
• Nutritional deficiencies
• Endometriosis
• Hyper prolactinemia
• Smoking/Oxidative stress

Symptoms and Signs to tell you have LPD

It is possible that your periods are shortened as the luteal phase of normal 14 days duration is now curtailed to less than that. Additionally you may have one or more of following:

• Repeated miscarriages of early pregnancy (1st trimester)
• Unexplained Infertility
• Spotting and inter-menstrual bleeding
• Pre-menstrual syndrome (PMS)
• Short menstrual cycles

However infertility (difficulty in getting pregnant) is the most common and only symptom.

Diagnosis of Luteal Phase Defect

In medical parlance this is still in controversial territory because the test results are not conclusive. Conventionally the diagnosis of LPD used to be done with endometrial biopsy wherein a small sample of the endometrium is sent for dating histologically. Nowadays serum progesterone is done one week after presumed ovulation. None of these tests are conclusive and therefore the diagnosis of LPD remains elusive.

Luteal Phase Defect - Treatment

Typically suspected patients of LPD are given fertility medications only as it is thought that the growth of better quality follicles will circumvent the early corpus luteal demise and lead to a pregnancy. If still however a patient does not conceive with ovulation induction treatment then assisted conception in the form of IUI or IVF may be necessary.