Infertility can take many shapes and forms, and when you stop to think about all the intricate details that all need to come together correctly to create a new life, it truly is a miracle. Luteal phase defects can sometimes contribute to infertility problems, and unfortunately it seems that this problem is one that often goes undiagnosed. Women trying to conceive a child should be proactive in monitoring their menstrual cycles in order to pick up on any anomalies that may be occuring so that they may discuss the issue further with their doctor.
As described by TTC International, a woman’s menstrual cycle is divided into three basic parts; the follicle phase, ovulation and finally the luteal phase. The luteal phase occurs in the time after ovulation, up to the start of the next menstrual cycle. For couples trying to conceive, the luteal phase plays a key role in the success of their efforts- it is the time when the uterine lining is prepared for implantation. If a fertilized egg cannot be implanted, pregnancy will not occur.
After an egg is released from the ovary during the ovulation stage, the corpus luteum, or the “corpse of the follicle,” is left in the ovary. As described by Randine Lewis, p.h.D., those cells then undergo luteinization, a process where increased blood flow leads to a structural changes of the cells. After luteinization, these corpus luteum cells produce the hormone progesterone, which helps to prepare the endometrium (uterine lining) for implantation of a fertilized egg. The production of progesterone is dependant on the production of LH, or luteinizing hormone.
Simultaneously occuring during the luteal phase, the endometrium develops progesterone receptor cells, making conditions favorable for implantation; there is a relatively small window of time in which this can occur. If implantation is successful, the embryo will produce the hormone hCG, which in turn stimulates the ovary to produce more progesterone. Dr. Randine Lewis also points out that if implantation occurs too late, or if an egg is not fertilized, the luteinizing hormone secretion stops, in turn making progesterone levels drop. When progesterone levels drop, the uterus releases prostaglandins that make the uterus contract. This begins the shedding of the endometrium, otherwise known as the woman’s next period.
A normal luteal phase length is generally considered 11-14 days, although some doctors believe that up to 17 days is fine. Most experts seem to agree that a luteal phase 10 days or under is considered a luteal phase defect, because it does not allow enough time for the necessary preparation of the endometrium for implantation.
The most commonly noted cause for a luteal phase defect stems from the lack of progesterone production, but this theory is a little controversial. As some doctors, such as Randine Lewis, p.h.D., point out- if LPD was only related to decreased progesterone, then a treatment of progesterone supplementation should correct the problem. While this treatment does work for some women, it does not help everyone. It stands to reason then that other factors may be occuring in LPD. Some other theories include a lack of luteinizing hormone, or even decreased follicular stimulating hormone, or FSH, which occurs in the first phase in a menstrual cycle. Much more research needs to be done to sort out how all of these hormones work together to create a pregnancy.
Dr. Lewis offers another theory on possible causes of luteal phase defects; that there is a lag time in the body reacting to the increased progesterone levels. This means that even though an egg may be fertilized, it is not able to attach to the uterine wall because conditions are not favorable for implantation. In this case, the fertilized egg passes through with implanting, which triggers the woman’s period to begin early.
The ties between a luteal phase defect and infertility can be quite a gray area. While conception is not necessarily compromised, the chance of successful implantation is decreased. Also, if the luteal phase defect is linked to decreased progesterone levels, conception and possibly even implantation may realistically be occuring, but the body is not reading high enough progesterone levels to be able to support the pregnancy, resulting in very early multiple miscarriages.
Detection of a luteal phase defect can be difficult. According to Luteal Phase Defect, a biopsy of the uterine lining can be performed, and ultrasounds can be used to detect the release of eggs from the ovary. Perhaps the easiest way is through charting basal body temperatures- while not foolproof, it can be a good indication of a luteal phase problem. Since the hormone progesterone is believed to increase basal body temperature, there should be a spike in temperatures when ovulation occurs. Since progesterone continues to be released until the next menstrual cycle begins, you can simply count the days the temperature stays elevated to determine luteal phase length.
So now comes the tricky part- once a luteal phase defect is suspected, what treatment is available to correct the problem? As mentioned before, one of the most common treatments is to supplement with progesterone. This can be taken orally, injected, or with vaginal suppositories, beginning after ovulation. It should be noted however, that if progesterone levels then become too high, it can “trick” the body into thinking that pregnancy has occurred even if that is not the case, and so the start of the next period can be consequently delayed. Perhaps an easier treatment is to supplement with B6 vitamins, as noted by the article “What is a Luteal Phase Defect or LPD?” B6 vitamins are safe to take in daily doses of 50mg to 200 mg since they are water soluble, and when they are taken throughout the entire cycle, they can extend the luteal phase.
Besides progesterone or vitamin B6 treatments, another medicine currently being used is clomiphene citrate, or Clomid. Ricki Pollycove, M.D., of San Francisco, California describes how Clomid works; “this drug tricks the body into thinking that it is deprived of estrogen, which in turn stimulates the ovary into producing higher levels of hormones.” Besides Clomid, trigger shots of hCG can be used to further stimulate the corpus luteum. One downfall to this treatment is that hCG is the hormone detected in when pregnancy occurs, so it is possible to get a false positive pregnancy test while using these injections.
Many doctors will treat women with luteal phase defects with a variety of methods, using a combination of Clomid and progesterone supplementation for example. The key to luteal phase defects is first determining that there is in fact a problem; once this is diagnosed, the next step is finding out WHY the defect is occuring. Only then can the best treatment options be determined.
Infertility can be quite the emotional roller coaster, as anyone who has ever experienced it at any level can attest. Luteal phase defects are no exception to this frustration, but with proper diagnosis and treatments, a positive outcome is well within reach.
Sources:
TTC Intl, Luteal Phase Defect, (LPD), TTC Intl.
Gwen Morrison, Luteal Phase Defect, How LPD affects Fertility, iParenting
What is a Luteal Phase Defect or LPD?, Baby Hopes
Randine Lewis, p.h.D, licensed acc., Luteal Phase Defect, acudenver.com
