luteal phase defect

1. How do you define luteal phase?
Luteal phase is the interval from ovulation to onset of the next mensues.
* Normal is 14 Days.
* <10 - >14 LPD
What cause luteal phase defect?
1. Poor Follicle formation.
2. Premature demise of Corpus interim
3. Failure of uterine leniing to respond to
normal levels of P2
What is implantation window?
Endometrial Receptiuty day 20-24 of cycle
8,9,10th day post ovulation.
Imparts Earliest if 6 day
Latest 12 day
Late implantation >9 Miscarriage Risk
Apposition Pinopodes
Adherence App. Around 21st day
Invasion present only for few days
How so you diagnose LPD?
1. BBT only helps in persistent short luteal phase.
2. USG:- Impractical as need daily scan.
3. P testing – serum progesterone
4. Prolactine Level
Future: No practical methods yet available
Specific secretary proteins from endometrial
5. EB is Gold standard best current methods of Diagnostic
Predictive value of progesterone measurement in luteal Phase/
Any role of random single progesterone measurement?
Serum Progesterone is a simple, Reliable, Widely available
& cost effective test
Single measurement >10mg/ml Standard
P2 secreted in pulsatile manner
Sapling during morning hours

2. Daily sampling –Most reliable but clinically impractical
How do you suspect LPD from clinical
characteristics of patient?
Just after menarche, before menopause, post partum period, hyper prolactenemia
Defective Ovulation LPD
•Shortened menstrual cycles
•Premenstrual spotting
•Sub fertile patient
4. H/O Recurrent pregnancy loss
Prevalent in 5-10% of Infertility women.
What role does traditional endometrial
histological dating has?
>2 days different between histological dating and menstrual dating of endometrial
If this pattern repeats in 2 or more cycle
Histologically documented in
20-40% of women with recurrent spont abortions.
Role of Clomiphene V/S Letrozole in IUI
cycles for correction of Luteal phase.
If absence of ovulation is the cause of LPD then clomiphene
is the first choice
What is the rational for Luteal phase support in
ART ?
Supra physiological level of sex steroid.
Insufficient LH
Puncturing of Graunlosacel
OPU Densensitization of Pituitary
Multiple Follicles Formation
Endometriosis
Unexplained Infertility

3. Role of HCG in Luteal phase
supplementation
Many prefer to give HCG in interval therapy post ovulation
Progesterone supplementation – Which
progesterone and what dosages?
Micronised progesterone oral ,im
Progesterone suppository vaginally
Progesterone gels