Cheesman, K. L., Cheesman, S. D., Chatterton, R. T., Jr., & Cohen, M. R. (1983). Alterations in progesterone metabolism and luteal function in infertile women with endometriosis. Fertility and Sterility, 40(5), 590-595. https://doi.org/10.1016/s0015-0282(16)47414-5
Cheesman KL, Cheesman SD, Chatterton RT Jr, Cohen MR. Alterations in progesterone metabolism and luteal function in infertile women with endometriosis. Fertil Steril. 1983;40(5):590-595. doi:10.1016/s0015-0282(16)47414-5
Cheesman, Kerry L., et al. "Alterations in progesterone metabolism and luteal function in infertile women with endometriosis." Fertility and Sterility, vol. 40, no. 5, 1983, pp. 590-595.
For EndNote, Zotero or Mendeley:
License
No open license is recorded for this paper. Reuse terms are set by the publisher.
RRM Academy Synopsis
Progesterone appeared delayed in infertile women with endometriosis
A 1983 comparison of 66 infertile women found that women with endometriosis appeared to make most of their progesterone late in the cycle. Forty had endometriosis. Twenty-six had other causes of infertility. Daily urine tests pointed to a shortened functional luteal phase. Biopsies ran behind schedule.
Key Findings
Of 22 dated biopsies from women without endometriosis, 18 (82%) matched the expected day by the Noyes criteria. With endometriosis, 12 of 36 (33%) did.
Biopsies matching the timing of the LH peak: 16 (73%) among women without endometriosis and 13 (36%) among women with it.
Nearly every woman with endometriosis (32 of 37) showed two LH peaks in urine, 2 to 3 days apart. The 26 women without it each showed one.
Corpora lutea appeared at laparoscopy in 70% (28 of 40) with endometriosis and 69% (18 of 26) without. An ovulation stigma showed in 39% and 72% of those, respectively.
Midluteal blood progesterone did not differ between the groups, including when women were divided by severity of endometriosis.
Interpretation
This study followed 66 infertile women for one cycle at a single fertility practice. Forty had endometriosis. Twenty-six had other causes of infertility. Daily urine tracking and timed biopsies showed a shortened luteal phase in the women with endometriosis. The shortened phase may be one cause of their infertility. The authors offer two ideas for the delayed urine progesterone marker. The ovary may make less progesterone at first. Or the body may be slow to turn it into the marker found in urine. The authors say more study is needed to tell these ideas apart. The findings support larger studies of luteal timing in women with endometriosis.
RRM Context
Temperature rise and blood progesterone looked the same in both groups. Daily urine series and biopsies showed the delay. The authors reject a single midluteal progesterone draw as enough to rule out ovulatory dysfunction in endometriosis. Restorative reproductive medicine treats the root cause and evaluates before it treats. NaProTechnology charts the whole cycle day by day, so a timing shift like this one does not hide behind a single blood draw.
Our editorial summary of this paper, not the article's abstract.
Abstract
The concentrations of pregnanediol-3-glucuronide (PGD) and pregnanolone (PN) were measured in daily morning urine specimens from 66 infertile women (40 with varying degrees of endometriosis and 26 control subjects) and correlated with daily changes in basal body temperature (BBT) and with midluteal levels of serum progesterone (P). PN and BBT rose at midcycle in women with endometriosis, as expected, indicating secretion of some P at that time. However, PGD, the major endpoint of P metabolism, was delayed in its excretion. Endometrial biopsies were similarly delayed (out of phase) in women with endometriosis, and a significantly higher incidence of follicular luteinization was seen. It appears that while P secretion begins at midcycle, the bulk of P secretion is delayed, perhaps because of the process of follicular luteinization, and that a shortened functional luteal phase thus exists in women with endometriosis.
