Chapter 35: Follicular and Luteal Phase Deficiencies: Advancing Concepts and New Terminology

Hilgers TW

Reproductive Endocrinology · Luteal Phase

Chapter 35: Follicular and Luteal Phase Deficiencies: Advancing Concepts and New Terminology

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 425-452, 2004

RRM Academy Synopsis

NaProTECHNOLOGY sorts luteal phase deficiency into five types

A NaProTECHNOLOGY textbook chapter reports that luteal phase deficiency divides into five types and follicular function into five levels. Each type has its own hormone profile, timed to the Peak Day of the Creighton Model FertilityCare System (CrMS). The chapter compares women with infertility with normal controls.

Key Findings

The chapter proposes calling an out-of-phase endometrial biopsy secretory phase dysfunction, a disorder of the endometrium, and judging luteal phase deficiency together with follicular function.
Type I combines a short post-Peak phase with low progesterone, Type II a normal post-Peak phase with a suboptimal progesterone profile, and Type III a late drop in progesterone.
Type IV, an uncommon pattern for further study, shows low progesterone only early in the luteal phase. Type V shows a predominant fall in luteal estradiol with an otherwise normal preovulatory profile.
Follicular function falls into five levels (AAA, AA, A, B and C), with B and C suboptimal. Altered follicle development leads to abnormal luteal function, particularly in Type I and II defects.

RRM Context

Restorative reproductive medicine treats the cycle as one connected process: the follicle that ovulates becomes the corpus luteum, so a luteal finding points back to follicular function. Estradiol from the follicle readies the uterine lining, and progesterone from the corpus luteum then supports it. Creighton Model charting gives a fixed reference day, the Peak Day, so that hormone results from different cycles can be compared. NaProTECHNOLOGY builds its work-up on that timing and assesses luteal and follicular function together.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter reviews the history of luteal phase deficiency from the work of Ogino, Knaus and Jones and the limits of endometrial biopsy dating, single progesterone levels and the basal body temperature in its diagnosis, and proposes the term secretory phase dysfunction for an out-of-phase endometrial biopsy. Using targeted periovulatory estradiol and post-Peak progesterone and estradiol profiles in a study of 328 patients with infertility, the chapter defines Type I, II and III luteal phase deficiency and reports abnormal luteal function in 53.7 percent of the cycles. The chapter adds a Type IV pattern shown through a case presentation and a Type V pattern marked by a predominant decrease in luteal phase estradiol, and classifies follicular function into five levels by periovulatory estradiol sums. Hilgers also reports that the CrMS mucus cycle score was significantly decreased in Type I, II and III luteal phase deficiency, and describes the follicular stimulation and luteal support approaches used at the Pope Paul VI Institute.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Cycle Biomarkers › Cervical Mucus Monitoring

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 35: Follicular and Luteal Phase Deficiencies: Advancing Concepts and New Terminology

NaProTECHNOLOGY sorts luteal phase deficiency into five types

Key Findings

RRM Context

Abstract

Topics

By this author

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