Characterization of hormonal profiles during the luteal phase in regularly menstruating women

Rene Ecochard; Thomas Bouchard; Rene Leiva; Saman Abdulla; Olivier Dupuis; Olivia Duterque; Marie Garmier Billard; Hans Boehringer; Christophe Genolini

doi:10.1016/j.fertnstert.2017.05.012

Reproductive Endocrinology · Luteal Phase

Characterization of hormonal profiles during the luteal phase in regularly menstruating women

Ecochard R, Bouchard T, Leiva R, Abdulla S, Dupuis O, Duterque O, Garmier Billard M, Boehringer H, Genolini C

Published July 2017 Fertility and sterility

DOI 10.1016/j.fertnstert.2017.05.012 PMID 28579410

RRM Academy Synopsis

Early luteal phase length varies mostly between one woman's cycles

The early luteal phase varied more between cycles of one woman than between women, in a study of 99 women with regular cycles and 266 cycles. Longer luteal phases went with a slower rise in progesterone and higher LH.

Key Findings

Ultrasound confirmed ovulation in 283 of 326 cycles (87%). After excluding 17 possible pregnancies, the authors analyzed 266 cycles from 99 women.
88% of the variability in early luteal phase length was seen between cycles of the same woman, and 12% between women.
A long luteal phase went with a longer early luteal phase (an additional 2 days) and, less clearly, a longer midluteal phase (+1.2 days).
Three days after ovulation, LH was lower than on the day of ovulation in 52% of cycles and higher in 48%.
The luteal phase lasted under 10 days in 3% of cycles. In this group of young women, age did not significantly predict any luteal phase characteristic.

Interpretation

The paper is an observational secondary analysis of data collected in 1996 and 1997 at eight natural family planning clinics in five European countries. The women had regular cycles and were young, with a mean age of 32.5 years. Women with abnormal cycles or a luteal phase defect were excluded. Cycles with very long luteal phases were removed as possible pregnancies. The authors say the figures cannot show how often short luteal phases occur in the general population. They call for confirmation of the unexpected link between day 3 hormone levels and luteinization speed.

RRM Context

Luteal phase adequacy is a live question in restorative reproductive medicine, which builds evaluation on cycle charting. Early luteal length that swings within one woman suggests a single cycle gives a partial picture. Reading several cycles fits the cycle-charting-informed principle. The paper describes normal cycles and reports no treatment outcomes.

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

Abstract

Objective

To characterize the variability of hormonal profiles during the luteal phase in normal cycles.

Design

Observational study.

Setting

Not applicable.

Patients

Ninety-nine women contributing 266 menstrual cycles.

Interventions

The women collected first morning urine samples that were analyzed for estrone-3-glucuronide, pregnanediol-3-alpha-glucuronide (PDG), FSH, and LH. The women had serum P tests (twice per cycle) and underwent ultrasonography to identify the day of ovulation.

Main Outcome Measures

The luteal phase was divided into three parts: the early luteal phase with increasing PDG (luteinization), the midluteal phase with PDG ≥10 μg/mg Cr (progestation), and the late luteal phase (luteolysis) when PDG fell below 10 μg/mg Cr.

Results

Long luteal phases begin with long luteinization processes. The early luteal phase is marked by low PDG and high LH levels. Long luteinization phases were correlated with low E1G and low PDG levels at day 3. The length of the early luteal phase is highly variable between cycles of the same woman. The duration and hormonal levels during the rest of the luteal phase were less correlated with other characteristics of the cycle.

Conclusions

The study showed the presence of a prolonged pituitary activity during the luteinization process, which seems to be modulated by an interaction between P and LH. This supports a luteal phase model with three distinct processes: the first is a modulated luteinization process, whereas the second and the third are relatively less modulated processes of progestation and luteolysis.

Topics

Reproductive Endocrinology › Luteal Phase › Corpus Luteum Function · Menstrual Cycle › Cycle Physiology › Luteal Phase · Diagnostics › Hormone Testing › Urinary Metabolites

Rene Ecochard, Thomas Bouchard, Rene Leiva, Saman Abdulla, Olivier Dupuis, Olivia Duterque, Marie Garmier Billard, Hans Boehringer, Christophe Genolini

R Ecochard, Tom Bouchard, T Bouchard, R Leiva, S Abdulla, O Dupuis, O Duterque, M Billard, H Boehringer, C Genolini

PMID 28579410 28579410 DOI 10.1016/j.fertnstert.2017.05.012 10.1016/j.fertnstert.2017.05.012 Ecochard et al. 2017, Ecochard 2017

Characterization of hormonal profiles during the luteal phase in regularly menstruating women

Early luteal phase length varies mostly between one woman's cycles

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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