Clinical investigation of the menstrual cycle. III. Clinical, endometrial, and endocrine aspects of luteal defect

J P Gautray; J de Brux; G Tajchner; P Robel; M Mouren

doi:10.1016/s0015-0282(16)45374-4

Reproductive Endocrinology · Luteal Phase

Clinical investigation of the menstrual cycle. III. Clinical, endometrial, and endocrine aspects of luteal defect

Gautray JP, de Brux J, Tajchner G, Robel P, Mouren M

Published March 1981 Fertility and Sterility, 35(3), 296-303

DOI 10.1016/s0015-0282(16)45374-4 PMID 7202753

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RRM Academy Synopsis

Women with luteal defect had lower progesterone and disturbed cycles

In a 1981 French clinic study, the 88 women with luteal defect had lower progesterone than the 79 normal cycles. The 88 came from 328 women with cycle problems or infertility, diagnosed by endometrial biopsy. Their temperature charts showed cycle disturbances such as late ovulation or a slow rise. The authors suggest a central origin.

Key Findings

Of 328 outpatients with menstrual disorders and/or infertility, 88 (26.8%) had luteal insufficiency on endometrial biopsy. The comparison group was 79 normal cycles.
Biopsy patterns sorted the 88 women into 41 with pure luteal defect and 47 with luteal insufficiency with persistent estrogenic influence.
Basal body temperature charts placed 29 cycles within the normal range for phase lengths and 59 outside it. All 29 showed a slow temperature rise.
Plasma progesterone and estradiol were lower than in normal cycles in both groups, particularly with persistent estrogenic influence. Days 5 to 8 after ovulation showed the most significant deficiency.
Receptors were measured in 41 endometrial samples. Estradiol receptor concentrations and nuclear progesterone receptor concentrations were lower than in normal cycles.

Interpretation

The report is a 1981 case series of clinic patients, with normal cycles as the comparison. It describes patterns that occurred together in these women, and the authors speculate about cause. The authors suggest a central origin but could not measure gonadotropin levels. The women were outpatients with cycle problems or infertility, so the 26.8% describes that group only. The authors call the diagnosis ill-defined and say more cases are needed before receptor measurements can be used in diagnosis.

RRM Context

Cycle charts show the pattern this study linked to luteal defect: late ovulation or a slow temperature rise. Restorative reproductive medicine looks for the cause of a weak luteal phase. The women also had low progesterone, low estradiol and abnormal endometrial patterns.

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

Abstract

This study was intended to correlate different clinical and biologic parameters to better define luteal insufficiency (LI) and to contribute to a better understanding of its origin. Endometrial patterns were used as the basis for classification of clinical cases. Of 328 outpatients with menstrual disorders and/or infertility, 88 were considered to have LI. Their cycles were compared with 79 normal cycles. Two different principal endometrial patterns of LI are described: pure LI, when the endometrium is more than 2 days out of phase; and LI with persistent estrogenic influence, when the histologic estrogenic stigmata are excessive during the luteal phase. Basal body temperature charts demonstrated menstrual cycle disturbances: either ovulation delay or a slow increase in temperature (longer than 2 days). Plasma steroid concentrations also demonstrated a perturbation of the entire menstrual cycle: progesterone levels were statistically significantly lower in LI than in normal cycles and this defect was worse when the estrogenic influence was persistent; the preovulatory estradiol peak was disturbed in all circumstances, as was the concentration of endometrial steroid receptors. These simultaneous abnormalities strongly suggest a central origin of LI.

Topics

Related research

Luteal Phase · Luteal Phase Deficiency

Clinical importance of endometrial histology and progesterone level assessment in luteal-phase defect

Kusuhara K, 1992 Horm Res

In order to clarify the relationship between endometrial histology and progesterone (P4), plasma P4 and estradiol levels in the luteal phase were measured in 126 cases of unexplained infertility. Endometrial biopsies were performed in the midluteal period of menstrual cycles. Forty-three of the 126 cases showed retarded endometrium. Of these 43 cases, 23 exhibited three different types of abnormal P4 secretion. Type A showed low P4 levels throughout the luteal period. Type B showed low P4 levels only in the early luteal period. Type C showed normal P4 levels in the early luteal period followed by a prompt decline. These findings indicated that P4 determination during the early, mid- and late luteal phases is necessary to assess P4 secretion. However, 20 of the 43 cases had normal P4 levels through the entire luteal phase, demonstrating an insufficient response of the endometrium to P4. Consequently, histological examination of the endometrium is required to investigate the luteal phase defect.

Luteal Phase · Luteal Phase Deficiency

Clinical evaluation of luteal function

Nakajima ST et al., 1994 Obstet Gynecol

To determine the ability of luteal phase length determined by basal body temperature (BBT) pattern and a midluteal serum progesterone level to predict the result of an endometrial biopsy in a subsequent cycle. We performed a retrospective analysis of 141 women with a history of infertility who were being evaluated for luteal function. The luteal phase length determined from a BBT chart of one menstrual cycle was compared to a single midluteal serum progesterone level from a second menstrual cycle. These findings were compared to a luteal phase endometrial biopsy performed in a third menstrual cycle. Subjects were divided into four groups depending upon luteal phase length (normal 11 or more days) and serum progesterone level (normal at least 10 ng/mL). The four groups were designated "normal," "short luteal phase," "low progesterone," and "abnormal," depending upon the results of the two tests. The frequency of in- and out-of-phase endometrial biopsy results in the four groups was compared. There was no difference in the occurrence of an in- or out-of-phase endometrial biopsy when the four groups were compared. Neither luteal phase length nor a single midluteal serum progesterone level was predictive of subsequent in-phase or out-of-phase endometrial biopsy.

Luteal Phase · Luteal Phase Deficiency

Twenty-four-hour progesterone and luteinizing hormone profiles in the midluteal phase of the infertile patient: correlation with other indicators of luteal phase insufficiency

Olive DL et al., 1989 Fertil Steril

The authors have further analyzed women diagnosed as having luteal phase insufficiency in hope of determining the value of specific screening tests as well as determining the degree of heterogeneity of pathophysiologic mechanisms involved in the disorder. Twelve women with the disorder were identified, 6 with two consecutive midluteal serum progesterone (P) levels less than 10 ng/ml (group 1) and 6 with two consecutive late luteal phase endometrial biopsies out of phase (group 2); 4 infertile women with normal serum P and late luteal biopsies also were studied (group 3). All underwent serum sampling for P and luteinizing hormone (LH) at 20-minute intervals for 24 hours, beginning at 9:00 A.M. of day 7 post-LH surge. No significant differences were noted among the three groups for LH area under the curve, pulse frequency, or pulse amplitude. Furthermore, no differences were ascertained for P area under the curve. However, individuals were identified who had one or more hormonal abnormalities but no abnormal biopsy, as well as patients with normal hormonal profiles but having abnormal endometrial development. Receiver Operating Characteristic curves demonstrated that pooled morning serum P levels provided optimal predictive ability of biopsy results. The authors conclude that luteal phase insufficiency is a heterogeneous disorder, and that neither endometrial biopsy nor serum hormonal analysis obviates the need for the other.

Luteal Phase · Luteal Phase Deficiency

Luteal phase deficiency: characterization of reproductive hormones over the menstrual cycle

Soules MR et al., 1989 J Clin Endocrinol Metab

The recurrent deficiency of progesterone (P) secretion by the corpus luteum has been associated with infertility and habitual abortion and given the clinical diagnosis of luteal phase deficiency (LPD). There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. In this study we have examined reproductive hormone levels and preovulatory follicular size in women with LPD (n = 10). For the purposes of this study, LPD was determined by an endometrial biopsy in the studied cycle that was more than 2 days out of phase. These biopsies were performed in women with infertility or habitual abortion who exhibited an out of phase biopsy in a prior cycle. The control group consisted of 28 normal women. Daily serum levels of the following hormones were determined in each subject: LH and FSH [immuno- and bioactive (LH-immuno and LH-bio)], P, estradiol (E2), and inhibin. The LPD women exhibited significant decreases in integrated luteal phase levels of inhibin [10,615 +/- 898 vs. 13,560 +/- 662 (U/L).days; P less than 0.02] and E2 [5,015 +/- 275 vs. 6,435 +/- 393 (pmol/L).days (1366 vs. 1753 (pg/mL).days); P less than 0.05] in addition to the expected decrease in P [280 +/- 23 vs. 420 +/- 23 (nmol/L).days (88 vs. 132 (ng/mL).days); P less than 0.01]. On days 6-11 after the LH surge (day 0), there was a significant (P less than 0.05) decrease in mean LH-bio levels in LPD compared with those in normal women (146 +/- 26 vs. 212 +/- 24 micrograms/L). The midcycle LH surge was deficient in LPD when both LH-immuno [482 +/- 30 vs. 672 +/- 43 (micrograms/L).days; P less than 0.01] and LH-bio [1711 +/- 179 vs. 2248 +/- 226 (micrograms/L).days; P less than 0.05] levels were compared with normal values. When comparing the follicular phase in LPD with that in normal women, similar follicle size, peak and integrated E2 levels, and mean LH and FSH (immuno and bio) levels were found. The only follicular phase abnormality noted in this study was decreased mean levels of serum inhibin in the early and midfollicular phases (221 +/- 19 vs. 308 +/- 25 U/L; P less than 0.01). In this group of women with LPD, low levels of inhibin in the follicular phase were consistent with the concept of a defect in function of the preovulatory follicle, possibly as a result of previously described defects in gonadotropin secretion in this condition.(ABSTRACT TRUNCATED AT 400 WORDS)

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Diagnostics › Endometrial Assessment › Luteal Phase Biopsy · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances

J de Brux

PMID 7202753 7202753 DOI 10.1016/s0015-0282(16)45374-4 10.1016/s0015-0282(16)45374-4 Gautray et al. 1981, Gautray 1981

Cite this article

Gautray, J. P., de Brux, J., Tajchner, G., Robel, P., & Mouren, M. (1981). Clinical investigation of the menstrual cycle. III. Clinical, endometrial, and endocrine aspects of luteal defect. Fertility and sterility, 35(3), 296-303. https://doi.org/10.1016/s0015-0282(16)45374-4

Keywords

Adult, Animals, Body Temperature, Corpus Luteum/physiopathology, Endometrium/pathology, Estradiol/blood, Female, Humans, Menstruation, Ovarian Diseases/diagnosis, Progesterone/blood, Rabbits, Receptors, Estrogen, Receptors, Progesterone, Receptors, Estrogen, Receptors, Progesterone, Progesterone, Estradiol