Correlation between estradiol and progesterone in cycles with luteal phase deficiency

Dov Goldstein; Henrick Zuckerman; Samuel Harpaz; Joseph Barkai; Adam Geva; Samuel Gordon; Eliezer Shalev; Moshe Schwartz

doi:10.1016/s0015-0282(16)46094-2

Reproductive Endocrinology · Luteal Phase

Correlation between estradiol and progesterone in cycles with luteal phase deficiency

Goldstein D, Zuckerman H, Harpaz S, Barkai J, Geva A, Gordon S, Shalev E, Schwartz M

Published March 1982 Fertility and Sterility, 37(3), 348-354

DOI 10.1016/s0015-0282(16)46094-2 PMID 7060785

RRM Academy Synopsis

Luteal phase deficiency can occur with normal progesterone levels

Luteal phase deficiency turned up despite normal progesterone in women with low estradiol. This 1982 hospital study followed 144 women with infertility, including 32 controls. Sixteen women had low estradiol but normal progesterone. They had a low conception rate and mostly out-of-phase linings on biopsy. The authors conclude that progesterone alone may not help these women conceive.

Key Findings

The study covered 144 women over 455 cycles. All were under 35 with regular 28 to 32 day cycles. Thirty-two served as controls.
Groups by midluteal hormones: high estradiol and high progesterone, 36 women; high estradiol and low progesterone, 25; both low, 35; low estradiol and high progesterone, 16.
Of 50 women with ovulatory progesterone levels who had a biopsy, 35 (70%) had a secretory endometrium. Only 18 of those 35 were in phase (51%).
Defined as a secretory out-of-phase endometrium in ovulatory cycles, luteal phase defect appeared in 22.2% of group 1 ovulatory biopsied cycles and 80% of group 2.
In group 3, all ovulatory cycles had it (30% of cycles). Group 4 had it in 75% of ovulatory biopsied cycles, with a mean luteal phase of 8.5 ± 3.2 days.

Interpretation

Goldstein and colleagues grouped 144 women by their midluteal estradiol and progesterone levels. The grouping showed a link between hormone levels, endometrial dating, and luteal phase length. Group 4 had low estradiol but normal progesterone. Women in group 4 still showed luteal phase deficiency on biopsy. The authors say estradiol helps progesterone act on the endometrium. The authors link low estradiol in the luteal phase to infertility in these women. All participants were under 35, had regular cycles, and had normal tubes, postcoital tests, and partner semen results. The findings support larger studies of estradiol's role in luteal phase health.

RRM Context

A luteal phase defect can hide behind a normal progesterone result. One hormone number alone may miss it. Restorative reproductive medicine's root-cause approach examines the whole cycle before treating. NaProTechnology evaluates luteal phase length and hormone patterns through cycle charting to find the cause of an inadequate luteal phase. The paper found a mean luteal phase of 8.5 days in the low-estradiol, high-progesterone group. Controls averaged 15.2 days.

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

Abstract

Many studies have been published on luteal phase deficiency, and the emphasis in most of them is on progesterone deficiency. In this study 144 patients (455 cycles) with infertility were studied. The patients were divided into four groups. Group 1 consisted of patients with high estradiol and high progesterone levels in the midluteal phase. Group 2 consisted of patients with high estradiol and low progesterone levels. Group 3 consisted of patients with low estradiol and low progesterone levels. Group 4 consisted of patients with low estradiol and high progesterone levels. As expected, patients in groups 2 and 3 showed a low conception rate with outphased endometrial biopsy. However, group 4, in spite of the normal progesterone levels, had a low conception rate with an outphased endometrium. We conclude that estradiol deficiency during the luteal phase is a major factor in infertility, and replacement therapy with progesterone alone in these patients may not improve fertility.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Hormone Testing › Serum Panels

Dov Goldstein, Henrick Zuckerman, Samuel Harpaz, Joseph Barkai, Adam Geva, Samuel Gordon, Eliezer Shalev, Moshe Schwartz

D Goldstein, H Zuckerman, Sam Harpaz, S Harpaz, Joe Barkai, Joey Barkai, J Barkai, A Geva, Sam Gordon, S Gordon, E Shalev, M Schwartz

PMID 7060785 7060785 DOI 10.1016/s0015-0282(16)46094-2 10.1016/s0015-0282(16)46094-2 Goldstein et al. 1982, Goldstein 1982

Keywords

Adult, Biopsy, Body Temperature, Endometrium/pathology, Estradiol/blood, Female, Humans, Infertility, Female/blood/pathology, Luteal Phase, Menstruation, Progesterone/blood, Prolactin/blood, Progesterone, Estradiol, Prolactin

Correlation between estradiol and progesterone in cycles with luteal phase deficiency

Luteal phase deficiency can occur with normal progesterone levels

Key Findings

Interpretation

RRM Context

Abstract

Topics

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Keywords