Luteal phase defects and ectopic pregnancy

Guillaume AJ; Benjamin F; Sicuranza B; Deutsch S; Spitzer M

doi:10.1016/s0015-0282(16)57292-6

Reproductive Endocrinology Luteal Phase

Luteal phase defects and ectopic pregnancy

Guillaume AJ, Benjamin F, Sicuranza B, Deutsch S, Spitzer M

Published January 1995 Fertility and Sterility, 63(1), 30-33

DOI 10.1016/s0015-0282(16)57292-6 PMID 7805920

RRM Academy Synopsis

Luteal phase defect linked to more ectopic pregnancy and miscarriage

Women whose infertility came from a luteal phase defect had higher rates of ectopic pregnancy and miscarriage than women who were not ovulating. A 1995 hospital study followed 633 pregnant women. About 12 out of 100 pregnancies with the defect were ectopic, against about 3 out of 100 in the other group.

Ectopic pregnancy: Luteal phase defect, 11.8 in 100; Women not ovulating, 2.9 in 100. Source: Guillaume AJ et al., 1995, PMID 7805920.

Study at a glance, cohort study: Luteal phase defect was linked to more ectopic pregnancy and miscarriage — Study at a glance, cohort study of 633 pregnant women: Luteal phase defect was linked to more ectopic pregnancy and miscarriage. Source: Guillaume AJ et al., 1995, PMID 7805920.

Key Findings

Luteal phase defect was the only cause found in 62 patients, and 51 became pregnant. In 393 patients not ovulating was the cause, and 210 became pregnant.
Ectopic pregnancy occurred in 6 of 51 pregnancies (11.8%) with luteal phase defect and 6 of 210 pregnancies (2.9%) in women not ovulating (P < 0.01).
Spontaneous abortion (miscarriage before week 20) occurred in 19 of 51 pregnancies (37.3%) with the defect and 12 of 210 (5.7%) in the other group (P < 0.001).
Of 31 pregnancies with the defect and no treatment, 15 (48.5%) ended in miscarriage and 5 (16%) were ectopic. Of 20 pregnancies on an ovulation drug, 4 (20%) and 1 (5%).

Interpretation

This cohort study followed 633 pregnant women at two New York hospitals from 1981 to 1986. The data show an association between luteal phase defect and both ectopic pregnancy and miscarriage, and the authors suggest the defect may be a factor in ectopic pregnancy. Women in the defect group had normal tubes on imaging and laparoscopy and no history of pelvic infection or IUD use. Pregnancies with the defect that went untreated had higher rates of both miscarriage and ectopic pregnancy than those treated with an ovulation drug. The findings support larger studies of luteal phase defect and its role in pregnancy loss and ectopic pregnancy.

RRM Context

Restorative reproductive medicine considers the whole cycle, including the days after ovulation. This paper links a luteal phase problem to worse outcomes after conception. The authors advise an early ultrasound to rule out ectopic pregnancy in women with the defect who become pregnant.

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

Abstract

Objective

To determine whether luteal phase defect (LPD) may be an etiologic factor in ectopic pregnancy (EP).

Design

All patients who were seen over a 6-year period with the chief complaint of infertility underwent an extensive infertility workup and were followed prospectively. The diagnoses of the causes of infertility were assigned retrospectively.

Setting

Two hospital-based tertiary care reproductive endocrine-infertility units.

Patients

A total of 1,077 infertility patients were evaluated. Of the 633 who became pregnant, the infertility had been due to LPD in 51 and to anovulation in 210.

Main Outcome Measures

All the infertility patients who became pregnant were followed to determine whether they miscarried, developed an EP, or had a viable birth. The incidence of EP and miscarriage in the patients whose infertility was found to be due to LPD were compared with a control group in whom the infertility was due to anovulation.

Results

The EP rate in the patients with LPD was significantly higher than in a control group whose infertility was due to anovulation (6 of 51 pregnancies versus 6 of 210 pregnancies, respectively). The spontaneous abortion rate in LPD cases also was highly significantly greater than in the control group (19 of 51 pregnancies versus 12 of 210 pregnancies, respectively). The EP and spontaneous abortion rates also were higher in patients with LPD who were untreated than in those who were treated.

Conclusions

This study suggests that there is a significantly increased incidence of tubal EP in patients with LPD and that when patients with LPD become pregnant early ultrasound should be performed to rule out EP. The study also indicated that spontaneous abortion occurs in a significantly high percentage of LPD cases.

Topics

Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Pregnancy › Early Pregnancy › Ectopic Pregnancy · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances

PMID 7805920 7805920 DOI 10.1016/s0015-0282(16)57292-6 10.1016/s0015-0282(16)57292-6 Guillaume et al. 1995, Guillaume 1995

Keywords

Female, Humans, Incidence, Infertility, Female/complications, Luteal Phase, Pregnancy, Pregnancy Outcome, Pregnancy, Ectopic/epidemiology/etiology, Prospective Studies

Luteal phase defects and ectopic pregnancy

Luteal phase defect linked to more ectopic pregnancy and miscarriage

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords