Grunfeld, L., Sandler, B., Fox, J., Boyd, C., Kaplan, P., & Navot, D. (1989). Luteal phase deficiency after completely normal follicular and periovulatory phases. Fertility and Sterility, 52(6), 919-923. https://doi.org/10.1016/s0015-0282(16)53152-5
Grunfeld L, Sandler B, Fox J, Boyd C, Kaplan P, Navot D. Luteal phase deficiency after completely normal follicular and periovulatory phases. Fertil Steril. 1989;52(6):919-923. doi:10.1016/s0015-0282(16)53152-5
Grunfeld, Lawrence, et al. "Luteal phase deficiency after completely normal follicular and periovulatory phases." Fertility and Sterility, vol. 52, no. 6, 1989, pp. 919-923.
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Luteal phase deficiency may follow normal follicular phases
A study followed 30 ovulatory women and found that 7 out of 30 women with normal follicle growth and ovulation had delayed endometrial development on a late luteal phase biopsy. Five met the definition when dated from the luteinizing hormone surge. The follicular phases of those five women ran slightly longer than the others.
Key Findings
Of 37 women monitored, 30 met every criterion for normal follicular development and had a late luteal phase endometrial biopsy; 7 of the 30 (23%) showed delayed endometrial development.
The women with delayed development had normal hormonal and ultrasound findings; estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone and follicle size did not differ significantly from women with normal biopsies.
Dating from the luteinizing hormone surge identified delayed development in 5 of 30 women (20%), and dating from the next menstrual period identified it in 7 of 30.
All cases identified by surge dating would also have been classified as abnormal by dating from the next period.
Follicular phases averaged 17.0 ± 1.1 days in the 5 women with delayed development by surge dating and 14.5 ± 0.3 days in women with in-phase biopsies (P < 0.05).
Interpretation
The report describes a prospective study of 37 consecutive women from an IVF program. Their infertility arose from tubal disease, male factor or immunologic causes. The study monitored one cycle per woman and took an endometrial biopsy late in the luteal phase. The authors note that only a single cycle was studied, so they draw no conclusion about whether the delay repeats. The authors conclude that factors other than aberrant follicle development caused the delay in these women. They suggest that biopsies in carefully monitored pregnancy cycles should clarify the significance of endometrial dating.
RRM Context
Restorative reproductive medicine assesses each phase of the cycle on its own evidence. In this study, 7 of 30 women had normal ovulation followed by a delayed uterine lining. The finding supports assessing the luteal phase directly.
Our editorial summary of this paper, not the article's abstract.
Abstract
Luteal phase defect (LPD) accounts for a significant proportion of reproductive disorders, however its etiology is still debated. A prospective study was performed on 37 ovulatory women to determine whether LPD can occur in cycles characterized by completely normal folliculogenesis. Criteria for normal folliculogenesis included: a gradual rise of serum estradiol, a luteinizing hormone (LH) surge, the presence of a dominant follicle that disappeared, an increase of serum progesterone, and normal serum levels of prolactin, testosterone, dehydroepiandrosterone sulfate, follicle-stimulating hormone, and LH. Thirty of 37 women fulfilled the above mentioned strict criteria and underwent endometrial biopsy in the late luteal phase. Seven of 30 (23%) demonstrated a delay in endometrial development and all had normal hormonal and ultrasonographic parameters of folliculogenesis and ovulation. Women with delayed endometrial development demonstrated slightly longer follicular phases (17.0 +/- 1.1 versus 14.5 +/- 0.3 days). Perfectly normal follicular and periovulatory events may be followed by deficient luteal phases.
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