Soules, M. R., McLachlan, R. I., Ek, M., Dahl, K. D., Cohen, N. L., & Bremner, W. J. (1989). Luteal phase deficiency: characterization of reproductive hormones over the menstrual cycle. The Journal of Clinical Endocrinology and Metabolism, 69(4), 804-812. https://doi.org/10.1210/jcem-69-4-804
Soules MR, McLachlan RI, Ek M, Dahl KD, Cohen NL, Bremner WJ. Luteal phase deficiency: characterization of reproductive hormones over the menstrual cycle. J Clin Endocrinol Metab. 1989;69(4):804-812. doi:10.1210/jcem-69-4-804
Soules, M. R., et al. "Luteal phase deficiency: characterization of reproductive hormones over the menstrual cycle." The Journal of Clinical Endocrinology and Metabolism, vol. 69, no. 4, 1989, pp. 804-812.
Women with luteal phase deficiency had low inhibin and a weak surge
Women with luteal phase deficiency had lower progesterone, estradiol and inhibin after ovulation, and a weaker midcycle luteinizing hormone surge. This 1989 study compared 10 of them with 28 women with normal cycles. Inhibin was also low in the early and midfollicular phases.
Key Findings
Across the luteal phase, the 10 women with luteal phase deficiency had lower total progesterone, estradiol and inhibin than the 28 women with normal cycles.
The midcycle luteinizing hormone surge was weaker in the deficiency group, whether measured by immunoactive or bioactive luteinizing hormone.
On days 6 to 11 after the luteinizing hormone surge, mean bioactive luteinizing hormone was lower in the deficiency group.
In the follicular phase, follicle size, estradiol, luteinizing hormone and follicle-stimulating hormone matched the normal group. Inhibin was lower in the early and midfollicular phases of the deficiency group.
Interpretation
This entry summarizes the published abstract, which the source cut off before its end. The study drew daily blood samples across one cycle. The 10 women with luteal phase deficiency had infertility or habitual abortion and an endometrial biopsy more than 2 days out of phase in the studied cycle. A group of 28 women with normal cycles served for comparison. The authors describe the low follicular inhibin as consistent with a defect in preovulatory follicle function.
RRM Context
Restorative reproductive medicine looks for the root cause of low progesterone after ovulation. Low inhibin before ovulation fits a flaw in how the egg follicle works, the authors say. That flaw may result from earlier-described problems in signals to the ovary.
Our editorial summary of this paper, not the article's abstract.
Abstract
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)
