Wentz, A. C., Herbert, C. M., Maxson, W. S., & Garner, C. H. (1984). Outcome of progesterone treatment of luteal phase inadequacy. Fertility and Sterility, 41(6), 856-862. https://doi.org/10.1016/s0015-0282(16)47898-2
Wentz AC, Herbert CM, Maxson WS, Garner CH. Outcome of progesterone treatment of luteal phase inadequacy. Fertil Steril. 1984;41(6):856-862. doi:10.1016/s0015-0282(16)47898-2
Wentz, Anne Colston, et al. "Outcome of progesterone treatment of luteal phase inadequacy." Fertility and Sterility, vol. 41, no. 6, 1984, pp. 856-862.
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Progesterone-treated luteal phase inadequacy ended in 19 deliveries
Among 79 women in a 1984 chart review, 54 on progesterone suppositories alone had 23 pregnancies and 19 deliveries. All had luteal phase inadequacy.
8 in 10 women with early pregnancy loss history who took progesterone went on to deliver. Source: Wentz AC et al., 1984, PMID 6724001.Study at a glance, chart review of 79 women: Progesterone-treated luteal phase inadequacy ended in 19 deliveries. Source: Wentz AC et al., 1984, PMID 6724001.
Key Findings
Diagnosis needed a biopsy over 2 days out of phase in two cycles, or one in high-risk women. Forty-five of 50 (90%) repeat biopsies were out of phase.
Among 45 women who had a biopsy during treatment, 37 of 45 (82%) showed an in-phase biopsy. In 7 of 45 (16%), the defect was not corrected.
Among 38 women with two out-of-phase biopsies who took progesterone alone, 16 pregnancies were documented, 14 during treatment. Twelve of 14 delivered.
Among 20 women with a history of early pregnancy loss, 8 of 10 (80%) treated with progesterone delivered.
Interpretation
The 1984 chart review followed 79 women with confirmed luteal phase inadequacy at one center. Doctors matched treatment to the suspected cause. Women got progesterone suppositories for the luteal defect, fertility drugs for a long follicular phase, or both. Thyroid and prolactin problems were treated on their own and tracked separately. Progesterone correction was linked with a return to normal biopsy timing in most repeat biopsies, and with pregnancies and deliveries in every treatment group, including women with a history of early pregnancy loss. The authors call that subgroup finding a trend, since the group was small. The findings support larger studies of matched treatment for luteal phase inadequacy.
RRM Context
The authors looked for other treatable causes first. They matched treatment to the suspected cause. Women with thyroid or prolactin problems were treated for those and left out. Women with long follicular phases received clomiphene citrate. This follows the restorative reproductive medicine principle of evaluation before treatment. The paper also lists male factor among other diagnoses that can coexist.
Our editorial summary of this paper, not the article's abstract.
Abstract
Diagnosis, choice of therapy, and pregnancy outcome were analyzed in 79 women evaluated for luteal phase inadequacy. Criteria for the diagnosis were established, and groups at risk for luteal inadequacy were identified. Treatment choices, tailored to the suspected cause, included progesterone suppositories in 54 women, with 23 pregnancies and 19 deliveries; clomiphene citrate in 6 women, with 2 pregnancies and deliveries; and combined treatment in 7 women, with 5 pregnancies and 4 deliveries. Eight women received no treatment, including three who underwent endometrial biopsy in the cycle of conception and who subsequently delivered. These data suggest that careful diagnosis and the proper choice of treatment are important, and that progesterone supplementation may result in improved pregnancy outcome for patients with infertility and pregnancy wastage who have luteal phase inadequacy.
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