Luteal phase defect is a corpus luteum progesterone deficiency
A 1976 clinical review defines the luteal phase defect as too little progesterone from the corpus luteum (the gland that forms after ovulation), in amount or duration. Patients present with infertility or repeated first-trimester miscarriage. The author states that clinical diagnosis requires a timed endometrial biopsy 2 or more days out of phase, repeated in at least two cycles.
Key Findings
In the review's infertility population, corpus luteum insufficiency was a causal factor in approximately 3.5% of cases; it was identified in approximately 35% of its habitual abortion patients.
Diagnosis rests on a well-timed endometrial biopsy that is 2 or more days out of phase in at least two cycles, while temperature charts can raise suspicion.
The review describes several causes of the defect, including primary ovarian defects, primary central defects of the hypothalamic-pituitary axis, primary metabolic defects, and specific defects in luteal cell steroidogenesis.
The author names substitution with progesterone as the treatment of choice and states that successful therapy must be provided in the cycle in which pregnancy occurs.
The author reports that oral progestational agents are ineffective in the great majority of cases and can be luteolytic, meaning they can inhibit corpus luteum function.
Interpretation
The article is a clinical review of how the luteal phase defect is diagnosed, what causes it, and how it is treated. The author notes that the habitual abortion group is highly selected for endocrine problems. The review presents the defect as a clinical entity with several causes and ties the diagnosis to a repeated, well-timed biopsy finding.
RRM Context
Restorative reproductive medicine seeks the cause of low progesterone, the hormone made after ovulation. The review keeps progesterone apart from synthetic agents, a line restorative clinicians still hold. NaProTechnology times progesterone support to the cycle by charting. A full workup with timed testing can find a cause that would stay undiagnosed.
Our editorial summary of this paper, not the article's abstract.
Abstract
In summary, the luteal phase defect is a deficiency of corpus luteum progesterone steroidogenesis, either in amount or duration, or both. The clinical manifestations include either primary infertility or repeated first trimester abortions. The diagnosis can only be made clinically on the basis of a well-timed endometrial biopsy that is read histologically as 2 or more days out of phase with the next period in at least two cycles.
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