Luteal Phase Defect
The luteal phase of a woman’s cycle is the second half of her cycle. It begins right after ovulation and generally lasts around 12-14 days. The luteal phase is named after the corpus luteum. The corpus luteum is a yellow structure that forms after ovulation. The corpus luteum is responsible for progesterone production. Progesterone has several functions which are necessary for a healthy pregnancy. If you have a defect with your corpus luteum you may not produce enough progesterone to sustain a pregnancy.
How is luteal phase defect diagnosed?
Your doctor may recommend that you keep track of your temperature upon waking with a bbt chart. Progesterone causes a rise in temperature that is visible on a bbt chart during the second half of your cycle. Normally, you will see temperatures rise after ovulation and stay up for about 12-14 days before menstruation. You can tell how long your luteal phase is by looking at your bbt chart. If your luteal phase is shorter than ten days you may have a luteal phase defect. Some doctors may be concerned if your luteal phase is shorter than twelve days.
Endometrial biopsies are another way that luteal phase defect is diagnosed. Endometrial biopsies are usually done late in your menstrual cycle around 11 or 12 days after ovulation. An endometrial biopsy is a scraping of part of the endometrium (the lining of your uterus). Your doctor will use an instrument to take a sample of the lining of your uterus. He will send this sample off to a lab to be evaluated. The lab will take a look at the sample under a microscope and determine what stage of development the tissue is. If the tissue is not developed as much as it should be for where you are in your cycle you may be diagnosed as having a luteal phase defect.
Since progesterone production is the big concern with luteal phase defect, some doctors will check your blood progesterone level to diagnose luteal phase defect. This is done by checking your progesterone levels at different stages of your menstrual cycle. If your progesterone level is low, you may be diagnosed with having a luteal phase defect. There are some drawbacks to checking blood progesterone levels. The level of progesterone in your blood fluctuates from hour to hour throughout the day. You may appear to have a normal blood progesterone level at one point in the day but have a lower level if your blood was drawn at a different time of day. Also, blood progesterone levels vary for normal pregnancies making it difficult to establish what level is inadequate to sustain pregnancy.
Treatment of luteal phase defect
There are a few ways that luteal phase defect is treated. Some doctors simply prescribe progesterone suppositories to increase the level of progesterone in your bloodstream. How effective progesterone treatment is has not been determined. Progesterone therapy is generally started a few days after ovulation and continued until the placenta begins to take over progesterone production around the twelfth week of pregnancy. Not all doctors are comfortable with progesterone supplements. Progesterone’s safety has not been established. Although there is no evidence of birth defects caused by progesterone supplementation, there really is no long term data on its use either. We are just not sure that there will not be repercussions from using progesterone or even if it is effective.
Fertility drugs like Clomid are sometimes used to treat luteal phase defect. If follicle development is poor during the first half of a woman’s cycle, the resulting egg and corpus luteum may be poor. Clomid is used to stimulate a woman’s follicles to ovulate. If treatment is successful, the corpus luteum will be healthier and subsequently, progesterone production will be better.
HCG injections are yet another treatment for luteal phase defect. HCG is normally produced during pregnancy and helps maintain the corpus luteum. HCG injections help to stimulate the corpus luteum and increases progesterone levels during the luteal phase.