eMedicine Specialties > Obstetrics and Gynecology > Reproductive Endocrinology and Infertility

Luteal Phase Dysfunction: Follow-up

Author: Thomas L Alderson, DO, Program Director, Assistant Professor, Department of Obstetrics and Gynecology, Mount Clemens Regional Medical Center, Michigan State University College of Osteopathic Medicine
Contributor Information and Disclosures

Updated: Oct 8, 2008

Follow-up

Further Inpatient Care

Luteal phase dysfunction does not require hospitalization and therefore no inpatient diagnostic workup or treatment.

Further Outpatient Care

All diagnostic testing and treatment can be performed in an outpatient setting.

Inpatient & Outpatient Medications

  • Medications used to treat luteal phase dysfunction include dopamine receptor agonists to treat elevated serum prolactin levels.
  • Thyroid replacement treats hypothyroidism.
  • Supplemental progesterone increases the lower levels in the luteal phase observed with this condition.
  • Clomiphene citrate enhances follicular development and thus increases luteal-phase progesterone levels.
  • Human menopausal gonadotropins enhance follicular development and increase luteal-phase progesterone levels.

Deterrence/Prevention

No methodology prevents luteal phase defect. Maintain a high level of clinical suspicion that such a condition exists when seeing a patient with infertility or recurrent pregnancy loss.

Complications

Complications are associated with the endometrial biopsy. Be cautious when performing the biopsy to avoid perforating the uterus. Advise patients to take a nonsteroidal anti-inflammatory drug (NSAID) prior to the procedure to alleviate uterine cramping. No antibiotic prophylaxis is needed.

Prognosis

The lack of double-blinded placebo-controlled studies prevents an accurate prognosis for this condition.

Patient Education

Patients should keep an accurate menstrual cycle calendar. Abnormal cycle length may heighten the physician's suspicion that a luteal phase dysfunction exists.

Miscellaneous

Medicolegal Pitfalls

Failure to consider the diagnosis of luteal phase deficiency when seeing a patient with infertility or recurrent pregnancy loss

Special Concerns

The best treatment of luteal phase deficiency is not yet established because of the lack of double-blinded placebo-controlled studies with an adequate number of patients from whom appropriate conclusions can be made. The overall conclusion is that luteal phase dysfunction does exist, but the endometrial biopsy is not sufficient to diagnose the defect. The defect may be at a molecular level and specific markers are needed.

Research on molecular defects have found such abnormalities in the endometrium in women with endometriosis, polycystic ovarian syndrome, and hydrosalpinx. Taylor has shown diminished HOXA10 gene expression in these women.21 Endometrial receptivity may depend on gene expression that may be regulated by estrogen and progesterone. Until investigators can resolve these issues, the decision to treat patients with luteal phase deficiency occurs through an open and honest discussion between the physician and patient.

 


More on Luteal Phase Dysfunction

Overview: Luteal Phase Dysfunction
Differential Diagnoses & Workup: Luteal Phase Dysfunction
Treatment & Medication: Luteal Phase Dysfunction
Follow-up: Luteal Phase Dysfunction
References
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References

  1. Behrman HR, Endo T, Aten RF. Corpus luteum function and regression. Reprod Med Rev. 1993;2:153-80.

  2. Cermik D, Selam B, Taylor HS. Regulation of HOXA-10 expression by testosterone in vitro and in the endometrium of patients with polycystic ovary syndrome. J Clin Endocrinol Metab. Jan 2003;88(1):238-43. [Medline].

  3. Cicinelli E, de Ziegler D, Bulletti C, et al. Direct transport of progesterone from vagina to uterus. Obstet Gynecol. Mar 2000;95(3):403-6. [Medline].

  4. Cooke ID. The corpus luteum. Hum Reprod. Feb 1988;3(2):153-6. [Medline].

  5. Csapo AI, Pulkkinen MO, Ruttner B et al. The significance of the human corpus luteum in pregnancy maintenance. I. Preliminary studies. Am J Obstet Gynecol. Apr 15 1972;112(8):1061-7. [Medline].

  6. Daftary GS, Taylor HS. Hydrosalpinx fluid diminishes endometrial cell HOXA10 expression. Fertil Steril. Sep 2002;78(3):577-80. [Medline].

  7. Giudice LC. Growth factors and growth modulators in human uterine endometrium: their potential relevance to reproductive medicine. Fertil Steril. Jan 1994;61(1):1-17. [Medline].

  8. Healy DL, Schenken RS, Lynch A, et al. Pulsatile progesterone secretion: its relevance to clinical evaluation of corpus luteum function. Fertil Steril. Jan 1984;41(1):114-21. [Medline].

  9. Jones GES. Some newer aspects of management of infertility. JAMA. 1949;141:1123-1129.

  10. Jones GS. The luteal phase defect. Fertil Steril. Apr 1976;27(4):351-6. [Medline].

  11. Karamardian LM, Grimes DA. Luteal phase deficiency: effect of treatment on pregnancy rates. Am J Obstet Gynecol. Nov 1992;167(5):1391-8. [Medline].

  12. Li TC, Nuttall L, Klentzeris L, Cooke ID. How well does ultrasonographic measurement of endometrial thickness predict the results of histological dating?. Hum Reprod. Jan 1992;7(1):1-5. [Medline].

  13. McNeely MJ, Soules MR. The diagnosis of luteal phase deficiency: a critical review. Fertil Steril. Jul 1988;50(1):1-15. [Medline].

  14. Murray DL, Reich L, Adashi EY. Oral clomiphene citrate and vaginal progesterone suppositories in the treatment of luteal phase dysfunction: a comparative study. Fertil Steril. Jan 1989;51(1):35-41. [Medline].

  15. Noyes RW, Hertig AW, Rock J. Dating the endometrial biopsy. Fertil Steril. 1950;1:3-25.

  16. Peters AJ, Lloyd RP, Coulam CB. Prevalence of out-of-phase endometrial biopsy specimens. Am J Obstet Gynecol. Jun 1992;166(6 Pt 1):1738-45; discussion 1745-6. [Medline].

  17. Peters AJ, Wentz AC. Luteal phase inadequacy. Seminars in Reprod Endo. 1995;13:162-171.

  18. Sherman BM, Korenman SG. Measurement of plasma LH, FSH, estradiol and progesterone in disorders of the human menstrual cycle: the short luteal phase. J Clin Endocrinol Metab. Jan 1974;38(1):89-93. [Medline].

  19. Shoupe D, Mishell DR Jr, Lacarra M, et al. Correlation of endometrial maturation with four methods of estimating day of ovulation. Obstet Gynecol. Jan 1989;73(1):88-92. [Medline].

  20. Soules MR. Luteal phase deficiency. In: Pitkin RM, ed. Clinical Obstetrics and Gynecology. Vol 34. Philadelphia, PA: JB Lippincott; 1991:123-126.

  21. Taylor HS, Bagot C, Kardana A, et al. HOX gene expression is altered in the endometrium of women with endometriosis. Hum Reprod. May 1999;14(5):1328-31.

  22. Yen SC, Jaffe RB, Barbieri RL. Luteal phase defects. In: Reproductive Endocrinology. 4th ed. 1999:244-5.

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Further Reading

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Keywords

luteal phase dysfunction, LPD, luteal phase deficiency, luteal phase defect, progesterone, infertility, recurrent pregnancy loss

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Contributor Information and Disclosures

Author

Thomas L Alderson, DO, Program Director, Assistant Professor, Department of Obstetrics and Gynecology, Mount Clemens Regional Medical Center, Michigan State University College of Osteopathic Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital, Mammoth Lakes, California, Pioneer Valley Hospital, Salt Lake City, Utah, Warren General Hospital, Warren, Pennsylvania and Mountain West Hospital, Tooele, Utah
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Galil None Consulting

 
 
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