Luteal Phase Dysfunction Workup

Updated: Jul 12, 2021
  • Author: Thomas L Alderson, DO; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Laboratory and Imaging Studies

Laboratory studies

Serum progesterone levels have been studied as a means to diagnose luteal phase deficiency (LPD). Early data showed that peak progesterone production occurred in the mid-luteal phase. Later studies confirmed that progesterone is released in a pulsatile fashion, suggesting that a single sample is nondiagnostic. The use of multiple samples to overcome the pulsatile nature of progesterone is expensive and inconvenient.

Urinary luteinizing hormone (LH) kits provide a useful test to estimate the appropriate timing of an endometrial biopsy (EB). Following a positive test finding, ovulation occurs within 24-26 hours. The EB should be performed on the 12th day of a 14-day luteal phase.

Studies measuring progestin endometrial protein (PEP) have not been conclusive in diagnosing LPD. Studies regarding cell adhesion molecules or integrins, growth factors, and cytokines are all in the experimental phase.

Imaging studies

Ultrasound documentation of ovulation from follicular growth to collapse of the follicle is very accurate; however, this procedure is too expensive and time consuming to be realistic in all patients. [6] Ultrasound measurement of endometrial thickness has not been shown to be effective in the prediction of luteal phase deficiency.




In 1950, Noyes, Hertig, and Rock established that the diagnosis of luteal phase deficiency (LPD) is centered on histologic dating of the endometrium. However, the location and time of the biopsy can greatly influence endometrial biopsy (EB) findings. Some authors believe that mid-luteal phase biopsy is the best for accurate diagnosis of LPD.

Biopsies from the fundus of the uterus yield improved histologic samples compared to those taken from the lower uterine segment. Specimens taken approximately 1-2 days prior to menses provide better specimens for interpretation. For example, women with cycles of 28 days should have an EB performed on the 26th day.

Histologically, a luteal phase defect provides a biopsy that lags behind the date of actual endometrial sampling by 3 days or more. To confirm that such a result is not a variance within the reference range, the biopsy should be performed in 2 consecutive cycles; however, the discomfort associated with the biopsy causes difficulty in convincing the patient to have the procedure performed twice.

Several methods can be used to time the EB just prior to menses. The basal body temperature (BBT) chart is one such method.

The BBT chart can aid in determining the length of the luteal phase. A luteal phase of less than 11 days may be associated with LPD. The BBT chart can also assist in timing the EB by observing the patient's cycle length and performing the biopsy 2 days prior to the expected menses. Although the BBT chart is easy and inexpensive, interpretation can be difficult and frustrating with a woman who is infertile or has suffered multiple pregnancy losses.

The American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility do not recommend endometrial biopsy for histologic dating of the endometrium. Endometrial biopsies only have the precision to differentiate the early luteal, mid-luteal, and late luteal phases, and they have not been shown to distinguish fertile from infertile women. [5]