August 2003 · Vol. 15, No. 8Luteal phase deficiency: What we now know
Disagreement about the cause, true incidence, and diagnostic criteria of this condition makes evaluation and management difficult. Here, 2 physicians dissect the data and offer an algorithm of assessment and treatment.
LAWRENCE
ENGMAN,
MD;
ANTHONY
A.
LUCIANO,
MDDr. Engman is a fellow in reproductive endocrinology and infertility, University of Connecticut School of Medicine, Farmington, Conn. Dr. Luciano is professor of obstetrics and gynecology, University of Connecticut School of Medicine, and director, Center for Fertility and Women’s Health, New Britain General Hospital, New Britain, Conn.
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KEY POINTS
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Luteal phase deficiency (LPD), defined as endometrial histology inconsistent with the chronological date of the menstrual cycle, may be caused by deficient progesterone secretion from the corpus luteum or failure of the endometrium to respond appropriately to ovarian steroids.
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Wide variation in the reported incidence of LPD—3.7% to 20% in infertile women—reflects lack of agreement about its diagnostic criteria.
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Histologic dating of an endometrial sample is the gold standard for evaluation of the corpus luteum.
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Two main treatment strategies have been suggested: improving follicular dynamics using follicle-maturing drugs such as clomiphene, and use of supplemental progesterone during the luteal phase and first trimester of pregnancy.
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Despite scanty and controversial supporting evidence, evaluation of patients with infertility or recurrent pregnancy loss for possible luteal phase deficiency (LPD) is firmly established in clinical practice. In this article, we examine the data and offer our perspective on the role of LPD in assessing and managing couples with reproductive disorders (FIGURE 1).
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