What are Luteal Phase Defects (LPD)?
It is when the body stops producing enough progesterone to establish ovulation, or leads to a short-term luteal phase, along with insufficient uterine lining to support the pregnancy. Because of the luteal phase defects, pregnancy issues can occur. It is the situation when the uterine lining is unable to thicken in the second half of the menstrual cycle. This can lead to issues with embryo implantation, causing issues with pregnancy sustainability. On the other side, normal luteal phase ranges between 12 to 16 days, but luteal phase defects, the range reduces to 10 or less days, meaning periods begin earlier than usual (within 10 days of ovulation).
Right before this phase, an ovary releases eggs, which further travel through the fallopian tube, and this increases progesterone levels. If the eggs are fertilised by sperm, then they travel from the uterine lining, resulting in successful pregnancy. While it doesn’t fertilize, the hormone level drops, and women shed, resulting in periods.
Physiology of luteal function
Corpus luteum develops in the luteal phase just before the ovulation phase, and this aids in preparing the uterus for pregnancy by thickening the uterine lining. In the normal pregnancy cycle, the corpus luteum is the one that produces progesterone, which helps in supporting pregnancy until the placenta becomes competent to take over hormone production. If the corpus luteum is removed before the placenta is fully functional, then the loss of pregnancy can occur due to a lack of sufficient progesterone levels. On the other side, if the pregnancy does not happen, then it naturally dissolves, progesterone level decreases, and the menstrual cycle starts. Here are some physiological observations of the luteal phase:
The length of the luteal phase is 12 to 14 days, but can range between 11 to 17 days.
- After (6 to 8 days) ovulation, progesterone levels peak.
- Luteinizing hormones control the progesterone secretion, and these are produced by the corpus luteum in response to LH pulses.
- Endometrial is the responsive reflection of luteal phase progesterone and estrogen, and follicular phase estrogen.
- Rising of human chorionic gonadotropin (hCG) level influences progesterone secretion by the corpus luteum. While hCG failure results in a decline in progesterone, and a failed corpus luteum.
Symptoms and Causes
Causes:
Hormonal imbalance-
inadequate production of progesterone causes issues with ovulation and disrupts the preparation of the uterine lining.
Structural abnormalities-
because of fibroids and uterine polyps, the ability of the endometrium to support the pregnancy because to the abnormal uterine lining. Several issues like reduced granulosa cells, LH surge, abnormal folliculogenesis, endometrial receptivity, and thickness can also cause LPD.
Various health conditions-
- Endometriosis: it impacts the corpus luteum (causing abnormal luteolytic), which is a temporary structure after ovulation, leading to inadequate progesterone production.
- PCOS: Due to the insufficient level of progesterone due to anovulation or irregular ovulation, the corpus luteum is unable to function properly.
- Thyroid: This disrupts hormonal balances, which is essential for the menstrual cycle, leading to insufficient production of progesterone. Also, due to low thyroid hormone levels, up prolactin levels can hinder the ovulation and implantation process.
- Obesity: this causes insulin resistance, level up androgen, reduces LH pulse amplitude, affects ovarian response, and reduces progesterone, which is essential to maintain uterine lining.
- Eating disorders like anorexia: this causes malnutrition, leading to low body fat and hormonal fluctuation, impacting the hypothalamic pituitary ovarian axis. It also weakens GnRH pulses, leading to poor corpus luteum formation.
- Pituitary gland disorder: The pituitary gland is responsible for producing LH and FSH, but the disorder makes it difficult to produce these hormones, and impacts the quality of eggs and follicles.
Additional factors-
– Lifestyle factors like excessive exercise, smoking, drinking, and stress.
– Aging is one of the core factors of the issue.
– Some studies indicated that ART is also associated with LPD.
– A genetic condition like untreated 21-hydroxylase deficiency can affect the production of cortisol levels.
Symptoms:
There are signs of luteal phase defects that can help you know about the issue-
- Spotting occurs because the uterine lining is unable to thicken enough to support pregnancy.
- Rise of Basal Body Temperature (BBT) because progesterone is released after ovulation. But in LPD, due to irregular production, BBT fluctuation happens.
- Shorter menstrual cycle (less than 21 days), because of inadequate progesterone, and early shedding of the uterine lining.
- For those who are continuously tracking their cycle and have a luteal phase defect, they might have noticed a shorter period of time from ovulation to periods.
Treatments
- Clomiphene citrate (clomid)- This medicine is used to stimulate ovulation and improve the production of progesterone. In some cases, clomid helps lengthen the luteal phase. Don’t consider taking this pill without consulting with expert.
- Human chronic gonadotropin mimics the role of LH, stimulating the corpus luteum to produce progesterone, and enhancing the implantation in women. By maintaining a level of hormones, hCG can prevent from short luteal phase, and enhance pregnancy support.
- Progesterone shots or pills- these are considered to be given to the patient after ovulation, increasing the chances of growing uterine lining. This also ensures adequate blood flow and offers nutrition to the embryo.
- Lifestyle changes- although treatment does help to improve LPD issues, lifestyle modifications like a healthy diet, regular workouts, reducing stress through mindful practices, and maintaining a healthy weight can also create positive changes.
Takeaway
For all women, it is necessary to track their menstrual cycle. You should know about the length of the luteal and ovulation phases. If your luteal phase lasts up to 10 days or less, then this is an indication of LPD and infertility. And if you are considering extending family and unable to attain the desired results, then start tracking your cycle and consult with the expert.
Aveya Fertility Center is working effortlessly to make a difference in women’s lives and ensuring to give positive results for those who are dealing with reproductive health issues or unable to conceive. If you are looking for a professional who can guide and treat you, then Aveya Fertility Center is the one.
For more information, contact Aveya IVF today!
