{"id":37325,"date":"2020-02-11T08:00:00","date_gmt":"2020-02-11T16:00:00","guid":{"rendered":"https:\/\/www.avawomen.com\/?p=37325"},"modified":"2020-02-28T14:13:38","modified_gmt":"2020-02-28T22:13:38","slug":"luteal-phase-defect","status":"publish","type":"post","link":"http:\/\/www.avawomen.com\/avaworld\/luteal-phase-defect\/","title":{"rendered":"Luteal Phase Defect: How it Affects Your Chances for Pregnancy"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">If you\u2019re trying to become pregnant and find yourself taking a while to conceive, or if you became pregnant and suffered one or more first trimester miscarriages, you may be wondering if you have a luteal phase defect (LPD).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This is a good question to ask. Luteal phase defects are <\/span><a href=\"https:\/\/ovarianresearch.biomedcentral.com\/articles\/10.1186\/s13048-015-0205-8\"><span style=\"font-weight: 400;\">thought<\/span><\/a><span style=\"font-weight: 400;\"> to be a <\/span><a href=\"https:\/\/www.mdedge.com\/obgyn\/article\/61414\/luteal-phase-deficiency-what-we-now-know\"><span style=\"font-weight: 400;\">common cause<\/span><\/a><span style=\"font-weight: 400;\"> of problems becoming pregnant. However, their diagnosis and relationship to fertility remain <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=25681857\"><span style=\"font-weight: 400;\">controversial<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here\u2019s what we know: <\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">A normal luteal phase is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4436586\/\"><span style=\"font-weight: 400;\">necessary for successful implantation and growth of the embryo<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0 <\/span><\/li>\n<li><span style=\"font-weight: 400;\">We also know that assisted reproduction techniques like IVF cause luteal phase defects. Ovarian stimulation <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29778366\"><span style=\"font-weight: 400;\">interferes with progesterone production during the luteal phase<\/span><\/a><span style=\"font-weight: 400;\">. <\/span><\/li>\n<li><span style=\"font-weight: 400;\">Women undergoing ovarian stimulation are therefore <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29778366\"><span style=\"font-weight: 400;\">routinely<\/span><\/a> <a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.12770\"><span style=\"font-weight: 400;\">treated<\/span><\/a><span style=\"font-weight: 400;\"> with supplemental progesterone. This practice <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26148507\"><span style=\"font-weight: 400;\">dramatically improves<\/span><\/a><span style=\"font-weight: 400;\"> ongoing pregnancy and live birth rates following IVF.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">What\u2019s controversial is how to test for and diagnose LPD in women trying to conceive <em>naturally<\/em>. Doctors used to test <\/span><a href=\"https:\/\/www.avawomen.com\/avaworld\/progesterone-levels-day-21\/\"><span style=\"font-weight: 400;\">progesterone levels<\/span><\/a><span style=\"font-weight: 400;\"> or take a biopsy of the uterine lining. But these tests are no longer considered accurate. The inability to diagnose LPD has greatly hindered research on how LPD contributes to infertility in natural (unassisted) cycles.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Of course, just because we cannot test for something does not imply it is not a problem. Many clinicians will therefore treat LPD, especially since most the common treatments, like supplemental progesterone, are well-studied and considered low risk.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What happens during a normal luteal phase?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The luteal phase starts on the day of ovulation and lasts until the first day of your period. This is when your uterine lining (endometrium) thickens to prepare for a possible pregnancy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Ovulation occurs when the dominant follicle (or sac) in your ovaries releases an egg. The egg then travels down the fallopian tube to become fertilized.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">After releasing the egg, the remaining follicular cells form a structure on the ovary known as the <\/span><a href=\"https:\/\/www.britannica.com\/science\/corpus-luteum\"><span style=\"font-weight: 400;\">corpus luteum<\/span><\/a><span style=\"font-weight: 400;\">. The corpus luteum then begins releasing hormones, mainly progesterone and estrogen. These hormones cause your uterine lining (endometrium) to thicken and to undergo other changes to prepare for implantation.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If implantation occurs, the corpus luteum continues to secrete progesterone to maintain the pregnancy. A corpus luteum is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/4688578\"><span style=\"font-weight: 400;\">required to sustain pregnancy for the first 7-9 weeks<\/span><\/a><span style=\"font-weight: 400;\">, at which point the placenta takes over.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is a luteal phase defect (LPD)?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A luteal phase defect occurs when your uterine lining fails to adequately prepare for pregnancy. It can lead to failed implantation or early miscarriage. Often, this arises as a luteal phase that is shorter than normal. But sometimes <\/span><a href=\"https:\/\/academic.oup.com\/jcem\/article\/99\/6\/E1007\/2537296\"><span style=\"font-weight: 400;\">progesterone levels are low<\/span><\/a><span style=\"font-weight: 400;\"> despite the luteal phase being a normal length.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A normal luteal phase <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4436586\/\"><span style=\"font-weight: 400;\">lasts anywhere from 11-17 days<\/span><\/a><span style=\"font-weight: 400;\">, with most between 12-14 days. Luteal phases less than 10 days are too short to allow for successful implantation and growth of a fertilized egg.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How do you know if you have a luteal phase defect?<\/span><\/h2>\n<h3><span style=\"font-weight: 400;\">Cycle Tracking<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The length of your menstrual cycle alone cannot tell you whether you have a luteal phase defect. If, for example, you have a<\/span><a href=\"https:\/\/www.avawomen.com\/avaworld\/late-ovulation\/\"><span style=\"font-weight: 400;\"> long pre-ovulation (follicular) phase<\/span><\/a><span style=\"font-weight: 400;\"> followed by a short luteal phase, the long time to ovulation masks the short luteal phase.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">To determine your luteal phase length, count the number of days between ovulation and your period. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/6743610\/\"><span style=\"font-weight: 400;\">Start counting on the day of ovulation and stop counting on the first day of your menstrual period<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">(For example, if you ovulated on cycle day 14, and got your period on cycle day 28, your luteal phase was 14 days long.)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You\u2019ll also have to track this for more than one cycle. A single menstrual cycle cannot tell you if you have a luteal phase defect. Many women have a short luteal phase from time to time; this is normal and unlikely to affect your fertility.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">However, a luteal phase <\/span><i><span style=\"font-weight: 400;\">consistently<\/span><\/i><span style=\"font-weight: 400;\"> shorter than 10 days <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5337433\/\"><span style=\"font-weight: 400;\">can make it harder for you to become\u2014or to stay\u2014pregnant<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Clinical Tests\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Doctors <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15533340?dopt=Abstract\"><span style=\"font-weight: 400;\">used to diagnose a luteal phase defect<\/span><\/a><span style=\"font-weight: 400;\"> by measuring progesterone in the blood or by taking a biopsy (sample) of the uterine lining. Neither of these approaches are currently considered accurate. Progesterone levels vary dramatically from hour to hour (up to 800% within 90 minutes), and <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25681857\"><span style=\"font-weight: 400;\">biopsies of the uterine lining do not reliably distinguish women with normal cycles from those with a luteal phase defect<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Other possible symptoms of a luteal phase defect include:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Spotting between periods<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.avawomen.com\/avaworld\/miscarriage-101\/\">Miscarriage<\/a>, especially early or <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27887710\"><span style=\"font-weight: 400;\">recurrent miscarriages<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Difficulty becoming pregnant<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Short menstrual cycles<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">What causes a luteal phase defect?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A luteal phase defect occurs when <\/span><a href=\"https:\/\/academic.oup.com\/jcem\/article\/99\/6\/E1007\/2537296\"><span style=\"font-weight: 400;\">your ovaries fail to produce enough progesterone or when your uterine lining fails to respond to normal levels of progesterone<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Assisted reproductive techniques, such as IVF, that use hormones to stimulate egg production <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25379149\"><span style=\"font-weight: 400;\">cause luteal phase defects<\/span><\/a><span style=\"font-weight: 400;\">. Women undergoing ovarian stimulation therefore take progesterone to ensure the proper development and maintenance of the uterine lining.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Certain health conditions and other factors can raise your risk of a luteal phase defect. These include:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6027099\/\"><span style=\"font-weight: 400;\">Obesity<\/span><\/a><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Excessive exercise (<\/span><a href=\"https:\/\/www.avawomen.com\/avaworld\/exercise-fertility\/\"><span style=\"font-weight: 400;\">more info on how to exercise without lowering your fertility<\/span><\/a><span style=\"font-weight: 400;\">)<\/span><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.avawomen.com\/avaworld\/what-is-pcos-fertility\/\"><span style=\"font-weight: 400;\">Polycystic Ovarian Syndrome (PCOS)<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Stress<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Breastfeeding\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3136077\/\"><span style=\"font-weight: 400;\">Thyroid problems<\/span><\/a><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/424097\/\"><span style=\"font-weight: 400;\">Hyperprolactinemia<\/span><\/a><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Can stress cause a short luteal phase?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">One of the most irritating and obnoxious responses to disclosing your problems becoming pregnant is to be told, \u201cjust relax. don\u2019t stress.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">That said, stress does seem to play a role in luteal phase defects, especially if the stress is severe or prolonged.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Stress in humans is difficult to study experimentally. In monkeys, researchers have shown that <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11994369?dopt=Abstract\"><span style=\"font-weight: 400;\">severe, prolonged stress lowers progesterone levels during the luteal phase<\/span><\/a><span style=\"font-weight: 400;\">. And at least one study suggests the same may be true in humans. Among women in rural Malaysia, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15368600\/\"><span style=\"font-weight: 400;\">higher urinary cortisol (a stress hormone) correlated with lower progesterone levels during their luteal phase<\/span><\/a><span style=\"font-weight: 400;\">. However, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10453249\"><span style=\"font-weight: 400;\">other studies<\/span><\/a><span style=\"font-weight: 400;\"> have not found a link between stress and luteal phase progesterone.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some stress is unavoidable. How it affects your body comes down to not just how severe, prolonged, or frequent it is, but also how well you can cope or find calm in its midst.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Can breastfeeding cause a short luteal phase?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Many women who are breastfeeding <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1521642\"><span style=\"font-weight: 400;\">experience short luteal phases<\/span><\/a><span style=\"font-weight: 400;\">. Things tend to return to normal 1-2 cycles after weaning.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are a couple of reasons for this. First, breastfeeding releases prolactin, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/943740\"><span style=\"font-weight: 400;\">a hormone that can interfere with ovulation and proper functioning of the corpus luteum<\/span><\/a><span style=\"font-weight: 400;\">. Second, breastfeeding requires a lot of calories, which can disrupt the menstrual cycle by <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3305908\/\"><span style=\"font-weight: 400;\">creating a negative energy balance<\/span><\/a><span style=\"font-weight: 400;\"> (when you expend more energy than you consume).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Birth, even when not followed by breastfeeding, also <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7165971\"><span style=\"font-weight: 400;\">disrupts the luteal phase<\/span><\/a><span style=\"font-weight: 400;\"> for your first few menstrual cycles.\u00a0\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How is a luteal phase defect treated?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Certain health conditions, like thyroid problems, can cause luteal phase defects. Your doctor will evaluate you for these potential underlying conditions. If no obvious health culprit is identified, treatment aims instead to improve hormone levels during the luteal phase.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are a couple of popular approaches:\u00a0<\/span><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> Stimulate egg development with clomiphene citrate (clomid), letrozole, or <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11172853\"><span style=\"font-weight: 400;\">human menopausal gonadotropins (HMG)<\/span><\/a><span style=\"font-weight: 400;\"> to improve the quality of the dominant follicle and thus the corpus luteum.<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> Directly stimulate uterine lining growth with progesterone and\/or HCG during the luteal phase.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Because of the difficulty of diagnosing LPD, it is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed?term=25681857\"><span style=\"font-weight: 400;\">unclear<\/span><\/a><span style=\"font-weight: 400;\"> whether these treatments help women who have trouble becoming pregnant. But for women who have suffered multiple miscarriages, supplemental progesterone <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27887710\"><span style=\"font-weight: 400;\">does seem<\/span><\/a> <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30298541\"><span style=\"font-weight: 400;\">to lower<\/span><\/a><span style=\"font-weight: 400;\"> their chances of a subsequent miscarriage.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Natural treatments for Luteal Phase Defect?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you think you might have a luteal phase defect, the best course of action is to seek medical care. Your doctor can tell you if you have an underlying condition that might be affecting your luteal phase.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A few small, low-quality studies have suggested that <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/12909517\"><span style=\"font-weight: 400;\">vitamin C<\/span><\/a><span style=\"font-weight: 400;\"> might help improve progesterone levels in women with luteal phase defects. While the value of supplement vitamin C is unclear, eating a varied diet rich in fruits and vegetables is always a good idea.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some other natural care providers suggest using an over the counter progesterone cream. But caution is warranted. We do not know the value (or risks) of using these OTC creams while trying to conceive.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you\u2019re trying to become pregnant and find yourself taking a while to conceive, or [&hellip;]<\/p>\n","protected":false},"author":10027,"featured_media":37453,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[772,775],"tags":[74,400],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v17.3 (Yoast SEO v18.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Luteal Phase Defect: How it Affects Your Chances for Pregnancy - Ava<\/title>\n<meta name=\"description\" content=\"Luteal phase defects are thought to be a common cause of problems becoming pregnant. 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