The luteal phase begins during the second half of a menstrual cycle normally (not always) lasting around 12-14 days after ovulation. The corpus luteum, where “luteal phase “ is named after, is formed right after ovulation and is responsible for producing progesterone. During the luteal phase, production of hormone secretions such as progesterone and estrogen, begin to increase helping to prepare uterine lining for a possible fertilized egg. If there is no presence of a fertilized egg or the hormones levels are not optimal, then the menstrual cycle begins.
- Is your luteal phase less than 12 days long?
- Do you have vaginal spotting before you get your menstrual bleed?
- Have you noticed a slow or low rise on your basal body temperature chart following ovulation?
- Have you had a vaginal ultrasound just prior to ovulation to document an adequately thick endometrium (a normal range is 6-10mm)?
- Has the doctor taken a blood test to evaluate progesterone levels mid-way between ovulation and your menstrual cycle? (A level of less than 10 nanograms may indicate a problem.)
- If you have had an endometrial biopsy, was it done after day 21 in your cycle?
- If the endometrial biopsy showed a “lag” and you are being treated for a luteal phase defect, will another biopsy be done in the future to evaluate results?
- If you have been on clomiphine, has the doctor evaluated your luteal phase? Clomiphene can sometimes thin the endometrial lining of the uterus.
- Some new tests to evaluate the uterine lining during the luteal phase include Doppler ultrasound and the evaluation of the integrins in the endometrial tissue. Talk with your doctor about these tests.
A luteal phase defect will be diagnosed if progesterone levels are inadequate for implantation. This information is gathered from luteal phase progesterone labs (5 & 8 days post ovulation) and endometrial biopsy results.
There are three methods of therapy commonly used linked to treat luteal phase defect.
- clomiphene citrate or human menopausal gonadotropins (hMG) to stimulate follicular growth
- supplemental hCG to improve corpus luteum secretion of progesterone
- additional progesterone after ovulation given by injection, orally or by vaginal suppositories or gel is often used.
DIRM is truly a place where dreams, through science, become reality.