category > fertility-treatments > female-treatments > conditions > luteal-phase-defect

Fertility HealthFertility Conditons
Fertility TreatmentsStart you fertility journey

Luteal Phase Defect

LPD Diagnosis & Treatment

Diagnosing and treating LPD is complicated by the many possible causes and links to other conditions that reduce fertility. Thankfully, a range of effective treatments and self-help options exist, and the diagnosis is confirmed when:

  1. A luteal phase lasts less than ten days.
  2. Progesterone levels are below 30 nml/l on the seventh day after ovulation level.

However, it should be suspected when:

  • The luteal phase is less than 12 days.
  • There are menopausal symptoms.
  • There’s spotting before menstruation.
  • BBT temperatures are low or erratic in the second part of the cycle.
  • It’s difficult getting pregnant.

Causes

The luteal phase relies on high and stable progesterone levels in the second part of the cycle, when the temporary corpus luteum gland produces progesterone, and problems can occur when:

  1. The dominant follicle was of poor quality, leading to an inadequate quality corpus luteum developing from it. This doesn’t produce enough progesterone, so although it’s a luteal phase problem, the cause lies in the follicular phase.
  2. The corpus luteum doesn’t last as long as it should despite it coming from a good quality dominant follicle, possibly due to stress causing fluctuating hormone levels from the hypothalamus.
  3. The hypothalamus-pituitary-ovarian axis (HPO) remains crucial in this stage of the cycle. During the luteal phase, the hypothalamus pulses GnRH to stimulate the corpus luteum to release progesterone. However, a malfunction with the pulse generator in the hypothalamus is the cause of about half of all LPD. i

LPD and PCOS

Polycystic ovary syndrome (PCOS) has some surprising similarities with LPD as they’re both:

  • Conditions involving dysfunctional ovaries that are causing infertility.
  • Associated with hyper-insulinaemia (high levels of insulin in the blood relative to glucose).
  • Associated with an excess of the anti-Mullerian hormone.
  • Associated with defects in the development of the corpus luteum. ii

Hypertension, obesity, high cholesterol and glucose intolerance (often due to a high fat and sugar diet) increase the chances of Hyper-insulinaemia. This connection makes reducing fat and sugar in the diet and increasing wholefoods crucial tools to reduce the chances of both LPD and PCOS.

Luteal Phase Deficiency Testing

  1. Testing for progesterone on the seventh day after ovulation, which is usually done on day 21 (based on ovulation on day 14). However, if ovulation was on day 9, the test would be inaccurate.
  2. Blood tests for prolactin, androgens and TSH levels.
  3. Ultrasound to measure the thickness and development of the womb lining and to track follicle development and egg release (see LUFS).

Luteal Phase Disorder Treatments

  1. Progesterone injections or gels (crinone or progestin) are synthetic progesterones used to supplement progesterone in the luteal phase of IVF protocols (or treat recurrent miscarriages from low progesterone levels). They’re often used in suspected LPD cases. iii
  2. Clomiphene citrate (clomid).
  3. Gonadotrophins such as follicle-stimulating hormone (FSH) or human chorionic gonadotropin (hCG) when there’s evidence low FSH or oestradiol levels are causing the LPD.
  4. Heparin or aspirin (75 mg per day) when there’s evidence of low flow in the uterine artery.
  5. Humeria, IVIg, corticosteroids or LIT for raised uterine immunological activity.
  6. Herbal medicine to support the growth and development of follicles, the function of the corpus luteum and promote progesterone levels.

Self-help for LPD

These mainly rely on changes to diet, and the addition of supplements:

  • Supplements, particularly folic acid, vitamin B6, vitamin C, vitamin D, vitamin E, iodine, selenium, iron, and DHA, help improve the fertility of women with LPD. iv
  • Fertility charting provides accurate feedback on hormone levels.
  • Adjusting lifestyle and diet for the appropriate fertility profiles will improve egg quality and corpus luteum function.

Other factors to bear in mind include:

  • Low cholesterol levels can cause LPD as all hormones are made from cholesterol. People with low body weight and little fat are affected most, and they should avoid “low-fat” diets and increase clean cholesterol from organic beef and milk, whole milk yoghurt, kefir, free-range eggs, organic butter and coconut oil.
  • Vitamin E, L-arginine and sildenafil citrate improve endometrial depth when the functional layer is too thin for successful implantation. v
  • Vitamin C improves hormone levels and increases fertility in some women with LPDvi, and 25% of women supplementing with vitamin C got pregnant in 6 months, compared to 11% in the placebo group. Foods rich in vitamin C include papaya, bell peppers, broccoli, brussel sprouts, strawberry and oranges.
  • Vitamin B6 is linked to more stable luteal phases and increased fertility. vii
  • Essential fatty acids (EFAs) are essential for hormone production, and many people have low EFA (specifically omega 3) levels. Foods rich in EFA’s include walnuts, salmon, sardines, halibut, shrimp, scallops, liver, eggs and flaxseeds.
  • Green leafy vegetables are rich in the B vitamins essential for proper hormone balance; the greener, the better!
  • Vitex (Chasteberry) is effective at boosting progesterone levels and lengthening the luteal phase.
  • Progesterone Cream is often used to lengthen the luteal phase. However, if the problem lies with low LH, then adding progesterone won’t work. There are serious health considerations in self-medicating, and not all creams have a similar action, so please seek professional advice before using them.
  • Antioxidants reduce oxidative damage that can cause LPD, and women with LPD or recurrent miscarriages have much lower levels of antioxidants than healthy women. The many benefits of antioxidants are discussed in oxidative stress and fertility.