More On Luteal Phase Defect

After the January 10th Q & A regarding Luteal Phase Defect while on Clomid, I received another question which I would like to include to further enlighten those who struggle with this problem and are not receiving an adequate explanation or treatment for it..

Question:

Hi Dr. Ramirez, My question is that I have a LP (luteal phase) of 8 days. I ovulate on day 23. I always spot beginning of cycle, mid cycle and after cycle for 2-4 days. I started taking 100mg of B6 vitamins last month and progesterone cream immediately after ovulation. Last month, I began spotting two days post-O (I stopped the cream at that time).

The problem is my spotting has increased (menstruation CD 1-9, spotting CD 10, 11, 15-18, 25-31 and menstruating during new CD 1-10). What can I do about this? I am taking my BBT (temps are elevated post-O, I am also taking OPKs so I know I am ovulating. My Dr has done pelvic u/s (ultrasound), ovarian u/s, etc. everything is normal, so are hormone levels. Is there anything I can do on my own to increase my chances of conception? Or is there anything I can bring to my Dr.'s attention? Help! Thx..

Answer:

Thank you for your question. I would like to explain a little about what the luteal phase is before addressing your concerns. The luteal phase is one of the most exact parts of a woman's cycle, if she is ovulatory. It is the second half of the menstrual cycle after ovulation. The corpus luteum secretes progesterone which prepares the endometrium for the implantation of an embryo. A normal luteal phase is 14 days. However, there is a disorder of the luteal phase whereby this part is short. It is called a luteal phase defect. It sounds like you may have a luteal phase defect, which is cuased by hormonal asynchrony. Hence the abnormal bleeding. The uterine lining (endometrium) is very dependant on appropriate hormonal synchrony to keep it stable. If it is unstable, it breaks apart, hence the bleeding at odd times during the month.

The luteal phase can be supported by using supplemental progesterone. It is generally used beginning on cycle day #16 and extending for two weeks. Of course, a pregnancy test will have to be done because the period may be suppressed. If it is positive, you continue the progesterone until 10 - 12 weeks gestational age.

However, based on your scenario, LPD is not the only problem. You may actually need to go an an ovulation induction protocol with Clomid, Latrezole or Gonadotropins in addition to the progesterone supplementation. These medications will help your ovary to perform normally and synchronize the hormonal situation. It may also alleviate the luteal phase defect.

I hope this helps!

Edward J. Ramirez, MD, FACOG

Executive Medical Director

Fertility and Gynecology Center

Monterey Bay IVF

http://www.montereybayivf.com/

Monterey, CA