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Luteal Phase Defect Treatment

by
on January 20, 2017
In: CONDITIONS

Luteal phase defect treatment (LPD) is complicated because there are multiple causes of this condition, and a number of associated conditions that also reduce fertility. There’s a range of effective treatments and self-help options for many of the causes, but it’s crucial to diagnose the condition first, which is confirmed when:

  1. Luteal phases last 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 levels of progesterone  from the corpus luteum, and problems can occur when:

  1. The dominant follicle was of poor quality, and a poor quality corpus luteum doesn’t produce enough progesterone, so although it’s a luteal phase problem, the cause lies in the follicular phase.
  2. The corpus luteum degenerates early despite it coming from a good quality dominant follicle and is usually due to stress disrupting hormone levels from the hypothalamus
  3. The hypothalamus pulses GnRH that stimulates the corpus luteum to release progesterone; however, malfunctions with the pulse generator in the hypothalamus cause about half of all LPD. i

LPD associated conditions

There are multiple conditions associated with LPD, which highlights the importance of reducing sugar and carbohydrates in the diet and increasing wholefoods. These are crucial tools to reduce the chances of both LPD and PCOS

  • Hypertension
  • Hypertension
  • Obesity
  • Hyperinsulinaemia
  • High cholesterol
  • Glucose intolerance
  • High AMH levels

Conventional treatments for LPD

  1. Progesterone injections or gels (crinone or progestin) are synthetic progesterone that are used to supplement progesterone in the luteal phase of IVF protocols (or treat recurrent miscarriages from low progesterone levels), and they’re often used in suspected LPD cases. iii While progesterone cream can lengthen luteal phases, it won’t work if the problem is due to low LH. There are serious health considerations in self-medicating, and not all creams have a similar action, so seek professional advice before using them
  2. Clomiphene citrate (Clomid)
  3. Gonadotrophins such as follicle-stimulating hormone (FSH) or human chorionic gonadotropin (hCG) when there’s evidence that 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 when immune dysfunction is suspected

Self-help and other treatments for LPD

  1. Herbal medicine supports the growth and development of follicles and the function of the corpus luteum to promote progesterone levels
  2. Acupuncture regulates the hypothalamus and the autonomic nervous system to promote better ovarian health
  3. Fertility charting provides accurate feedback on hormone levels
  4. Adjusting lifestyle and diet to match the appropriate personal fertility profiles improves egg quality and corpus luteum function

Changes to diet and the addition of supplements help to improve the fertility of women with LPD iv

  • 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 in a trial 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 greater 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
  • 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

References
i “LH pulses and the corpus luteum: the luteal phase deficiency (LPD)”. Wuttke W, Pitzel L, Seidlová-Wuttke D, Hinney B Department of Obstetrics and Gynecology, University of Göttingen, Germany. Vitamins and Hormones [2001, 63:131-58]
ii ‘Common pathophysiological mechanisms involved in luteal phase deficiency and polycystic ovary syndrome. Impact on fertility’ Georgios Boutzios, Maria Karalaki, Evangelia Zapanti Endocrine April 2013, Volume 43, Issue 2, pp 314-317.
iii“Estrogens and Progestins”. Loose, Davis S.; Stancel, George M. (2006). In Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. (eds.). Goodman & Gilman’s The Pharmacological Basis of Therapeutics (11th ed.). New York: McGraw-Hill. pp. 1541–71. ISBN 0-07-142280-3.
iv ’The effect of micronutrient supplements on female fertility’ Buhling, Kai J.; Grajecki, Donata. Current Opinion in Obstetrics & Gynecology: June 2013 – Volume 25 – Issue 3 – p 173–180
v “Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium”. Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N (April 2010).  Fertil. Steril. 93 (6): 1851–8.
vi ’Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect.’ Henmi H et al. Fertility and Sterility (2003;80:459–61)
vii ’The effect of micronutrient supplements on female fertility’ Buhling, Kai J.; Grajecki, Donata. Current Opinion in Obstetrics & Gynecology: June 2013 – Volume 25 – Issue 3 – p 173–180