Insufficient luteal phase: laboratory diagnostic aspects. Opinion of Practice Committee of the American Society for Reproductive Medicine
DOI:
https://doi.org/10.18370/2309-4117.2016.27.106-110Keywords:
insufficient luteal phase, progesterone, infertility, miscarriageAbstract
Insufficient luteal phase is considered today as one of the causes of miscarriage and infertility. Traditional methods of diagnostics of this condition are mainly based on laboratory methods. The article describes the possibilities
of laboratory diagnostics of luteal phase deficiency, based on the updated opinion of Practice Committee of the American Society for Reproductive Medicine (ASRM) by 2015.
Various methods are used for the luteal phase deficiency diagnostics, most of them are laboratory tests: evaluation of basal body temperature (experts of the American Society for Reproductive Medicine propose to treat it as
already a historical criterion, taking into account all difficulties and convenience for the patient); evaluation of luteinizing hormone level in urine and assessment of the luteal phase duration; evaluation of progesterone levels in
the blood; endometrial biopsy with histopathological examination. Each method has its own possibilities and limitations in the diagnostics of luteal phase deficiency that must be considered when results are interpreting.
One of the most common methods used for the luteal phase deficiency diagnostics is test for serum progesterone level. It is important to remember high progesterone variability (8-fold concentration fluctuation within 90 min); no
global standardization in the progesterone level, minimum necessary to ensure fertility; possible fluctuations in the hormone content in different cycles; strict definition of the day of progesterone test – 6–8 days after ovulation.
At evaluation the luteinizing hormone level in urine it is necessary to determine the peak secretion (ovulation) and the luteal phase length. With its duration of 11–13 days confirmed the normal menstrual cycle, 8 days or
less – a short luteal phase of the menstrual cycle.
Detection of endometrial maturation disorders by biopsy today is traditionally regarded as one of the standard of luteal phase deficiency diagnostics
References
- Practice Committee of the American Society for Reproductive Medicine. “Current clinical irrelevance of luteal phase deficiency: a committee opinion.” Fertil Steril 103 (2015): 27–32.
- Practice Committee of the American Society for Reproductive Medicine. “Current clinical irrelevance of luteal phase deficiency: a committee opinion.” Fertil Steril 98 (2012): 1112–7.
- Murray, M.J., Meyer, W.R., Zaino, R.J., et al. “A critical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women.” Fertil Steril 81 (2004): 1333–43.
- Myers, E.R., Silva, S., Barnhart, K., Groben, P.A., et al. NICHD National Cooperative Reproductive Medicine Network. “Interobserver and intraobserver variability in the histological dating of the endometrium in fertile and infertile women.” Fertil Steril 82 (2004): 1278–82.
- Coutifaris, C., Myers, E.R., Guzick, D.S., et al. NICHD National Cooperative Reproductive Medicine Network. “Histological dating of timed endometrial biopsy tissue is not related to fertility status.” Fertil Steril 82 (2004): 1264–72.
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