Luteal phase deficiency
Progesterone therapy is recommended for women who have infertility (or habitual miscarriages) secondary to a problem called luteal phase deficiency.
Luteal phase deficiency is a result of inadequate production of progesterone by the ovaries during the second half of the menstrual cycle. The ovaries continue to make progesterone during the first 8-10 weeks of pregnancy (since the last menstrual period).
If there is insufficient progesterone during early pregnancy, the embryo may not survive. After this 8-10 week interval, the placenta becomes a major source of progesterone and the ovarian hormones are no longer needed.
It is assumed that if the ovaries cannot make sufficient progesterone during the latter half of the menstrual cycle, then they would not produce the required amounts of progesterone during pregnancy as well. In women with luteal phase deficiency, it has been customary to extend the progesterone treatment into the early weeks of pregnancy to supplement ovarian production of progesterone.
If a woman has had four or five miscarriages in the first six or eight weeks of a pregnancy, this is always due to luteal phase failure, says Dr. John Lee.
Progesterone is needed to facilitate implantation and to prevent rejection of the developing embryo, but the follicle may not respond to the ovum with enough progesterone. Dr. John Lee’s recommendation: “Wait till you ovulate, and then four to six days after possible conception do a blood test (for HCG) to see if you’re pregnant. If you are, start the progesterone; that way you will increase you chance of having a healthy baby.”
Blood tests for pregnancy tend to be positive within seventy-two hours of conception, whereas he says urine pregnancy tests are not usually positive until two weeks after conception.
Women can develop luteal phase deficiency after receiving the ovulation medications for In Vitro Fertilization (IVF). Progesterone is prescribed after to insure against luteal phase deficiency.
A new vaginal 8% progesterone gel (Crinone) has been developed for luteal phase support following IVF. The polycarbophil base maintains continuous absorption of progesterone, providing high progesterone concentrations within the uterine cavity. Crinone is undergoing investigation in the USA to determine the impact on IVF pregnancy rates.
