A prospective evaluation of luteal phase length and natural fertility

Short luteal phase length may have a negative impact on natural fertility.

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Volume 107, Issue 3, Pages 749–755

Authors:

Natalie M. Crawford, M.D., David A. Pritchard, M.S., Amy H. Herring, Sc.D., Anne Z. Steiner, M.D., M.P.H.

Abstract:

Objective

To evaluate the impact of a short luteal phase on fecundity.

Design

Prospective time-to-pregnancy cohort study.

Setting

Not applicable.

Patient(s)

Women trying to conceive, ages 30–44 years, without known infertility.

Intervention(s)

Daily diaries, ovulation prediction testing, standardized pregnancy testing.

Main Outcome Measure(s)

Subsequent cycle fecundity.

Result(s)

Included in the analysis were 1,635 cycles from 284 women. A short luteal phase (≤11 days including the day of ovulation) occurred in 18% of observed cycles. Mean luteal phase length was 14 days. Significantly more women with a short luteal phase were smokers. After adjustment for age, women with a short luteal phase had 0.82 times the odds of pregnancy in the subsequent cycle immediately following the short luteal phase compared with women without a short luteal phase. Women with a short luteal length in the first observed cycle had significantly lower fertility after the first 6 months of pregnancy attempt, but at 12 months there was no significant difference in cumulative probability of pregnancy.

Conclusion(s)

Although an isolated cycle with a short luteal phase may negatively affect short-term fertility, incidence of infertility at 12 months was not significantly higher among these women.

Clinical Trial Registration Number

NCT01028365.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comment

Go to the profile of Michael R Soules
Michael R Soules over 3 years ago

Hi there. I retired 3 years ago and don't know why I received a random copy of Fertility & Sterility in the mail this month but since it was here I looked through the Table off Contents and saw this article on Luteal Phase Deficiency[LPD]. . When I was a new Fellow at Duke in 1976 my 1st assignment was to summarize that clinic's experience with LPD. Little did I know or appreciate then that this disorder was/is very controversial; later I used to say that if you want to get a room full of REI's yelling at each other start a discussion on LPD. As it played out in my career I couldn't let go of this quirky disorder and ended up publishing a series of articles on its pathophysiology. The original diagnostic test [an endometrial biopsy] was subsequently proven to be too insensitive and a series of luteal progesterone levels was the only test that correlated with a low total luteal progesterone level [area under the curve; AUC] which was an accurate but impractical way to clinically identify LPD. In order to do those studies I did identify a small group of women with persistent LPD and showed that their brain [GnRH pulse generator] was the culprit in that the follicular phase LH pulse pattern was significantly different[faster] than normal. But LPD gradually became irrelevant in the clinical setting from about 1985 onward as it can occur randomly but rarely is persistent; is easily and adequately treated when empirical clomiphene citrate is prescribed; and is not a factor with super ovulation for IVF.

Therefore, it was interesting to me to see LPD revisited in 2017. The criteria used here of a luteal phase of 11 days or less is valid based on our earlier studies as all our women with a short luteal phase had low AUC luteal progesterone levels. But the incidence of LPD has rarely been studied in a relatively large group of women attempting conception as was done here. This was a robust study group [n=284] and the women with LPD as defined by a short luteal phase were temporarily sub-fertile but not persistently so. This all fits with my final conclusions about the disorder: a. it is relatively rare b. usually not persistent c. on the spectrum of ovulatory disorders LPD is the mildest deviation from normal that can be caused by a host of common things like physical or psychological stress, weight fluctuations, and ovarian aging. It was a nice contribution by the authors to revisit LPD as I believe every REI physician needs to be aware of its existence as it will occasionally be present in the clinic setting.