Luteal phase defect

Prior to ovulation, the pituitary gland releases luteinizing hormone (LH), which, together with follicle stimulating hormone (FSH), stimulates the ovaries to produce oestrogen and allow the dominant follicle to release a mature egg. The oestrogen causes the endometrium to thick and develop progesterone receptors. Once the egg has been released, the dominant follicle collapses and becomes a corpus luteum. The corpus luteum produces progesterone, which causes sticky, mucilaginous substances to be secreted by glands within the endometrium. Certain proteins appear on the epithelial cells of the endometrium for a short period of time, which allow for the implantation of the fertilized egg. If these factors are not present, or if they disappear before the fertilized egg reaches the uterus, then implantation will not occur. If implantation does occur, the embryo secretes Hcg, which stimulates the corpus luteum to produce more progesterone, until the placenta, at 8-10 weeks, is developed enough to take over the task of providing the progesterone.

The luteal phase of the cycle refers to the second phase of the cycle, from ovulation to menstruation. This phase should last at least 12-14 days. A luteal phase of less than 10 days rarely produces the environment necessary for implantation to occur and it is referred to as a luteal phase defect. For pregnancy to occur, the endometrium must be ready to receive the fertilized egg between 4 and 8 days after ovulation has occurred – any earlier or later than that and the blastocyst would find the endometrium unreceptive for implantation.

Most infertility specialists consider luteal phase defect to be caused by an insufficiency of progesterone production. Although this is undoubtedly a major aspect of the dysfunction, the fact that the administration of exogenous progesterone does not cure it suggests that this is not the only factor that influences it. Some studies have demonstrated that there is impaired follicular development in cases of luteal phase defect, and others have suggested that impaired levels of FSH and LH may be contributory factors.

Luteal phase defect is indicated if the luteal phase of the cycle is less than 12 days long (this often occurs as women approach the menopause), if there is spotting before the period, or if the body basal temperature (BBT) does not rise quickly or adequately after ovulation. Progesterone has a thermal effect and raises the body temperature. BBT should remain elevated for 14 days, and should peak about a week after ovulation. If the corpus luteum is not producing adequate quantities of progesterone, or if the uterine lining is not properly prepared for the role of progesterone, spotting may occur, the BBT may drop and the period may come early.

Treating luteal phase defect with acupuncture and Chinese herbal medicine

The aim of Chinese medicine is to treat the imbalance which is causing the insufficient progesterone. This might be due to Kidney or Spleen Qi Deficiency, Blood Stagnation, Cold in the Uterus, or Blood, Yin or Jing Deficiency. Each case is treated differently, according to the individual pattern discrimination. Progesterone creams may be applied, but this will not treat the root of the problem, just the manifestation. Chinese medicine, on the other hand, treats the underlying imbalance in the reproductive system which is effecting the subtle symphony of hormones.