Luteal phase defect is a common condition, which can cause infertility, early pregnancy loss and miscarriage. It accounts for 3-10% of all cases of female infertility and as much as 20-60% of miscarriages.
The luteal phase of your cycle spans from ovulation to the onset of your period and it should last 12-14 days. If the luteal phase lasts less than 10 days, the embryo may have difficulty in implanting and conception will not occur.
Luteal phase defect occurs either when the luteal phase lasts less than 10 days, when the progesterone levels are not sufficient or when the endometrium fails to respond to otherwise normal levels of progesterone. There may also be premenstrual spotting.
Luteal phase defect is diagnosed through Sarum progesterone test in the mid-luteal phase, by endometrial biopsy or Body Basal Temperature (BBT.)
It is thought to be associated with early (post menarche) and late (pre-menopause) reproductive age, emotional stress, or excessive physical strain (e.g. excessive exercise). It often occurs in conjunction with endometriosis PCOS or hyperprolactinemia and many other conditions.
After ovulation, the luteinised cells in the collapsed follicles secrete progesterone, which prepares the lining of the uterus for implantation. During the proliferative phase of your cycle (between period and ovulation), the endometrium develops progesterone receptors, under the influence of oestrogen. During the secretory phase (between ovulation and the onset of your period) progesterone causes the endometrium to become secretory in nature in order to provide an environment that will be favourable for the implantation of the embryo.
There is a small window of implantation during the luteal or secretory phase of your cycle when certain proteins appear on the epithelial lining of the endometrium. Once these proteins have disappeared, the window of opportunity for implantation has gone.
It is generally agreed that luteal phase defect is caused by low progesterone levels, but this is by no means the only factor. No event in the menstrual cycle occurs in isolation. Each and every step is part of an orchestrated hole. So events that take place in the luteal or secretory phase are very much dependent on events that take place in the follicular or proliferative phase of the cycle.
Other factors that may contribute to luteal phase defects are impaired follicular genesis, low levels of LH, abnormal levels of FSH or abnormal response by the ovaries to FSH, or abnormal response of the endometrium to progesterone. The causes are complex and not fully understood and biomedical treatment is limited.
Since progesterone is secreted by The corpus luteum, Western medical treatment may consist of improving follicular genesis with Clomiphene Citrate or Human Menopause Gonadotropin injections as well as supporting the corpus luteum or progesterone production with progesterone supplementation or hCG. However, the benefits of supplementation by exogenous progesterone are limited, and Clomiphene Citrate has many side-effects. This is where Chinese medicine comes into play.
Chinese medicine treats luteal phase defect by treating the underlying imbalance that is causing the dysfunction in the hypothalamus-pituitary-ovarian axis.
In Chinese medicine, Yin relates to the follicular or oestrogen dominated phase of the cycle, whilst Yang relates to the luteal or progesterone dominated phase of the cycle. Yin reaches its peak at ovulation and transforms into Yang, provided Qi and Blood are flowing smoothly and Yin and Yang are abundant.
This is reflected in the BBT chart, where the temperature should rise by at least 0.3° and it should take no more than three days. The temperature should remain high for 12-14 days. In the case of luteal phase defect, The temperature may be slow to rise, it may be insufficient, or it may rise and then fall, creating a Single camel-hump pattern. It may also present with a sore tooth pattern, with temperature fluctuations of more than 0.2°.
In Chinese medicine, kidney Jing, which is nourished and supported by Liver Blood, relates to the hormones. The Kidneys have a Yin and Yang aspect, the Yin forming the material substrate of the hormones, whilst The Yang relates to the expression of the hormones. In order for the reproductive system to function optimally, Yin and Yang should be in balance.
The development of the follicles is dependent on the nourishment by Kidney Kin, Jing and Blood, whilst Kidney Yang and Spleen Qi support the progesterone in the luteal phase of the cycle. Consequently, luteal phase defect usually involves Deficiency of Kidney Jing ,Yin and/or Yang or Spleen Qi deficiency. There may also be concomitant stagnation of Qi and/or Blood, which hinders the transformation of Yin into Yang midcycle.
Chinese medicine can treat luteal phase defect effectively. Acupuncture and Chinese herbal medicine can improve the corpus luteum function and increase progesterone production by promoting blood circulation in the ovaries to nourish the developing follicles and improve egg quality. As a result, the endometrium in the luteal phase becomes thick and receptive to the implantation of the blastocyst.
Acupuncture and Chinese herbal medicine also regulate the hypothalamus-pituitary ovarian access to balance the hormones.
Acupuncture is also very effective in lowering the stress hormone, cortisol, which inhibits the production of progesterone and lowers your chances of conception, whilst Chinese herbal medicine is particularly good at supplementing chronic deficiencies and nourishing Blood and Yin to improve egg quality. It also effectively boosts Qi and Yang, clears Dampness, and it can invigorate and break up Blood where there is significant Blood Stasis, as in the case of endometriosis, which can often be accompanied by luteal phase defect.
A nutrient-rich diet would be recommended with foods to tonify the Kidney Yin, Yang, spleen Qi and blood.
At Conceive Clinic, we offer acupuncture, Chinese herbal medicine, and nutritional therapy to treat luteal phase defect, as well as Maya abdominal fertility massage – a highly specialised massage therapy that manipulates the fascia in the pelvic cavity to unblock obstruction in the reproductive organs and promote blood circulation.
For more information, please email us at info@conceive.org.uk, or call us on 07957641946.