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Impaired follicular growth and abnormal luteinizing hormone surge in luteal phase defect
T Ayabe1, O Tsutsumi, M Momoeda
1Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan.
Objective:
To determine whether luteal phase defect (LPD) is associated with follicular growth or LH surge.
Design:
The length of luteal phase was determined by the date of ovulation assessed by serial ultrasound measurements of follicle growth on a daily basis. Luteal phase defect was defined when the length of the luteal phase was < 11 days and/or the midluteal serum P level was < 10 ng/mL (31.8 nmol/L). Preovulatory follicular growth was examined by transvaginal ultrasonography. Blood samples taken at midluteal phase were assayed for P. Urine LH levels were determined in samples collected twice a day during periovulatory cycles using rapid urinary assay kits.
Setting:
Infertility outpatient clinic, Tokyo University Hospital.
Patients:
Eighty-one menstrual cycles from 63 normally cycling infertile women who were not administered any medications.
Results:
Thirty-six of 81 cycles showed LPD. The mean +/- SD maximal preovulatory follicular diameter was significantly smaller in LPD cycles than in non-LPD cycles (16.5 +/- 2.7 versus 19.0 +/- 2.8 mm). The mean +/- SD peak level of urinary LH surge was significantly lower in LPD cycles compared with non-LPD cycles (50 +/- 25 versus 65 +/- 21 IU/L). Luteal phase defect cycles showed a relatively high incidence of abnormal LH surges, namely, lower peak levels or prolonged duration.
Conclusions:
Luteal phase defect was associated with impaired follicular growth and/or abnormal LH surge. These factors may be involved in the pathogenesis of LPD.