Luteal phase defect - how is it diagnosed?

[tryingfortwo]

We've been TTCing baby #2 for almost 2 years now, and no luck. All basic tests have come back normal - SA for DH is fine, my hormone tests looked good, also had a HSG that was fine.

Anyways, I've always had a short LP - prior to having DS, I was able to get it up to 11-12 days using Vit B6. After having DS and with nursing, it's been around 9-10 days, occasionally 11. These numbers are based on several months of temping, and also the fact that my average cycle length is about 25 days. I'm still taking Vit B6, but I haven't noticed much improvement. I've also tried Vitex and Maca (separately), and it didn't seem to do much for me.

At this point, I think I'd like to ask my doctor if this could potentially be the reason we're not conceiving (or a reason, at least). I've mentioned it before, that I thought my LP was short, and was kind of blown off. Is there specific testing to be done to officially diagnose it? I don't have spotting during my LP, it's just short. If I temp, my temps stay reasonably high during my LP, but occasionally dip down.

In addition, what's the treatment for LPD? Clomid? I'm still nursing a bit, but am going to try to wean in a few weeks (fingers crossed it goes smoothly...) Weaning in itself could help my LP a bit, I suppose, but also opens a few doors to medications that I couldn't take while breastfeeding.

Anyways, just looking for info, since I haven't had much luck discussing it with my doctor. At this point, I'd rather just go in and ask for it specifically instead of having it recommended by her. Thank you!

[no5no5]

Did you do the 7DPO progesterone test? Other than that, I'm not sure there's any way of testing for LPD. If your luteal phase is short, you've pretty much just got it. Though if you are still nursing, that could easily be the reason.

As for treatment, the options are basically clomid (or a similar drug) or progesterone, or both. I think most doctors will start you with clomid unless your 7DPO progesterone comes back low.

Have you seen a RE yet, or are you dealing with an OB/Gyn?

[tea_time]

I had a LPD that was diagnosed I think due to my spotting in the LP as well as a shorter LP. But IIRC it was more to do with the spotting? I also had "unexplained IF" diagnosed.

How long have you been seeing a RE? Or is your ob/gyn doing the testing? I'd recommend a RE and see what they think the issue is. Although, with IF you don't really need a clear dx, since there is still so much they don't understand about IF. They'd probably start you out on Clomid and see if it helps your cycle length.

[GaleTX]

Our RE and OB recommended a endometrial biopsy to rule out a luteal phase defect. Here is the info we were given:

"The endometrial biopsy is normally performed a few days before the next menstrual cycle is expected, ideally after a negative pregnancy result for the cycle has been obtained. The procedure consists of sampling a small amount of uterine lining and sending it to a pathologist for evaluation. Because the evaluation is done at a cellular level, the knowledge gained from it is at its most detailed and precise. The pathologist categorizes the lining as being typical of a particular cycle day. If this categorization is consistent with the actual cycle day that the sample was taken, the result is considered normal, and the uterine lining is in phase. If there is a discrepancy of more than two days, the lining will usually be considered out of phase. "

Because our insurance doesn't cover anything related to infertility, we decided against it because of cost (the actual procedure is $150, but you also have to pay for the lab fees and pathologist fees - we were told it's around $1k). I asked what would happen if I had a LPD and I was told Clomid is usually prescribed. Since I was being prescribed Clomid anyway, we decided to wait on the biopsy and see if we're successful with the Clomid. If we're not pg by Christmas, we'll probably do the biopsy. HTH!

[callieollie]

I was diagnosed with LPD based on having low progesterone. My luteal phase length is actually fine but my levels are still low. My OB tests very thoroughly and doesn't only do the 7dpo test but tests 3dpo, 5dpo, 7dpo, 9dpo, and 11dpo to see how the progesterone changes through the cycle and to get an overall measure of the progesterone rather than on just one day's read. I'm being started on progesterone (the oral kind administered vaginally). Hopefully that'll do the trick!

[tea_time]

I forgot that the endometrial biopsy was for LPD. I had that test done and it was the most painful one, worse than the HSG and sonohystogram. The other difficult part about that test is that you have to abstain that cycle, since it would interfere with a potential pregnancy. I hope you don't need that one Gale!

[slippy]

I always had short LPs same- 9-11 usually- 12 at the longest, and that was rare. I always thought it was the reason for my 2 early miscarriages. I finally talked to my RE about it. I had been doing IUIs with clomid for months, but it was still short. We did some bloodwork this past cycle, but she agreed to increase my clomid and start progesterone this last cycle before we got any results based on my short LP. I read somewhere that progesterone levels can vary a lot, so the blood tests aren't always the best indicator. Clomid can increase your LP, and progesterone too. I really think I was just getting my period too early to give any embryos a chance to get settled. It really depends on what you want to do. I think the progesterone is a bit more benign, but for me- I had tried everything- homeopathy, diet, vitamins, accupuncture, herbs over several years, so by this time- I was ready to pull out all the stops- and here i am 4 weeks pg- still early- but so far so good.

[ASusan]

I received acupuncture and chinese herbs to treat my (self-diagnosed) LPD. The midwife at my OB's practice said that they often suggest acupuncture before Clomid.

[tryingfortwo]

Congratulations on your PG, slippy! How exciting for you

Also interesting to hear that acupuncture might help - it has been recommended to me, but so far we haven't pursued it. DH isn't totally convinced it'll do anything, and it's not exactly cheap. However, I'm thinking about looking into it more in a month or so - if I'm able to wean DS, then I think it might be worth a try. I mean, it could be worth trying even if he doesn't wean, but I felt like our chances might be better if he's weaned...