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Thursday, August 28, 2014
Luteal Phase Defect
We are trying for baby #2. We have had at least 8 chemical pregnancies and a daughter who just turned 3. I was diagnosed years ago with a balanced translocation. I have been having a hard time getting pregnant at all in the last year. Recently one RE that I was seeing thought that I had an LPD. If I have poor follicle development, would that mean that my actual eggs will not work as well or do I just lack progesterone? Is it better to just supplement with progesterone or is it necessary to use an ovulation stimulant? I have 2 different REs and one wants to do multiple u/s every month, where as the other would just let me take progesterone the second half of the cycle. In your experience, is there a benefit to all of the monitoring? Thank you.
If you have had multiple chemical pregnancies, a work-up would be reasonable. The definition of recurrent pregnancy loss is 2 consecutive 1st trimester (<12 weeks) losses. A basic work-up consists of uterine cavity evaluation, chromosomal analysis in both partners (blood tests), autoimmune testing (blood tests), thrombophilic or "clot-friendly" work-up (blood tests), and hormonal testing. I would suggest talking to your doctor about whether any or all of these tests would be appropriate for you. If all of your testing were normal, empiric treatment would consist of using progesterone and baby aspirin following ovulation. Ultrasound monitoring would not be necessary to treat recurrent pregancy loss. Depending upon the number of losses, some patients may be candiates for injectable blood thinning medication such as heparin or lovenox. This is something you should discuss with your physician.
If you have been attempting pregnancy for greater than 1 year without success, an infertility evaluation would be indicated. This would consist of a semen analysis in your husband, a blood test to see if you are ovulating, as well as a dye test to make sure that your fallopian tubes are open.
If all of your testing is normal, treatment usually consists of fertility pills or shots combined with intrauterine insemination (injection of your husband's sperm into your uterus at the time of insemination) or in vitro fertilization (stimulation of your ovaries to make extra eggs, removal of those eggs from you ovary followed by mixing with your husband's sperm, allowing fertilization of the eggs and growth into embryos; approximately 2 embryos would then be injected into your uterus).
Daniel B Williams, MD
College of Medicine
University of Cincinnati