LUTEAL-PHASE DEFECTS

Luteal phase defects are defined as disorders resulting from abnormal corpus luteum function associated with insufficient progesterone produ ction. The incidence is difficult to estimate accurately, but the diso rder may affect 3-4% of infertile couples. Candidates for screening ar e those with unexplained infertility or recurrent abortion. Blood samp les should be obtained seven to nine days after ovulation as determine d by the thermogenic shift on basal body temperature monitoring or by a urinary luteinizing hormone surge. A midluteal phase serum progester one level <10 ng/mL is suggestive of the diagnosis. Endometrial biopsi es are indicated in those couples with unexplained infertility and rec urrent abortion, particularly if progesterone levels are >10 ng/mL. Wh ile there have been few comparative studies, the four treatments avail able are clomiphene citrate, progesterone vaginal suppositories, human menopausal gonadotropins and bromocriptine. Because of its simplicity of use, clomiphene citrate is the recommended first-line treatment.