How do you define luteal phase?How do you define luteal phase?Luteal phase is the interval from ovulation to onset of the next mensues.Luteal phase is the interval from ovulation to onset of the next mensues.

* Normal is 14 Days. * Normal is 14 Days.

* <10 - >14 LPD * <10 - >14 LPD

What cause luteal phase defect?What cause luteal phase defect?

1. Poor Follicle formation.1. Poor Follicle formation.2. Premature demise of Corpus interim 2. Premature demise of Corpus interim 3. Failure of uterine leniing to respond to3. Failure of uterine leniing to respond to

normal levels of P2 normal levels of P2

What is implantation window?What is implantation window?Endometrial Receptiuty day 20-24 of cycleEndometrial Receptiuty day 20-24 of cycle

8,9,10 8,9,10thth day post ovulation. day post ovulation.

Imparts Imparts Earliest Earliest if 6 dayif 6 dayLatest Latest 12 day12 day

Late implantation >9Late implantation >9 Miscarriage RiskMiscarriage Risk

AppositionApposition PinopodesPinopodesAdherence Adherence App. Around 21App. Around 21stst day dayInvasion Invasion present only for few dayspresent only for few days

How so you diagnose LPD?How so you diagnose LPD?1. BBT only helps in persistent short luteal phase.1. BBT only helps in persistent short luteal phase.

2. USG:- Impractical as need daily scan.2. USG:- Impractical as need daily scan. 3. P testing – serum progesterone3. P testing – serum progesterone

4. Prolactine Level4. Prolactine LevelFuture: No practical methods yet available Future: No practical methods yet available Specific secretary proteins from endometrialSpecific secretary proteins from endometrial

5.5. EB is Gold standard best current methods of DiagnosticEB is Gold standard best current methods of Diagnostic

Predictive value of progesterone measurement in luteal Phase/Predictive value of progesterone measurement in luteal Phase/Any role of random single progesterone measurement?Any role of random single progesterone measurement? Serum Progesterone is a simple, Reliable, Widely availableSerum Progesterone is a simple, Reliable, Widely available& cost effective test& cost effective test

Single measurement >10mg/mlSingle measurement >10mg/ml StandardStandard

P2 secreted in pulsatile mannerP2 secreted in pulsatile mannerSapling during morning hoursSapling during morning hours

Daily samplingDaily sampling –Most reliable but clinically impractical –Most reliable but clinically impractical

How do you suspect LPD from clinicalHow do you suspect LPD from clinical characteristics of patient?characteristics of patient?Just after menarche, before menopause, post partum period, hyper prolactenemia Just after menarche, before menopause, post partum period, hyper prolactenemia

Defective OvulationDefective Ovulation LPDLPD

••Shortened menstrual cyclesShortened menstrual cycles••Premenstrual spottingPremenstrual spotting••Sub fertile patient Sub fertile patient 4. H/O Recurrent pregnancy loss4. H/O Recurrent pregnancy loss

Prevalent in 5-10% of Infertility women. Prevalent in 5-10% of Infertility women.

What role does traditional endometrialWhat role does traditional endometrial histological dating has?histological dating has?>2 days different between histological dating and menstrual dating of endometrial >2 days different between histological dating and menstrual dating of endometrial If this pattern repeats in 2 or more cycleIf this pattern repeats in 2 or more cycle

Histologically documented inHistologically documented in20-40% of women with recurrent spont abortions.20-40% of women with recurrent spont abortions.

Role of Clomiphene V/S Letrozole in IUIRole of Clomiphene V/S Letrozole in IUI cycles for correction of Luteal phase.cycles for correction of Luteal phase.If absence of ovulation is the cause of LPD then clomipheneIf absence of ovulation is the cause of LPD then clomiphene is the first choiceis the first choice

What is the rational for Luteal phase support inWhat is the rational for Luteal phase support in ART ?ART ?

Supra physiological level of sex steroid. Supra physiological level of sex steroid. Insufficient LH Insufficient LH

Puncturing of Graunlosacel Puncturing of Graunlosacel

OPUOPU Densensitization of Pituitary Densensitization of Pituitary Multiple Follicles Formation Multiple Follicles Formation

EndometriosisEndometriosisUnexplained Infertility Unexplained Infertility

Role of HCG in Luteal phaseRole of HCG in Luteal phase supplementationsupplementationMany prefer to give HCG in interval therapy post ovulationMany prefer to give HCG in interval therapy post ovulation

Progesterone supplementation – WhichProgesterone supplementation – Which progesterone and what dosages? progesterone and what dosages? Micronised progesterone oral ,imMicronised progesterone oral ,imProgesterone suppository vaginallyProgesterone suppository vaginallyProgesterone gelsProgesterone gels