DISORDERS OF THE LUTEAL PHASE
Subtle abnormalities of follicular development may result in disorders of the luteal phase: luteal-phase dysfunction and “luteinized unruptured follicle” syndrome. Other defects may be recognized in the future.
Luteal-phase defects are characterized by decreased secretion of progesterone after ovulation.173 Progesterone secretion may be reduced in duration (i.e., luteal-phase insufficiency) or in
amount (i.e., luteal-phase inadequacy). In an extremely rare but related disorder, the endometrium is unable to respond to secreted progesterone because of the absence of progesterone receptors. Any defect in follicular development or corpus luteum function could cause luteal-phase dysfunction. Such defects include but are not limited to inadequate or inappropriate FSH secretion in the follicular phase, inadequate or inappropriate estradiol secretion by granulosa cells, an inadequate LH surge, inadequate tonic LH secretion in the luteal phase, or defective progesterone secretion by luteal cells.174 Evidence suggests that abnormalities in the frequency of gonadotropin pulses in the follicular phase account for most instances of luteal phase dysfunction.175
amount (i.e., luteal-phase inadequacy). In an extremely rare but related disorder, the endometrium is unable to respond to secreted progesterone because of the absence of progesterone receptors. Any defect in follicular development or corpus luteum function could cause luteal-phase dysfunction. Such defects include but are not limited to inadequate or inappropriate FSH secretion in the follicular phase, inadequate or inappropriate estradiol secretion by granulosa cells, an inadequate LH surge, inadequate tonic LH secretion in the luteal phase, or defective progesterone secretion by luteal cells.174 Evidence suggests that abnormalities in the frequency of gonadotropin pulses in the follicular phase account for most instances of luteal phase dysfunction.175
Clinical entities associated with luteal dysfunction include hyperprolactinemia (of any cause), strenuous physical exercise, inadequately treated 21-hydroxylase deficiency, and (presumably) recurrent abortion.8,73,176,177 Luteal dysfunction is more common at the extremes of reproductive life and in the first menstrual cycles after delivery, abortion, and discontinuation of oral contraceptives. It can occur during ovulation induction with clomiphene citrate or hMG.178,179
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