Patient's question:
Hypomenorrhea. I've been married for over three years, but I haven't been pregnant yet. Our whole family is very anxious. Recently, I've only been tracking my temperature, and it's been biphasic, with ovulation as well.Doctor's answer:
Hello! If there is luteal insufficiency!Definition of luteal insufficiency
Luteal insufficiency (abbreviated as LPD) refers to insufficient progesterone secretion by the corpus luteum or premature luteal regression, leading to inadequate secretion of the endometrium and consequently making it difficult for the embryo to implant or causing early pregnancy loss. Luteal insufficiency is a significant factor or cause of female infertility, accounting for 3% to 10%. In women who are older, have a history of recurrent miscarriages, or have hyperprolactinemia, the incidence of luteal insufficiency can be as high as 35% to 50%.
Symptoms of luteal insufficiency
Women with luteal insufficiency often exhibit short menstrual cycles, frequent menstruation, infertility, or miscarriage, with miscarriages primarily occurring in the early stages of pregnancy. Their basal body temperature (BBT) curve may show a shorter high-temperature phase than the entire cycle or a small difference between high and low temperatures.
Causes of luteal insufficiency
The exact factors or causes of luteal insufficiency are still unclear. It may be related to insufficient secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) by the pituitary gland, excessive or insufficient prolactin secretion, immature follicles that are unresponsive to gonadotropins, insufficient progesterone synthesis by the corpus luteum, or an imbalance in the ratio of estrogen to progesterone.
Diagnosis and treatment of luteal insufficiency
Clinically, in addition to a history of infertility, early menstruation, scanty menstruation, and miscarriage, there are rarely specific symptoms. After excluding other infertility factors, infertile women with regular menstrual cycles and ovulation should be considered for the possibility of luteal insufficiency. Luteal insufficiency may also alternate between normal ovulatory and anovulatory cycles, resulting in irregular menstrual cycles or excessive menstrual flow. However, precise diagnosis of luteal insufficiency remains challenging. Current diagnostic methods include measuring basal body temperature (BBT), endometrial biopsy before menstruation, blood hormone testing, and vaginal smear examination.
Treatment of luteal insufficiency
1. Replacement therapy: Starting from day 16 of the cycle, intramuscularly inject 10–20 mg of progesterone daily for 10 days to supplement progesterone deficiency.
2. Adjustment of human chorionic gonadotropin (HCG): Starting from day 16 of the cycle, intramuscularly inject 2000–3000 units of HCG every other day for a total of 5 times.
3. Clomiphene and Tamoxifen treatment: These two drugs promote the secretion of luteinizing hormone-releasing hormone (LH-RH) from the hypothalamus, increasing the secretion of FSH and LH by the pituitary gland. This leads to the development and maturation of follicles before ovulation, causing luteal cells to secrete more progesterone after ovulation. Therefore, it is effective for luteal insufficiency caused by insufficient FSH and LH secretion, but the efficacy is unstable.
4. Cabergoline (CBIs) treatment: Cabergoline has a certain therapeutic effect on luteal insufficiency caused by hyperprolactinemia.