Abstract
Background and Aims: Luteal phase deficiency (LPD) is a consequence of the inability of the corpus luteum (CL) to produce an adequate level of progesterone. This manifests clinically as a short menstrual cycle and infertility. Abnormal follicular development and inadequate steroidogenesis in lutein cells of the CL have been implicated in CL dysfunction and LPD. LPD and PCOS are independent disorders sharing a common pathophysiology. The aim of this case report is to highlight the importance of additional luteal phase support for patients with PCOS. Case report: A 34-year-old Indian lady with anovulation secondary to PCOS failed to get pregnant after 7 years of marriage. Her menses were irregular, and she had hirsutism. She was also overweight. (BMI 26.4 kg/m2) Her hormonal profile showed a reversal of the FSH/LH ratio of 2:1, and serum progesterone was low. (<1.6 IU/L). A transvaginal scan showed a classic pearl string sign, which was typical for patients with PCOS. She underwent laparoscopic dye insufflation and ovarian drilling, during which four puncture points were made on each ovary at 4 watts for 4 seconds. Later, she underwent a round of timed sexual intercourse and intrauterine insemination. (IUI) Dydrogesterone (10 mg, 8 hourly) was started for luteal phase support as per unit protocol. However, she complained of per vaginal spotting starting on day 7 after human chorionic gonadotropin (hcg) trigger, and both times, treatment was unsuccessful. Then, she had another round of ovarian stimulation with clomiphene citrate 50 mg daily and had IUI. She was given micronized progesterone 100 mg 12 hours a day in addition to the dydrogesterone. The urine pregnancy test was positive, and she is having a healthy, on-going pregnancy. Conclusion: Patients with PCOS may suffer from a defective luteal phase. Hence, it is important to supplement PCOS patients with additional support during the luteal phase, as this can lead to a successful pregnancy.
Published Version
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