Abstract
Objective: Explore potential relationships between preovulatory, periovulatory, and luteal-phase characteristics in normally cycling women.Design: Observational study.Setting: Eight European natural family planning clinics.Patient(s): Ninety-nine women contributing 266 menstrual cycles.Intervention(s): The participants collected first morning urine samples that were analyzed for estrone-3 glucuronide (E1G), pregnanediol-3- alpha-glucuronide (PDG), follicle stimulating hormone (FSH), and luteinizing hormone (LH). The participants underwent serial ovarian ultrasound examinations.Main Outcome Measure(s): Four outcome measures were analyzed: short luteal phase, low mid-luteal phase PDG level (mPDG), normal then low luteal PDG level, low then normal luteal PDG level.Results: A long preovulatory phase was a predictor of short luteal phase, with or without adjustment for other variables. A high periovulatory PDG level was a predictor for short luteal phase as well as normal then low luteal PDG level. A low periovulatory PDG level predicted low mPDG and low then normal luteal PDG level, with or without adjustment for other variables. A small maximum follicle predicted normal then low luteal PDG level, with or without adjustment for other variables. The relationship between small maximum follicle size and short luteal phase or small maximum follicle size and low mPDG was no longer present when the regression was adjusted for certain characteristics. A younger age at menarche and a high body mass index were both predictors of low mPDG.Conclusion: Luteal phase abnormalities exist over a spectrum where some ovulation disorders may exist as deviations from the normal ovulatory process.This study confirms the negative impact of a small follicle size on the quality of the luteal phase. The occurrence of normal then low luteal PDG level is confirmed as a potential sign of luteal phase abnormality.
Highlights
Several authors have reported a variety of hormonal profiles in normally fertile women
A long preovulatory phase, a small maximum follicle size, and a high PDG level during the periovulatory phase were all significantly associated with a higher risk of short luteal phase (Outcome 1) (p < 0.05)
A high body mass index, a younger age at menarche, a low PDG level during the early follicular phase, a small maximum follicle size, and a low PDG level during the periovulatory phase were all significantly associated with a higher risk of low mid-luteal phase PDG level (mPDG) (Outcome 2) (p < 0.05)
Summary
Several authors have reported a variety of hormonal profiles in normally fertile women. A continuum from normal to abnormal cycles exists [1,2,3,4,5,6]. We evaluated whether factors associated with luteal phase deficiency are predictors of various minor luteal phase deficiencies in normally cycling women. Several luteal phase characteristics have been considered as signs of luteal phase deficiency [7]. The more frequently cited are the length of the luteal phase [type 1 according to Hilgers [8]] and the average level of progesterone (Hilgers’ type 2) [see [3, 9]]. Others are related to the duration of the plateau of progesterone level: an early drop (Hilgers’ type 3) or a delayed increase (Hilgers’ type 4) is a sign of abnormal luteal phase. Hilgers has proposed a low level of estrogens during the luteal phase (type 5)
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