The beneficial effect of luteal phase support on pregnancy rates in women with unexplained infertility

D Check,J Liss,J.H Check

doi:10.12891/ceog4697.2019

Abstract

Purpose: To determine what percentage of women with regular menses and unexplained infertility seem to develop a mature dominant follicle (18-24 mm average diameter and serum estradiol >200 pg/mL). Also to determine the efficacy of empirical progesterone (P) supplementation in the luteal phase for those with unexplained infertility who seem to make mature follicles. Materials and Methods: Serial ultrasounds and serum estradiol levels performed in cases of infertility over one year duration in patients with patent fallopian tubes, normal semen parameters, and normal post-coital test. Vaginal P of different types were given in the luteal phase as exclusive treatment. Results: A viable fetus past the first trimester was found in 71.7% of the 80% of women developing a mature follicle who were treated with P. Conclusions: For the combined effect of efficacy of therapy, cost, convenience, and lack of side effects, supplemental use of P in the luteal phase should be considered as first line therapy for unexplained infertility rather than empirical use of “fertility” drugs and intrauterine insemination or even in vitro fertilization - embryo transfer (IVF-ET). Methods of determining who needs supplemental P are not presently available.

Highlights

What is unexplained infertility? The diagnosis may vary in different infertility centers according to the extent of the diagnostic work-up
Abnormalities of the pelvis despite normal hysterosalpingogram detected by laparoscopy: presence of fimbrial adhesions or adhesions interfering with relationship of fallopian tubes and ovaries, or presence of endometriosis [10, 11]
There was a prospective recruitment of women with unexplained infertility who were willing to be treated with P supplementation in the luteal phase exclusively

Summary

Introduction

What is unexplained infertility? The diagnosis may vary in different infertility centers according to the extent of the diagnostic work-up. “Pure vanilla” work-up: standard semen analysis with normal sperm concentration, normal motility and normal morphology, normal uterine cavity, and patent fallopian tubes by hysterosalpingogram, and normal properly timed post-coital tests. More sophisticated work-up for subtle ovulatory disorders: luteal phase defects [3], premature luteinization [4], luteinized unruptured follicle (LUF) syndrome [5-7], and short follicular phase [8, 9]. About 25 years ago a study was conducted involving women with at least one year of infertility whose only detected infertility factor was a luteal phase defect determined by a late luteal phase endometrial biopsy [12]. There is a great deal of controversy concerning the importance of an endometrial biopsy and its timing in determining the presence of a luteal phase defect [13]. There are some clinicians who doubt that luteal phase deficiencies are even a cause of infertility [14]

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