The endometrial biopsy as a guide to the management of luteal phase defect.

Abstract

The endometrial biopsy serves as a useful and valuable tool in the diagnosis and treatment of luteal phase defect (LPD). Eighty patients were diagnosed as having an LPD by endometrial biopsy. The subjects were divided into four equal groups, and different treatment protocols were introduced according to the histologic pattern found in the endometrial biopsy specimen. Patients in group I had glandular stromal asynchrony and were treated with clomiphene citrate therapy. Progesterone suppositories were administered to those patients in group II who showed glandular stromal synchrony. Groups III and IV had the same histologic pattern as groups I and II, but a reversal of the treatment protocol was made. The raw pregnancy rate was 85% and 80% for groups I and II, respectively. Groups III and IV had a raw pregnancy rate of 40% and 30%, respectively. Life-table analysis projected the pregnancy rate based on the protocol of therapy administered. This confirmed our findings and strengthened our belief that the endometrial biopsy is an invaluable guide in the treatment of LPD. This article addresses two distinct endometrial patterns within the framework of LPD and proposes a structured therapeutic regimen to treat this defect.