Luteal Phase Defect

Luteal Phase Defect occurs when the ovaries will not produce enough progesterone to support implantation and subsequent pregnancy.

This is one of the most common causes of miscarriage and one of the easiest problems to correct. See the explanation and treatment in the section “What to do if this is the case.” The treatment for Luteal Phase Defect is the use of progesterone vaginal suppositories (50 mg 3 times a day). The use of these suppositories for all recurrent miscarriage patients is highly recommended.

Prenatal Advice

Three months prior to attempting to become pregnant the female should begin to take prenatal vitamins and folic acid (1 mg). Materna Prenatal/Postpartum vitamins are excellent and contain 1 mg of folic acid, it is highly recommended that infertility and recurrent miscarriage patients take this additional 1 mg of folic acid. Folic acid is extremely important to help to prevent neural tube defects in the fetus that can lead to spina bifida among other problems. The Materna and folic acid should be continued through 12 weeks of pregnancy at which time folic acid may be discontinued but the Materna should be continued throughout the pregnancy and breastfeeding.

Following your infertility procedure, at least 5 days of complete bed rest is highly recommended for the female. She should think of herself as "pregnant until further notice." Gravity is her enemy. In addition, the female should avoid certain food additives which have been found to be harmful to the fetus. These include caffeine, aspartame (Nutrasweet, Equal, all diet sodas and "sugar free" products), nitrates (found in processed meats, hot dogs, and dried fruit such as prunes, raisins and dried apricots), and MSG (monosodium glutamate) found in Chinese food and other products. Caffeine is linked to low birth weights, aspartame to a slew of problems which include hyperactivity and neurological problems, nitrates have been linked to brain tumors in children, and MSG is suspected of causing physical problems for the mother during pregnancy.

Also, please avoid all excessive heat sources. Embryos do not like temperatures above 100 degrees. Following the infertility procedure, the female should avoid hot baths, hot tubs, electric blankets, heating pads, saunas and taking sun. If the female’s body temperature rises above 99 degrees (as with a fever), she should telephone her doctor and take a Tylenol (without codeine) immediately. Heat kills embryos.

If you are trying to become pregnant or have become pregnant you must avoid alcoholic beverages and all "recreational drugs" (including but not limited to cocaine, marijuana, and codeine). You should not consume over the counter medications (including but not limited to cold medicines) without a doctor’s permission. Remember, no smoking!

Most fertility centres will have the female do a blood test approximately 14 days after either ovulation or her ovum retrieval to determine whether or not she is pregnant. This test is called a Quantitative Beta-HCG. It is highly recommended that this test be accompanied by a test for progesterone level. It is also highly recommended that these two blood tests be repeated two days later in order to determine whether the pregnancy is proceeding normally. Normally the Beta-HCG level should be approximately 100 on the 14th day following ovulation or ovum retrieval and then at least double every two days for the first couple of months. The progesterone level should be at approximately 100 and stay there. Inadequate levels can be caused by a variety of medical conditions including but not limited to ectopic pregnancy and imminent miscarriage. That is why these blood tests need to be done ASAP with the results on the same or the next day.

Warning: If the blood and/or urine test for Beta-HCG is done within 10 days of the Profasi injection, the result may be a false positive. It is wise to test again two days later to be sure.

After the 7th week of pregnancy it is possible to see the baby’s heartbeat upon ultrasound examination. If a heartbeat can be seen, there is a 90% probability that the pregnancy will go to term.

A couple is deemed infertile if they have had unprotected sex for 1 year and a pregnancy has not occurred.

What to do if this is the case?

See an infertility specialist.

The following professionals are highly regarded experts in this field.

Dr. Togas Tulandi, Montreal 
Tel: (514) 843-1650

Dr. Michael Feinman, Huntington Reproductive Center, Westlake Village, California 
Tel: (805) 374-1737 
havingbabies.com

Dr. Christo Zouves, Daly City, California 
Tel: (650) 301-4933 
goivf.com

St. Barnabas Medical Center claims to have the highest fertility rates in the US. 
Tel: (973) 322-8286 
www.sbivf.com

Get tested.

Both partners should be tested to rule out an obvious physical reason for the infertility i.e.: the male should have a sperm analysis and the female should have her tubes examined via hystercelpingogram (special x-ray) to be sure that they are open as well as an ultrasound to check her uterus and ovaries. In addition, both partners will need blood tests to rule out HIV 1 and 2, Hepatitis B and C, HTLV, syphilis, rubella, and cytomelagovirus (CMV). It is advisable for both partners to have cultures done to test for clamydia, gonorreah, streptococcus B, and mycoplasma/ureaplasma.

Try artificial insemination.

It is usually suggested that artificial insemination is the first intervention. Most likely the female will be asked to use fertility drugs such as Clomid pills or Femara pills with Pergonal injections or Pergonal alone or some other combination, with or without an agonist such as Lupron or Buserilin in order to increase her egg supply. If no agonist is used she will most likely need Antegon to prevent premature ovulation. She is then given a Profasi injection to ensure the timing of the insemination. She will be monitored by ultrasound. Multiple pregnancy is possible. It is highly recommended to attempt artificial insemination on 2 consecutive days, followed by 5 days of bed rest.

Male reproductive problems

If the male’s sperm analysis is abnormal (i.e. low count or abnormal shape) this is curable 97% of the time. All that is needed is one sperm per egg.

In-vitro fertilization the next step

If the female’s tubes are blocked, surgery may restore them. If the tubes cannot be repaired and the male is able to produce viable sperm, in-vitro fertilization may be necessary.

In Toronto you contact the Toronto Center for Assisted Reproductive Technology (T-Cart) at (416) 972-0110.

In Southern California, Dr. Michael Feinman is a highly regarded expert in this field. He is both an endocrinologist and infertility specialist, and is involved with the surrogate parenting program in Los Angeles.

In Northern California, Dr. Christo Zouves is a highly regarded expert in this field. He is an infertility specialist also involved with surrogacy.

Today, IVF has the same take-home baby rate (approx. 25%) as a young couple just starting out. Most IVF trials result in single births, with 20% resulting in multiple births. Most of these are twins. Triplets are rare but possible.

IVF: the procedure

In-vitro fertilization involves the retrieval of the female’s eggs following medication to increase her egg production. The eggs are retrieved using a special vaginal ultrasound probe with an instrument attached to it so that the doctor can pierce the wall of the vagina, access the ovaries, and retrieve the eggs. The procedure itself takes less than 1/2 hour and the female is well medicated against pain. Many centers offer the services of an anesthesiologist for an additional fee. Following the retrieval, the eggs are fertilized with the male’s sperm in the laboratory and incubated until the resulting embryo(s) is(are) 4 to 8 cells in size, approximately 2 - 3 days following the retrieval. The embryo(s) is (are) then introduced into the female’s uterus via artificial insemination which is painless. This is followed by 5 days of bed rest.

The importance of progesterone

Whatever fertility treatment you decide to use, using either injectible progesterone or progesterone vaginal suppositories (50 mg 3 times a day) following the procedure and continuing until 16 weeks of pregnancy is highly recommended. The reason for this is the possiblilty that the ovaries will not produce enough progesterone to support implantation and subsequent pregnancy. This is called Luteal Phase Defect and is one of the most common causes of IVF failure and recurrent miscarriage. Progesterone is a naturally occurring substance that is usually produced by the corpus luteum in the ovaries. Normally, the ovaries produce enough progesterone to maintain a pregnancy until the placenta can take over the job. In some women, the corpus luteum does not provide adequate progesterone which results in the failure of the embryo(s) to implant and/or miscarriage. The best progesterone vaginal suppositories on the market are made by Lynn Blouin.

When male sperm is not viable

If the male cannot produce enough viable sperm or if the eggs do not fertilize naturally, it is possible for the laboratory to isolate and inject a sperm into each egg. This is known as Intracytoplasmic Sperm Injection or ICSI. It is usually an additional procedure to IVF and therefore carries an added cost. The IVF procedure is needed to retrieve the eggs for ICSI and then to place the resulting embryo(s) into the uterus.

Assisted hatching can aid implantation problems

Implantation problems can result when the shell of the eggs are too strong for the multiplying cells inside to break out and attach to the uterus. A procedure called Assisted Hatching can be performed. A laboratory technician makes a tiny hole in the shell of the egg following fertilization to help the resulting cells inside break out and attach to the uterus. This procedure is highly recommended for females who are over 35 years of age or who have experienced more than 2 failed IVF cycles.

Patience is key

IVF generally does not result in a full term pregnancy on the first try. Some clinics offer a package deal of 3 attempts for the price of 2, etc. However, if you have undergone multiple IVF cycles without success you may wish to investigate whether there are any immunological factors involved (see "Recurrent miscarriage").

Work together

In many cases age is a factor, ovaries may be polycystic, fibroids may clog the uterus. There are as many reasons for infertility as there are solutions. Sometimes there is no specific reason. It is important for the couple to try to remain cohesive. Blaming should be avoided. If infertility is approached as a team effort, the result tends to be much more optimistic.