Luteal phase defect: myth or reality

Although the diagnosis of LPD has been described convincingly in the research setting, it remains a controversial clinical entity. In clinical practice. the diagnosis of LPD has been attempted by several methods-BBT charts. progesterone levels indirectly, and endometrial biopsy as a direct and invasive method. All of these methods are retrospective; the interpretation of endometrial biopsies-even with the recently proposed molecular markers-has not been satisfactory. Therefore, no reliable method exists to diagnose LPD. When LPD is found, most physicians are inclined to incriminate it as the cause of infertility or recurrent abortion. although there is no convincing scientific evidence to support these associations. Does the LPD appear consecutively or sporadically? This question further complicates discussions on the diagnosis and treatment of LPD. No specific treatment is intended to manage LPD. The treatment of LPD with progestin replacement has not been correlated with conception. The treatment decisions mostly are empiric. Treatment modalities that are recommended for unexplained infertility (eg, ovulation induction.. assisted reproduction) have been successful in achieving pregnancy in women who have LPD. These issuess undermine the efforts to diagnose the condition. LPD is a reality in assisted reproduction cycles with GnRH agonist/antagonist suppression. Otherwise, there is no convincing evidence to define LPD as a distinct clinical entity that leads to reproductive problems. It is not justified to include costly and cumbersome tests to diagnose LPD in patients who have infertility or recurrent abortion.