Implantation Failure

under-stimulation of the granulosa cells in the developing follicle so that not enough estradiol is made. The follicle does not develop normally and does not make enough progesterone to support a healthy pregnancy. The end result is that even if an egg is fertilized, the corpus luteum cannot support it.

Another theory behind a luteal phase defect is that there is not enough luteinizing hormone released by the pituitary gland, which results in abnormal amounts of androstenedione to be secreted by the theca cells of the follicle. This also leads to low estradiol levels, an abnormal follicle, and low levels of progesterone in the luteal phase. Another theory is that there are abnormalities in the vasculature of the endometrium that make the endometrium unresponsive to normal progesterone levels. Lastly, women who have hyperprolactinemia and hypothyroidism are at a greater risk of having a luteal phase defect. These conditions have an adverse effect on the relationship between the hypothalamus and the pituitary gland.

Women with a luteal phase defect have several treatment options. Women with hypothyroidism can be treated with the levothyroxine and women with unexplained luteal phase defect can be treated with vaginal progesterone suppositories. Suppositories and gel are preferred methods of getting progesterone because they give better levels and can be continued for several weeks into the pregnancy. Synthetic progesterone has been found to be better than non-synthetic progesterone. An additional treatment for luteal phase defect is clomiphene citrate, which improves the development of the follicle.

Implantation Failure

Implantation failure is another problem that can be associated with the luteal phase. It involves the inability of the uterus to be receptive to the implantation of the embryo. Two thirds of the time the problem is related to the uterine receptacle and one third of the time the problem is related to the embryo. Implantation failure can be improved by optimizing the endometrial cavity.

The best treatment for implantation failure is to support the luteal phase with progesterone. This has been known to increase the success rate of implantation and to improve the development of the early embryo, thereby promoting a healthy corpus luteum. Women who are known to have at least three implantation failures using assisted reproduction have been found to have improvement in implantation after providing them with low molecular weight heparin. This improves the live birth rate by 80%.