title: Luteal phase deficiency in regularly menstruating women: prevalence and overlap in identification based on clinical and biochemical diagnostic criteria.
abstract: BACKGROUND
  Although adequate luteal hormone production is essential for establishing pregnancy, luteal phase deficiency (LPD) is poorly characterized among eumenorrheic women.
  
  
  OBJECTIVE
  We assessed the prevalence and overlap of two established LPD diagnostic criteria: short luteal phase duration less than10 days (clinical LPD) and suboptimal luteal progesterone of 5 ng/mL or less (biochemical LPD) and their relationship with reproductive hormone concentrations.
  
  
  METHODS
  We conducted a prospective study in western New York (2005-2007) following 259 women, aged 18-44 years, for up to two menstrual cycles.
  
  
  RESULTS
  Among ovulatory cycles with recorded cycle lengths (n = 463), there were 41 cycles (8.9%) with clinical LPD, 39 cycles (8.4%) with biochemical LPD, and 20 cycles (4.3%) meeting both criteria. Recurrent clinical and biochemical LPD was observed in eight (3.4%) and five (2.1%) women, respectively. Clinical and biochemical LPD were each associated with lower follicular estradiol (both P ≤ .001) and luteal estradiol (P = .03 and P = .02, respectively) after adjusting for age, race, and percentage body fat. Clinical, but not biochemical, LPD was associated with lower LH and FSH across all phases of the cycle (P ≤ .001).
  
  
  CONCLUSIONS
  Clinical and biochemical LPD were evident among regularly menstruating women. Estradiol was lower in LPD cycles under either criterion, but LH and FSH were lower only in association with shortened luteal phase (ie, clinical LPD), indicating that clinical and biochemical LPD may reflect different underlying mechanisms. Identifying ovulation in combination with a well-timed luteal progesterone measurement may serve as a cost-effective and specific tool for LPD assessment by clinicians and researchers.
authors.affiliation: Division of Intramural Population Health Research (K.C.S., S.L.M., K.A.K., L.A.S., N.J.P., K.A.A., P.M., E.F.S.) and Program of Reproductive and Adult Endocrinology (K.A.K.), Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland 20852; Departments of Obstetrics and Gynecology (A.O.H.), University of Utah, Salt Lake City, Utah 84132; Department of Family and Preventative Medicine (A.O.H., J.B.S.), University of Utah, Salt Lake City, Utah 84106; and Department of Social and Preventive Medicine (J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14209.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Schliep
authors.forename: Sunni L
authors.initials: SL
authors.lastname: Mumford
authors.forename: Ahmad O
authors.initials: AO
authors.lastname: Hammoud
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Stanford
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Kissell
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Sjaarda
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Perkins
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Ahrens
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: Pauline
authors.initials: P
authors.lastname: Mendola
authors.forename: Enrique F
authors.initials: EF
authors.lastname: Schisterman
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008183:Luteal Phase / Q000097:blood; D008597:Menstrual Cycle / Q000097:blood; D008599:Menstruation Disturbances / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011374:Progesterone / Q000097:blood; D055815:Young Adult
chemical_list: D011374:Progesterone; D004958:Estradiol