Corpus Luteum Insufficiency as a Cause of Nidatory Failure

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Abstract
To assess the clinical significance of corpus luteum insufficiency (CLI), 612 women with infertility but otherwise without ovulatory defects, organic disturbances, or other untoward factors were evaluated. The procedures included endometrial biopsy (E.Bx.), and monitoring of serum progesterone (Pr) and estradiol-17.beta. (E2) levels in association with the patterns (I-IV) of basal body temperature (BBT) chart. The incidence of CLI varied depending on the method of evaluation. From the BBT, 65.4% of the 612 women were considered to have a CLI (patterns II, III, IV), but the short luteal phase (pattern IV) was detected in only 8.1%. The incidence of endometrial inadequacy determined by Noyes'' criteria differed according to the method of dating, namely, premenstrual or postovulatory dating. Of 49 women with pattern IV, retarded endometrium was found in 65% according to premenstrual dating, as compared with only 10% according to postovulatory dating. Thirty-one women became pregnant in the cycle of E.Bx., and only 3 aborted in the 1st trimester, 84% were dated postovulatorily as day .+-. 0 to day -2. No specific features were observed in the E.Bx. in the cycle of conception. The Pr and E2 levels in the mid-luteal phase were in the pattern order I, II, III, IV, but significant differences (P < 0.05) were seen only between patterns I and IV. E.Bx. obtained twice in the same cycle in 85 women revealed that in 48% of those with the retarded type in the mid-luteal phase, consistent endometrium was found in the late luteal phase and all 4 cases with an accelerated type in the mid-luteal phase were of the consistent type in the late luteal phase. These results suggest the importance of obtaining 2 specimens in the same cycle, on the basis of an accurate determination of the ovulatory day; the endometrium is best prepared for nidation on day .+-. 0 to day -2 as defined by postovulatory dating, and the criteria of endometrial dating of Noyes, et al. for patients with a short luteal phase are not applicable.