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The luteal phase is the part of the cycle follows after the egg has been released from the ovary. This phase may be inadequate in some way, and this is called a luteal phase defect.
The corpus luteum produces the hormone called progesterone. Which is essential for preparing the endometrium to receive the fertilized egg. Several things can go wrong with progesterone production: the rise in output can be too slow; the level can be too low; or the length of time over which it is produced can be too short. Another possibility is a defective endometrium that does not respond properly to the progesterone.
Luteal phase defects can be investigated either by a properly timed endometrial biopsy or by monitoring the progesterone output by taking a number of blood samples on different days after ovulation and measuring the progesterone level in them.
The immune system can react against the man's sperm, and, as a result, kill them, immobilize them or make them stick together. Women can also develop an immune reaction to the coating of their own eggs, which can prevent sperm from attaching to them.
Certain infections have been shown to be responsible for some cases of unexplained infertility. For example, mycoplasma or chlamydia may be present in numbers that are not enough to show up in a clinical examination, but which nevertheless cause infertility. This is why some doctors use empiric therapy with antibiotics.
Some men have a completely normal sperm count, but their sperm cannot fertilise the egg. The only way to make this diagnosis is by IVF; if donor sperm can fertilize wife's the eggs; but the husband's sperm fail to do so, then the diagnosis is confirmed.
Some women have an abnormal endometrium (uterine lining) which does not allow the embryo to implant. This is a subtle finding, which is often missed. It can be diagnosed by doing serial vaginal ultrasound scans, to assess the thickness and texture of the endometrium. In some infertile women, the endometrium remains persistently thin. This may be because of inadequate uterine blood flow, or poor estrogen receptors in the endometrial cells. This can be a difficult problem to treat, and therapy is usually empirical (either low-dose aspirin or high doses of estrogen). Vaginal administration of viagra (Sildenafil citrate) can also help to improve the thickness of the endometrium in some of these women, by enhancing uterus blood flow.
Studies on infertile groups of men and women have produced contradictory findings about the importance of psychological factors in causing infertility. Emotional disturbances, undoubtedly, appear to have some significance and this is not surprising since the whole hormonal cycle, is controlled from the brain. Has anything been missed?
All previous tests undergone by the couple should be carefully reviewed to ensure that the diagnosis is in fact "unexplained", and that no test has been omitted or missed. It may sometimes be necessary to repeat certain investigations. Thus, for example, if a previous laparoscopy has been done by a single puncture and been reported as normal, it may be necessary to repeat the laparoscopy with a double puncture in order, to look for early endometriosis.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
