Name
LUTEINIZING HORMONE DEFICIENCY
DESCRIPTION
DETAIL
* BASAL BODY TEMP CHART - TO EVALUATE THE ADEQUACY OF LUTEAL PHASE SINCE SUSTAINED TEMP RISE DURING THE LUTEAL PHASE OF MENSTRUAL CYCLE IS SEEN. * ULTRA SOUND EXAM - FOR DEMONSTRATION OF OVULATION OR FOLLICULAR STUDY & ENDOMETRIAL THICKNESS * ENDOMETRIAL BIOPSY - Urinary LH kits provide a useful test to estimate the appropriate timing of an endometrial biopsy (EB). Following a positive test finding, ovulation occurs within 24-26 hours. The EB should be performed on the 12th day of a 14-day luteal phase. * SERUM PROGEATERONE - SINGLE SAMPLE IS NON DIAGNOSTIC & TAKING MULTPLE SAMPLES IS EXPENSIVE & INCONVENIENT
TYPENOTES
MEDICAL TREATMENT : A general agreement is that LPD is probably a true diagnostic entity. Treatment modalities remain a source of contention. Medical management is the only choice of treatment for those with luteinizing hormone deficiency. Surgical therapy has no role in this disorder. Two broad categories of treatment exist. The first approach attempts to improve the quality of the follicle and the process of ovulation. The reasoning for this approach is based on the understanding that inadequate progesterone produced in the luteal phase is due to a suboptimal rise in LH levels. In turn, the poor LH level rise leads to the poor quality of the ovum that is released. Clomiphene citrate and gonadotrophins have been shown to be effective in this condition. Clomiphene citrate competes with endogenous estrogen to stimulate estrogen receptors in the hypothalamus. This provides a low estrogen signal that results in increased levels of FSH. The second approach to management of this clinical entity is to support the ovulatory cycle and early gestation with exogenous progesterone. The addition of progesterone helps to support the endometrial lining, normally maintained by endogenous progesterone from the corpus luteum and is usually administered to the patient beginning 3-4 days after ovulation. Supplementation is frequently provided through 8-10 weeks' gestation. Several commercial preparations are available for this purpose. DRUG TREATMENT : Therapies for patients with luteinizing hormone deficiency are synthetic progestational agents (progesterone) and ovulation induction agents (clomiphene citrate). In pregnancy rates, no demonstrable differences between these 2 drug choices exist. 1. OVULATION INDUCTION AGENTS : - CLOMIPHENE CITRATE 2. PROGESTATIONAL AGENTS :These agents may support the luteal phase of a female who is subfertile in whom inadequate intrinsic luteal phase progesterone is available. - PROGESTERONE - Can be administered PO, vaginally, or IM. All routes of administration are equally effective. Begin treatment 2-3 d after ovulation and continue until 10th wk of pregnancy.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
TSH, SERUM PROLACTIN ( NONPREGNANT FEMALE ), ULTRA SOUND OBSTETRICS, SERUM PROGESTERONE( FEMALE- FOLLICULAR PHASE), COMPLETE BLOOD COUNT, ULTRA SOUND FOLLICULAR STUDY