In modern medicine, female infertility has become an ever-increasing issue. Many women are choosing to have children when they are in the age range of 30-40+ where there is a significant risk in not being able to fall pregnant or carry the baby to full term. There are many reasons for female infertility, one of the most significant is luteal phase defect (LPD).
LPD is a recurrent post-ovulatory deficiency in the production of progesterone by the corpus luteum. For pregnancy to occur, the endometrium must be ready to receive the fertilized egg between four and eight days after ovulation. LPD can cause the events signalling endometrial development to be out of sync with the rest of the hormonal cycle. If the endometrium isn’t ready in time, the blastocyst will find it unreceptive for implantation. Administering external progesterone doesn’t always resolve the issue and some women will still experience infertility or miscarriage.
It is generally agreed that progesterone has a heating effect and after ovulation the basal body temperature (BBT) can raise four-tenths of a degree or more. A slow or low rise in temperature after ovulation might indicate a lack of progesterone. If the uterine lining is not properly primed to respond, then uterine lining won’t be thick enough for implantation to occur. Spotting may occur, BBT may drop, or the period may come early.
Several signs may make a doctor suspect LPD, including abnormal BBT, menstrual symptoms, low serum progesterone levels.
The Eastern View
According to TCM most cases of LPD are related to a kidney yang deficiency and/or spleen qi deficiency. Therefore, in cases of LPD these two deficiencies almost always need supplementation.
Spleen Qi Deficiency
The symptoms a woman may experience include fatigue, excess sweating, abdominal bloating, low blood pressure, pale/swollen togue and weak pulse. Periods may be heavy, watery and be slightly pink in colour and there will be loose stool before the period.
Adding progesterone to a woman’s system wouldn’t treat the root of her problem. The only way to correct the deficiency is to supplement Spleen Qi.
Kidney Yang Deficiency
Kidney Yang Deficiency is also common in cases of LPD. A woman may feel cold, especially in the hands and feet, experience fatigue, light-headedness, joint pains, midcycle vaginal discharge, frequent urination and spotting before her period is due. BBT rises slowly and stays low in the second half of the cycle. This pattern and spleen qi deficiency pattern will tend to respond well to the administration of clomiphene.
Liver Qi Stagnation with Heat
A woman who suffers from liver qi stagnation may get depressed, irritable, have pre-menstrual tension (PMT), acne, dry mouth and wiry pulse. Women with this pattern may have trouble getting pregnant even with clomiphene. This is because clomiphene further invigorates the yang qi creating more heat. This can produce a toxic environment, unfavourite to implantation.
Cold Uterus
A cold uterus will not respond well to the heating effect of progesterone. This pattern usually has Kidney Yang deficiency accompanied by blood stasis. A woman may experience cramping, and the lower belly will feel colder to the touch compared to the rest of the body. A cold uterus will not provide a suitable environment for implantation.
Blood Deficiency
Blood deficiency refers to insufficient blood volume and poor blood quality. After ovulation, in the second half of the cycle, progesterone stimulates a thick and spongy uterine lining to form. At this stage, the lining should be filled with plenty of rich blood to maintain the richness and quality of the uterine lining in preparation for pregnancy. If the blood volume is low the lining will become thin, dry and of poor quality, which can lead to miscarriage.
Chinese medicine plays a very important role in treating LPD. Different Chinese herbal formulas in conjunction with Acupuncture are successfully used to treat LPD .
I have treated may patients with LPD and many of them suffered from recurrent miscarriages. A woman visited my clinic after eleven miscarriages. After some time of both Chinese medicine and acupuncture treatment she finally got a girl on the and then a boy from the 12th and 13th pregnancies. It is vital to give the treatment enough time for it to be effective.