Infertility and the Luteal Phase

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We are still far from understanding the intricacies of the relationship of the ovary and uterus. The best insurance for an implantation is a healthy secretory endometrium, and development of secretory phase endometrium is a result of luteal phase progesterone secretion, which is dependent on estrogen priming. The first place to look for failure of implantation is in altered follicle development and ovulation. Even the most ardent supporters of endometrial biopsy as an assay do not support its use for ovulation detection. Although it is a generally reliable technique, it has been replaced by other, less invasive methods for ovulation detection. Unfortunately, many still use it as a part of the first line approach in the infertility evaluation. If it has a role, it should be relegated to a later stage, perhaps used when the cause of the infertility has not been forthcoming. The role of LPD in fertility is more conceptually sound than objectively proven. It is the endometrial biopsy that allowed this diagnosis, and it is the possibility of this diagnosis that remains the primary, if not only, indication.

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