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Re: luteal phase defectsFrom: guy (venezia.gaetano@mhsil.com)Sat Apr 8 08:13:55 2000
that seems like a very complete approach. what type and how much progest agent do you use. we have typically gone the vag route. thanks guy > >Progesterone levels are a +/- situation. > >Values alone may not be of much help, as I have on occasions seen patients >go through first trimester successfully, while their progesterones levels >hovered around 10 (lowest I have seen is 8, with patient pulling through >without any supplementation). > >On the other hand, I once presented a study correlating single midluteal >progesterone levels <15 with increased incidence of ILP on endometrial >biopsy (EBx). > >Over the years of practice I have developed the following approach: > >..in face of ILP on TWO biopsies: >--------if BBTC shows delayed ovulation, irrespective of what midluteal >prog. was, then I treat with clomiphene citrate to normalize the BBTC then >reconfirm with another EBx; >--------if, OTOH, the BBTC is normal, but midluteal prog. is low (<15) then >I first try supplementing prog., then remeasure the levelsin next cycle to >make sure they are appropriate and then reconfirm with repeat EBx > >..without prior diagnosis of ILP, if a patient shows up with low >progesterone, I just continue observation, with the only intent to prevent >it from going below 5, which is associated with irreversible abortion; the >problem is that as the level decreases I have less "wiggle room" to detect >the drop in a timely fashion and respond to it, I generally become very >uncomfortable below 20 and suggest to the patient supplementation when prog. >goes below 15, almost insisting if it continues to decline to 10 and below. > >-- >Rafael Haciski, MD FACOG >Gynecology and Infertility Associates >Baltimore, MD >410-825-0020 >web......http://www.IVF-MD.com >e-mail..GIA@IVF-MD.com > >> From: venezia.gaetano@mhsil.com (guy) >> Reply-To: ob-gyn-l@obgyn.net >> Date: Fri, 7 Apr 2000 12:12:31 -0500 >> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net> >> Subject: Re: luteal phase defects >> >> good points. i was also trained to do two, but has become difficult >> with pt compliance. the point i made on one bx was in reference to the >> recent acog audio cme in which the panel of gyn docs admited to doing >> just one emb at mid luteal phase toward the end of the cycle. (secondary >> to pt prefernce and pain) >> i still get a wide range of pain responses to my emb's. >> what do you think of progest levels...it is in the lit but am not sure >> it is of much clinical value. (wash univ and st louis univ are doing >> them) >> thanks >> guy >
-- guy
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