Q: How do you treat LPD?
A: If the cause of low progesterone levels is inadequate corpus luteum performance after ovulation, then progesterone support may be the appropriate solution.
But the cause of low progesterone may also be an inadequate follicle development before ovulation. It is therefore important to measure mid-cycle follicle size (via ultrasound) and estradiol levels (via a blood test).
If follicle development is normal, then progesterone supplementation during the luteal phase is normally the correct treatment.
If the follicle development is inadequate, an ovulatory stimulant such as Clomid or an injectable drug may help the follicle to mature more appropriately.
Clomid has the double benefit of producing a higher-quality egg and a better-functioning corpus luteum.
Women whose uterine lining fails to respond to normal progesterone levels often have normal follicle development and adequate progesterone levels at 7 days past ovulation. An ultrasound image of the lining at 7 DPO, however, will show a lining that has failed to convert from the triple layer lining typical of the time of ovulation. In this case, women are often given additional progesterone supplementation in the luteal phase in the hope that a higher level will be the push that the lining needs to convert appropriately.
Some doctors use injections of human chorionic gonadotropin(hCG) to further stimulate the corpus luteum.