LUFS

Ovulation is a key event in the menstrual cycle that women are encouraged to track while on their fertility journey. There are many reasons for ovulatory dysfunction, one of which being Luteinized Unruptured Folic Syndrome (LUFS).

LUFS is coming up more and more in my practice and IS a cause of sub-fertility given that it makes pregnancy impossible for any cycle that it occurs. It's even thought to be an increasing cause of "unknown fertility." 

What is Luteinized Unruptured Follicle Syndrome (LUFS)?

Normal ovulation is when the follicle develops, matures and releases an egg from the ovary within 36 hours of the Luteinizing Hormone (LH) surge.

LUFS causes ovulatory dysfunction when there is a dominate follicle that grows and matures but never actually ruptures, but turns immediately into a corpus luteum (that DOES secrete some progesterone), followed by a typical menstrual bleed (the egg stays trapped and there is no chance of conception). 

What are the signs of LUFS?

Unfortunately it can be really hard to tell if you're experiencing LUFS because all of the signs and symptoms of ovulation take place (LH surge-positive OPK, temperature rise (BBT) in the luteal phase, elevated progesterone on a lab test, AND a normal period) AKA a seemingly normal cycle. *It may not occur every cycle

How to diagnose

LUFS can only be detected through an ultrasound series at a clinic. A clinician will watch the dominant follicle grow and mature, and then confirms or denies the rupture. 

What are the causes of LUFS?

The experts aren't sure why this happens but here are some potential causes/risk factors: 

• Unexplained infertility: Those with unexplained infertility are more likely to be diagnosed with LUFS. This is important as there are studies that show unexplained fertility cases are as high as 30% in those who are trying to conceive. 

• Chronic inflammation or inflammation dysregulation

• Utilization of Clomid or having recurrent IUI's

• Pelvic adhesions and Endometriosis: These can contribute to LUFS by preventing a normal egg release during ovulation

• PCOS: Polycystic ovarian syndrome can be paired with hormonal imbalance, egg maturation issues, and chronic inflammation, which may make it harder for the egg to be released and make LUFS more common in those with PCOS

• NSAID use: Research has shown that NSAID use can be a potential driver of LUFS in women. They can block normal activity in the follicle, potentially delaying ovulation or triggering LUFS.

How do you manage LUFS?

To manage LUFS it's important to support risk factors and potential causes with a customized approach. This could look like: 

• hCG therapy (trigger shots)

• Avoiding NSAIDs

• Taking breaks from medicated cycles

• Working with a skilled practitioner to support optimal ovulation, hormonal balance and egg quality

• Support optimal blood flow to reproductive organs (acupuncture has been shown in research to be helpful