Ep. 60: LUF Syndrome 101

Welcome back to the Woven Well Podcast! If you haven’t yet, I’d like to invite you to subscribe to our podcast. This keeps our just released episodes in your podcast queue and ready for you, whenever you’re ready to listen. This includes client story episodes, interviews with guest experts, discussions on faith and fertility, and episodes like today’s - where we take a topic related to fertility and give you the run down on all the basics that you need to know. 

Which brings us to today’s topic: LUF 101. 

I wish there was a way to poll you to see how many of you already know what LUF syndrome is - because it’s not frequently discussed, but it can happen more often than you’d expect.  

If you’ve listened to our BASIC series, then you already know the reproductive process happening in your body each cycle. 

If you haven’t yet, then you can go back to episode 1 to hear exactly how your body works, but  at the start of each cycle, eggs in your ovaries are recruited for possible ovulation. Each follicle produces estrogen until one is selected to ovulate. This large follicle is then changed by the hormone LH (also known as luteinizing hormone) in order to release the egg inside the mature follicle. After this egg is released, the follicle is still important! Instead of estrogen, the follicle, now the corpus luteum, produces progesterone to prepare the lining of the uterus for possible pregnancy, among other things. 

Now, LUF stands for luteinized enraptured follicle. 

This is when the reproductive process follows exactly the same steps I just mentioned: body recruits eggs, follicles grow around these eggs and produce estrogen, LH surges to prepare the mature follicle for ovulation, Progesterone is produced by the mature follicle, now known as the corpus luteum. 

The key difference is that when the LH surged, the mature follicle didn’t actually ovulate.  All the elements were there. But for some reason, the follicle didn’t actually rupture, and the egg was unable to leave the ovary. 

This can be an incredibly frustrating thing for couples who are hoping to conceive a pregnancy. Everything looks right! The follicles are growing! Estrogen is pumping! You get that LH surge! You see beautiful cervical mucus! Progesterone follows ovulation! But there’s no egg to be fertilized. 

So how can you know if you have LUF syndrome? 

The truth is that most of the time, women don’t know. It’s possible to have LUF occur randomly or more consistently. It’s common in women with longer cycles and PCOS, and those with regular, seemingly healthy cycles. Frustrating, right? But, there are some clues out there to help you figure out if it may be a possibility for you.

The first is that, if you’re dealing with “unexplained infertility,” this is definitely something to look into. LUF can fly under the radar, because you may be having regular cycles, your hormone labs are coming back normally, and your pre-ovulatory ultrasound is showing a healthy, growing follicle. We don’t have exact data on how common LUF syndrome occurs, but we do know that it’s far more likely in women dealing with the symptom of infertility. 

Another thing that helps you figure it out if LUF cycles could be happening: Creighton charting! What do you know! There are signs of LUF that you can spot through Creighton charting! No wonder I’m such a fan of Creighton - it’s just plain helpful. And when you’re charting, you don’t have the pressure of figuring it out on your own. Your practitioner is trained in spotting flags that may suggest a LUF cycle or even a consistent pattern of LUF syndrome. 

When your charting shows this possibility, or you’re wondering if your unexplained infertility may actually be explained by LUF - there is a definitive way to diagnose it. 

The key to diagnosing LUF syndrome is a follicular ultrasound series. This is a common recommendation among Napro providers, but not necessarily with general OBGYNs or even Reproductive Endocrinologists. 

A follicular ultrasound series is not just an ultrasound at one point in your cycle - because LUF may show what looks like a normal ultrasound at the start, preovulatory, and even into the luteal phase (after supposed ovulation). 

When you have an ultrasound series, though, your provider is watching the small but critical changes occurring in the follicle right around ovulation. They’re specifically looking for the punctured balloon sort of look that’s common in the ruptured follicle after ovulation. It won’t happen immediately - you can’t really catch ovulation happening on an ultrasound. But you can see it within a few days afterward. 

So it’s important to track it over those specific days, so you won’t miss it. Wait until it’s a corpus luteum (which is the follicle after ovulation) and you’ll have missed what you’re looking for. 

This goes back to the benefit of charting with Creighton. These timed ultrasounds are important. And you don’t want to have them based on the guess that you ovulate around day 14. You don’t want to base them on any guesses at all! When you’re charting with the Creighton system, you have very specific data that allows you to see exactly when you’re ovulating. In fact, you’ll know when you’ve entered the start of your window of fertility - which is exactly what you’ll need for these timed ultrasounds. 

Once you’re able to get these ultrasounds, you’re finally able to get your diagnosis: LUF Syndrome! 

And now you can focus on treating it! Right? Of course. But also, you can see if you can address why it’s happening in the first place. 

The truth is, it’s a little tricky to know the exact reason. There have been studies that suggest things like recurring fertility treatments or NSAID use, like Advil/Aleve, can make you more likely to have LUF cycles. But it’s hard to know exactly how much influence these things have.

It’s also suggested that you’re more likely to have LUF if you have a chronic inflammatory condition. 

Now, inflammation can significantly affect your fertility. Whether the inflammation is coming from weak gut health like we talked about with Chiara in episode 57, unchecked insulin resistance, environmental toxins in our personal care and household products, or some other source - inflammation is our best guess at the cause of lots health issues, including reproductive ones like LUF and endometriosis. 

The good news is that if you’re experiencing LUF cycles, there are treatments. 

The first I would recommend is to reduce your inflammation. This process is going to need to be specific to each particular person and their body. It’s not always a one-size fits all process. If you have insulin resistance, then managing that imbalance is a great first step to reducing inflammation in the body. But if you don’t have insulin resistance, it’s not as necessary of a step. So you see my point. 

But being mindful of things like gut health and environmental toxins can benefit everyone. Like I mentioned, you can listen to our recent episode on gut health with Chiara and I’m hoping to have some more resources on environmental toxins coming out for you soon. 

Even reducing stress can improve the body’s inflammation. I realize we can’t always simply stop the stressors in our lives from being stressful. But we can incorporate practices of rest and renewal amidst the stress. 

What are things that make you feel less stressed? A hot bath and some epsom salts with essential oils? 20 mins of time with your favorite tea and a good book? Getting outside for a walk or run first thing in the morning? Or a game night with friends? Whatever it is, put it on the calendar - and know that you’re doing it for your health! 

Since LUF cycles can sometimes be caused by recurrent fertility treatments, another option is to take a little break from active treatments. For most couples, this doesn’t mean you have to stop trying to conceive during this time. But you just may not take Letrozole that cycle, for instance. 

I’m not saying that you need to stop any fertility treatments. I’m just letting you know that it’s an option, since it can be a cause of LUF syndrome. Maybe you take a break from medications for a month or two, and then see if it returns. 

If you don’t think your LUF cycles are caused by either, or if you’re ready to move forward regardless, then you can also benefit from hCG injections. hCG is the hormone produced by an early pregnancy, but it mimics some of our other reproductive hormones, like LH. So it can be used as an injection before the LH surge that causes ovulation, to help trigger a successful ovulation. You may have heard of this as a trigger shot. 

An hCG shot is fairly successful, but it’s not the most sustainable practice. It can be expensive, and sometimes challenging to do long term. So even if you choose to use these shots, which are a great option, keep in mind that the other approaches, like reducing inflammation, may still be worth doing at the same time. 

So there you have it! Now you know what LUF syndrome is, how to be on the lookout for whether or not you have it, how to actually get it diagnosed, what could be causing it, and what your options are for treatment. 

These 101 episodes are important to me, because women aren’t always given this basic information as they should be. Maybe you’ve been given a trigger shot, but never told why. Maybe you’re seeing signs of LUF and other issues caused by inflammation, and now feel more empowered to address it. Maybe you’ve had years of infertility, and LUF was never investigated. You deserve to have this information! 

If you’d like to have what we’ve talked about today in a written form, we have a handy LUF 101 resource guide on our website under our resources tab. You can get it for free at wovenfertility.com/resources. It can be really helpful when you’re preparing to talk with your doctor, or looking into other resources on your own. There are lots of other free resources you can check out there, as well. 

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As always, thanks for listening as we continue to explore together what it means to be woven well.