The Role of Folliculo-Luteal Function in the Outcome of Pregnancy

  • György Siklósi


Recently an increasing amount of evidence has shown that pregnancy outcome is already decided in the early phase of pregnancy and that inadequate placentation “ischaemic placental disease” underlies the various forms of adverse pregnancy outcome, the cause of which is still unclear. The characteristics of the secretory endometrium (thickness, blood supply, etc.) and thus the conditions for placentation are essentially determined by the preovulatory oestradiol (E2) and the following progesterone (P) and E2 level. Based on this, we assumed that the outcome of pregnancy is inherently determined by the quantitative relations of the folliculo-luteal function (FLF).

To test this assumption, we investigated the relationship between FLF and pregnancy outcome in 884 pregnancies conceived under treatment for unexplained infertility. We described FLF with the average value of luteal P and E2. The average luteal P and E2 was significantly (p < 0.001) different in pregnancies ending with miscarriage, preterm birth and mature birth and also in pregnancies resulting in newborns with retardation and in eutrophic newborns. We found a strong and significant correlation (r = 0.80–0.84, p < 0.001) between the luteal P and E2 values and the length of pregnancy (weeks). A strong correlation was also detected between the luteal P and E2 values and the length, weight, weight percentile and biparietal diameter of newborns (r = 0.73–0.84; p < 0.001).

Based on the outcome of pregnancy, three grades of folliculo-luteal insufficiency (FLI) can be differentiated:
  • Physiological FLF:
    • Average P > 23 ng/ml and E2 350–800 pg/ml: singular, mature and eutrophic birth

  • FLI grade I:
    • Average P 17–23 ng/ml and E2 220–350 pg/ml: preterm birth, IUGR, preeclampsia

  • FLI grade II:
    • Average P 11–17 ng/ml and E2 100–220 pg/ml: miscarriage during the first and second trimesters

  • FLI grade III:
    • Average P < 11 ng/ml and E2 < 100 pg/ml: infertility

We are able to determine FLF prior to conception – by treatment controlled with the luteal P and E2 value – which makes it possible to prevent the various forms of adverse pregnancy outcome.


Preterm Birth Pregnancy Outcome Embryo Transfer Adverse Pregnancy Outcome Recurrent Miscarriage 
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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • György Siklósi
    • 1
  1. 1.Semmelweis University Second Department of Obstetrics and GynecologyBudapestHungary

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