Ovulation is one of the most important events of the menstrual cycle that women should learn to detect month to month while on their fertility journey. There are many signs and symptoms of ovulation, from changes in cervical mucus and cervical position to mittelschmerz (ovulation pain), increased libido and a rising basal body temperature. When ovulation is disrupted, conception is not likely to happen.

One reason for disrupted ovulation that we hear about more and more is Luteinized Unruptured Follicle Syndrome (LUFS). Women with LUFS often come to us frustrated and worried that common medical efforts to address it could worsen the problem. Here’s what we know about LUFS, its causes, in addition to approaches that can help reduce its likelihood and enhance natural fertility.

What is LUFS?

In a normal month, the egg develops, matures and is released from the ovary. This is ovulation. In normal ovulation, follicle rupture (egg release) occurs within 38 hours of the Luteinizing Hormone or LH surge. The egg then travels down the fallopian tube to the uterus for potential conception and implantation.

In LUFS, the egg matures fully or partially inside the ovary but is never released. Sometimes called “trapped egg syndrome,” early research shows LUFS is in part the result of a chronic inflammatory response.

Diagnosing LUFS

LUFS can only be detected through serial ultrasounds or Napro Technology after the ovulatory phase of the menstrual cycle. Here’s why: In LUFS, the egg matures and is luteinized, forming a corpus luteum causing an LH surge. The LH surge is detectable in ovulation predictor kits (i.e. OPKs) and as a basal body temperature spike in fertility charting. Fertile cervical mucus may also be present. All of this suggests fertility is high, although the egg is actually trapped. Some women with LUFS never even know they have the problem. Further, LUFS can occur intermittently with normal ovulation.

• You may be wondering how common LUFS is. While we’re still learning about LUFS, early research finds it’s pretty rare. If you’re in your childbearing years and have regular cycles, you’re most likely experiencing normal ovulation the majority of the time. If your cycles are irregular and you’ve experienced unexplained infertility for a long period of time or have other risk factors (see below), exploring whether you have LUFS could be a good idea.

Risk Factors for LUFS

1. Unexplained infertility: Women with unexplained fertility are at greater risk for LUFS. In fact, LUFS could be the hidden culprit behind unexplained fertility.

2. IUI: Having multiple IUI’s (Intrauterine Inseminations) can play a role in the development of LUFS. In one study with women undergoing IUI with Clomid, those who had three consecutive cycles had a 58% chance of developing LUFS and a 90% recurrence rate. If you’re planning for this type of treatment, a break between IUI cycles may be helpful to reduce LUFS risk.

3. Various Fertility Health Issues: Pelvic adhesions, endometriosis, and blocked fallopian tubes can contribute to LUFS by preventing normal egg release into the abdominal cavity during ovulation.

4. NSAID Use: Research suggests NSAIDS (non-steroidal anti-inflammatory drugs) contribute to LUFS in some women. NSAIDS block normal prostaglandin activity within the follicle, possibly triggering LUFS or delaying ovulation.

5. PCOS: LUFS is more common in women with PCOS. This is thought to result from hormone imbalance, chronic inflammation or because the ovaries themselves are tougher and it’s harder for the egg to be released.

Integrative Approaches to Help the Body Rebalance

Medically, ovulation-stimulating drugs like hMG (human menopausal gonadotropin) and hCG therapy (human chorionic gonadotropin) or other combinations are used successfully to combat LUFS. Further, taking a break from fertility treatments or fertility drugs may reduce LUFS for some women.

For women whose risk is increased by taking NSAIDS, it’s important to avoid these drugs around ovulation or all together. Natural pain management approaches like massage therapy, chiropractic treatments or acupuncture can relieve pain without the side effects or fertility risks of NSAIDS.

In the natural world, we’re just beginning to learn about LUFS and ways to approach it. We don’t know anything definitive about herbs for LUFS at this time. However, there are helpful herbal options and non-invasive natural therapies that support normal ovulation and a healthy inflammatory response to consider:

• Tribulus (Tribulus terrestris): Tribulus is a nourishing tonic for the ovaries and the female reproductive system as a whole. This is a good herb to use prior to ovulation (from day 5-14 of the cycle) to help normalize the ovulatory process. It has benefits for a healthy immune system, and for encouraging ovarian health in PCOS.
• Vitex (Vitex agnus-castus): Vitex is a harmonizing and nourishing herb for the pituitary gland, which signals hormone production in the ovaries. Vitex can encourage the formation of the corpus luteum (mature egg), and help promote normal progesterone, luteinizing hormone (LH), and FSH (follicle stimulating hormone) levels, involved in ovulation. Vitex is best used all month long, taken on an empty stomach about a half hour before breakfast.
• Self-Fertility Massage: Self Fertility Massage can help break down scar tissue, adhesions or reproductive blockages that contribute to LUFS. Self Fertility Massage also increases circulation to the ovaries, relieving stagnation, promoting egg health and supporting normal ovulation.
• Systemic Enzyme Therapy: For LUFS related to reproductive blockages, Systemic Enzyme Therapy may also offer benefits. Systemic enzymes support normal fibrin breakdown and encourage a normal inflammatory response. In LUFS, the inflammatory response during the follicular phase is heightened. Systemic enzymes used on an empty stomach can decrease inflammation throughout the body, encouraging normal reproductive system health.

Work to Restore Normal Ovulation

If you have been told you have LUFS, review your risk factors and see if there are lifestyle changes or adjustments to your fertility treatments to help your body normalize. Your body could need a break from treatment in order to help restore normal ovulation. Further, you could need a different type of approach (medical or natural) to promote normal ovulation and enhance fertility.

Work closely with your practitioner for the best results and try to stay positive. While not all cases of LUFS are understood, there may be causative factors for many that can be addressed successfully through natural or medical approaches.

References
– The Mystery of Luteinized Unruptured Follicle Syndrome, NSAIDS and Unexplained Infertility. (2015, Aug.). Retrieved from: http://www.fertilityanswers.com/the-mystery-of-luteinized-unruptured-follicle-syndrome-luf-nsaids-and-unexplained-infertility/
– Luteinized Unruptured Follicle Syndrome. (2017). Retrieved from: https://www.fertilitysmarts.com/definition/408/luteinized-unruptured-follicle-syndrome-lufs
Ovulatory Disorders: Are Your Periods Normal? (2017). Retrieved from: http://www.ivf.com/cyclestu.html
– H. Qublan, Z. Amarin, M. Nawasreh, F. Diab, S. Malkawi, et al. (2006, April.) Luteinized unruptured follicle syndrome: incidence and recurrence rate in infertile women with unexplained infertility undergoing intrauterine insemination. Human Reproduction. 21 (8): 2110-2113. Retrieved from: https://academic.oup.com/humrep/article/21/8/2110/2938623/Luteinized-unruptured-follicle-syndrome-incidence
– Check JH, Dietterich C, Nowroozi K, Wu CH (1992, January- February). Comparison of various therapies for the luteinized unruptured follicle syndrome. International Journal of Fertility; 37(1):33-40. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/1348733
– LUFS Syndrome and Infertility. (2015). Retrieved from: http://www.drmalpani.com/articles/luteinized-unruptured-follicle-syndrome-luf-infertility
– PCOS Faqs. (2017). Retrieved from: https://www.inciid.org/PCOS-FAQ