Answer: Luteal Phase Deficiency is NOT a Recognized Cause of Female Infertility
The correct answer is B - luteal phase deficiency. This condition is not listed among the established causes of female infertility in current evidence-based guidelines, while endometriosis, septated uterus, and tubal scarring from STIs are all well-documented causes.
Recognized Causes of Female Infertility
According to the American College of Radiology's 2020 Appropriateness Criteria, the established female-specific causes of infertility include 1:
Tubal Damage (Option D - IS a cause)
- Tubal damage accounts for 14% of known infertility cases 1
- History of salpingitis from chlamydia infection is specifically identified as a major cause 1
- STI-related pelvic inflammatory disease leads to tubal scarring, occlusion, and peritubular adhesions that cause infertility 1
- Barrier methods that prevent STIs reduce risk of tubal infertility by 25% 1
Endometriosis (Option A - IS a cause)
- Affects at least one-third of women with infertility and up to 10% of reproductive-aged women 1, 2
- Recognized as a major female-specific cause of infertility, though the mechanism remains unclear 1
- Associated with reduced ovarian reserve and recurrent pregnancy loss 2
Uterine Cavity Abnormalities (Option C - IS a cause)
- Uterine cavity abnormalities interfere with implantation, causing inability to conceive or recurrent pregnancy loss 1
- Congenital anomalies like septated uterus are specifically listed as anatomical causes of infertility 3
- Acquired uterine conditions (myomas, synechiae) also contribute to infertility 3
Why Luteal Phase Deficiency is NOT Listed
Luteal phase deficiency is conspicuously absent from the comprehensive list of female infertility causes in the 2020 ACR guidelines 1. The guideline systematically reviews:
- Ovulatory disorders (particularly PCOS) 1
- Tubal damage 1
- Endometriosis 1
- Uterine cavity abnormalities 1
- Age-related oocyte quality deterioration 1
Multiple contemporary sources confirm the major causes as ovulatory failure (21%), tubal damage (14%), male factor (26%), and unexplained (28%) 1, 4, with no mention of luteal phase deficiency as a distinct diagnostic category.
Clinical Pitfall to Avoid
Do not confuse luteal phase deficiency with ovulatory disorders, which ARE a major cause of infertility accounting for approximately 25% of cases 4. Ovulatory dysfunction, particularly from PCOS, is well-established 1, 4, but luteal phase deficiency as a separate entity is not recognized in current evidence-based guidelines for female infertility evaluation.