Abstract
BackgroundTransient exposures may influence fertility and early embryonic development. To assess the time of conception in vivo and conduct concurrent biomonitoring, ovulation must be identified prospectively. We report on the development and validation of a simple, prospective method, the Peak Day method, to determine likely day of ovulation based upon daily observations of cervical fluid.MethodsWe recruited 98 women to learn the Peak Day method from a brochure, 26 of whom concurrently used the method with blinded daily urine hormone monitoring (estrone glucuronide and luteinizing hormone). All women were instructed to complete an exposure questionnaire immediately upon identifying ovulation. Briefly, the exposure questionnaire captured time-varying and transient exposures such as medication use, water consumption, and amount of sleep. We assessed timely completion of the exposure questionnaire, agreement of women’s estimated day of ovulation (EDO) and the EDO by expert review, and agreement between the EDO by expert review and by blinded urine monitoring.ResultsOf 147 cycles evaluated, women selected an EDO in 130 (88%) and subsequently completed the periovulatory exposure questionnaire in 122 (94%) cycles. Of the 26 cycles evaluated with blinded hormonal monitoring, the Peak Day “best quality” algorithm, based upon cervical fluid, identified ovulation ± 3 days of the urine monitor in 24 cycles (92%).ConclusionsWith simple written instructions, women can identify an estimated day of ovulation and perform periovulatory exposure assessment. The Peak Day method is highly cost-effective and could be applied by researchers to target periconceptional or very early developmental stage exposure assessment.
Highlights
Transient exposures may influence fertility and early embryonic development
We report on the pilot testing and validation of a basic written brochure for a streamlined, prospective method to identify the fecund window and likely day of ovulation based upon self-observation of changes in cervical fluid, with an option for additional use of basal body temperature
Of the total consented population, 10 women became pregnant before beginning to chart and 14 women had one or more uninformative cycles (n = 30 cycles) due to medical issues or incomplete charts (n = 4 cycles), leaving 58 women contributing a total of 147 cycles for analysis
Summary
Transient exposures may influence fertility and early embryonic development. To assess the time of conception in vivo and conduct concurrent biomonitoring, ovulation must be identified prospectively. Environmental contamination by endocrine disrupting chemicals or mutagens during the fetal period affects virtually all organ systems in fetal development and throughout subsequent life [3,4,5]. The mechanism for such action may be that environmental exposures affect cellular stress, hormone regulation, or metabolic pathways leading to epigenetic changes in the organism [3]. Determining ovulation dates can identify precise time intervals between ovulation, conception, implantation, and subsequent development and would allow for targeted exposure assessment during the relevant developmental windows, such as fertilization and implantation [8,9,10]
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