Prediction Of Ovulation Research Articles

Determination of Urinary Luteinizing Hormone for Prediction of Ovulation

Detection of the approximate time of ovulation is important in the in vitro fertilization-embryo transfer programs in order to avoid a possible early surge of luteinizing hormone (LH) before human chorionic gonadotropin administration in the induction of ovulation and for timing of artificial insemination. In the present study correlation between the detection of LH in urine and serum levels (mean +/- SEM) of estradiol greater than 557 +/- 118 pg/ml, progesterone less than 1.9 +/- 0.37 ng/ml and leading follicle diameter greater than 26.2 +/- 1.3 mm (mean +/- SEM) was found. Thus, the prediction of ovulation via detection of urinary LH in urine by a dipstick procedure is a good semiquantitative method, accurate enough, reliable, cheap and acceptable by the women.

Expert Systems for the Prediction of Ovulation: Comparison of an Expert System Shell (Expertech Xi Plus) with a Program Written in a Traditional Language (BASIC)

The use of an expert system shell (EXPERTECH Xi Plus) in the construction of an expert system for the diagnosis of infertility has been evaluated. A module was devised for predicting ovulation from the medical history alone. Two versions of this system were constructed, one using the expert system shell, and the other using QuickBASIC. The two systems have been compared with respect to: (1) ease of construction; (2) ease of knowledge base update; (3) help and explanation facilities; (4) diagnostic accuracy; (5) acceptability to patients and clinicians; (6) user-friendliness and ease of use; (7) use of memory space; and (8) run time. The responses of patients and clinicians were evaluated by questionnaires. The predictions made by the computer systems were compared to the conclusions reached by clinicians and to the "gold standard" of day 21 progesterone. The conclusions of this pilot study are: (1) the construction of this expert system was NOT facilitated by the use of this expert system shell; (2) update of the knowledge base was not facilitated either; (3) the expert system shell offered built-in help and explanation facilities, but as the system increased in complexity these became less useful; (4) after initial adjustment of decision thresholds the diagnostic accuracy of the system equalled that of the clinician; (5) the patient response to computer history-taking was very favorable but much less favorable to computer diagnosis; (6) the clinicians took a positive attitude to computer diagnosis; (7) the systems were easy to use; (8) the expert systems shell required much more memory space and had a much slower response time than the system written in BASIC.

Prediction of ovulation

The purpose of this investigation was to evaluate all available ovulatory diagnostics with respect to sensitivity, specificity, diagnostic specificity (predictive value of a positive test, PVP) and diagnostic sensitivity (predictive value of a negative test, PVN). Twenty-one ovulatory women with more than 3 years of infertility problems were included in the study. PVP and PVN were highest for detection of urinary luteinizing hormone (LH) peak at ovulation (PVP = 90%, PVN = 95%) and for serum-estradiol peak 1 day before ovulation (PVP = 83%, PVN = 97%). The predictive values were lower for all other tests. The PVP (54%) and PVN (90%) were rather low for detection of ovulation with vaginal electric impedance. However, all ovulations were predicted when urinary LH peak and vaginal impedance were combined. Two women were stimulated with human chorionic gonadotropin to investigate a possible connection between the LH peak and the preovulatory vaginal electric impedance. No close connection between them could be demonstrated. Basal body temperature should not be used for the prediction of ovulation (PVP = 25%). We suggest that ovulation should primarily be predicted from the identification of the urinary LH peak and that other methods be supplementary.

New tests for the prediction of ovulation.

With improvements in basic science understanding and technology, it is predictable that within the next decade, more reliable and accurate methods of ovulation prediction will be available. The former may result from the exploration of gonadal peptides and their measurement whereas the latter may result from the ever-increasing resolution of ultrasonographic imaging. The current state of the art in predicting ovulation involves the combination of several of the described techniques (cervical mucus, urinary LH, ultrasonography). Used skillfully together they serve the infertility specialist well.

The accuracy of urinary luteinizing hormone testing in predicting ovulation

Transvaginal ultrasonography and daily urinary luteinizing hormone testing were used to evaluate the accuracy of urinary luteinizing hormone testing in predicting ovulation in 33 spontaneously ovulating women beginning on cycle day 10. Ovulation was confirmed in all patients with luteal phase progesterone levels and endometrial biopsy specimens. The results demonstrated that transvaginal ultrasonography and urinary luteinizing hormone testing detected ovulation in all cycles. However, the onset of urinary luteinizing hormone occurred after follicle rupture was documented by ultrasonography in 9% of the women studied. Thus the question of accuracy of urinary luteinizing hormone testing in prediction contrasted to detection of ovulation is raised. This observation is of importance in patients in whom prediction of ovulation is critical to treatment management. Therefore, an ultrasonographic examination to confirm the presence of an unruptured follicle on the day of onset of urinary luteinizing hormone surge is recommended, particularly in patients failing to conceive after three to six cycles of artificial insemination when the inseminations are timed with the onset of urinary luteinizing hormone surge.

Predicting Ovulation in the Mare on the Basis of Follicular Growth and Serum Oestrone Sulphate and Progesterone Levels

Follicular growth and hormone determinations were used to predict ovulation in the mare. Thirty Finnhorse mares were used for the investigation and 38 oestrous cycles were studied. The mares were examined by rectal palpation and ultrasonography every 6 hours during late oestrus. Daily blood samples were obtained for progesterone and oestrone sulphate determination. The preovulatory follicle grew 3 mm a day up to 2 days before ovulation. The size then remained constant, before diminishing by 2-3 mm during the last 12 hours. The maximal diameter of the follicle was 43 +/- 4 mm. In 89% of the follicles the round shape became more irregular before ovulation. During the last 24 hours before ovulation 37 of 38 follicles were regarded as mature on rectal palpation. The oestrone sulphate level was highest 24-48 hours before ovulation, the first decrease being observed most commonly around ovulation (+/- 1 day). The size of the follicle was the most reliable criterion in the prediction of ovulation.

Inability of sonography to detect imminent ovulation.

Sonographic visualization of the cumulus oophorus or of morphologic alterations in the wall of the dominant follicle have been reported to be reliable signs of imminent ovulation when conventional transabdominal sonography is used. To determine if transvaginal sonography could allow a more frequent and confident prediction of imminent ovulation, we prospectively monitored 22 ovulatory menstrual cycles in four women undergoing artificial insemination and in 13 normally menstruating volunteers. Scanning was done on alternate days in the periovulatory period; a 7.5-MHz transvaginal transducer was used. Despite the improved resolution obtained with transvaginal sonography, confident identification of the cumulus oophorus or of mural changes in the follicle was not possible in any of the cycles followed. No other consistent follicular characteristic predicted imminent ovulation. We conclude that confident prediction of imminent ovulation is not possible with sonographic analysis.

Natural family planning: A review and assessment

This article describes 3 new Natural Family Planning (NFP) methods which have taken the place of the calender rhythm method and reviews the relevant literature. 1) The basal body temperature (BBT) method relies on the womans body temperature (BT) which reflects variations in the progesterone levels during the menstrual cycle. It requires longer periods of abstinence than the other NFP methods because of the uncertainties of determining the timing of ovulation using BT. 2) The cervical mucus method based on changes in the quality and quantity of cervical mucus perceived by women uses their relation to the estrogen level to predict the timing of ovulation. It is relatively easy to learn and is the only NFP method that applies to women of all reproductive categories. 3) The symptothermal method combines the use of mucous symptoms the BBT and 2ndary signs associated with ovulation such as cervical changes abdominal pain intermenstrual bleeding and breast tenderness in its ovulation prediction. A major problem is that different signals of ovulation can sometimes be in conflict. NFP is an educational approach rather than a special technology. Training of teachers is of critical importance. Instruction in group setting is the effective approach. Self-instructional methods of training are inadequate; its users need greater motivation than artificial method users and a shared cooperative approach to family planning by partners is very important. Useful literature on the physiologic basis and psychological impact of NFP are now available for family planning counselors and other health care professionals to assist the continuing growth of both public and private sector NFP programs around the world. While the need exists for systematic research efforts concerning NFP preliminary conclusions indicate that the effectiveness of NFP methods is not as poor as often assumed but that instructional techniques and organization of NFP need further improvement.

Prediction and self-prediction of ovulation in clomiphene citrate-treated patients

We studied 15 infertile patients for a total of 25 cycles in order to compare the predictive value of the following parameters in timing ovulation: basal body temperature (BBT), cervical mucus, serum E 2 and LH, follicular growth as shown by ultrasonography, and urinary LH. The patients themselves tested urinary LH at home using Clearplan kits. BBT had low value as a predictive test for the time of ovulation, whereas ultrasonography had a predictive value of 9%, serum E 2 50%, cervical mucus 59%, serum LH 63.6% and Clearplan kits 63.6%. The best predictive reliability in timing ovulation was obtained by considering both serum LH and E 2 measurements. The Clearplan kits were as reliable as serum LH measurements and have greater practical advantages.

A semiquantitative and rapid radioimmunosorbent assay of luteinizing hormone for early prediction of time of ovulation in cattle

A radioimmunoassay (RIA) for bovine luteinizing hormone (LH) is presented. It is based on the binding of the second antibody to polystyrene vials. Less than 4 h is required to estimate the hormone level in the plasma. LH content is determined by comparing unknown plasma samples to relevant control plasma to identify the preovulatory LH surge. Of 182 samples, 176 (97%) were found to contain either more or less LH than the control plasma, and 12 out of 13 (92%) LH surges were identified using the immunosorbent RIA. The method can be used for early prediction of ovulation in cattle, and it may be used to time aspiration of oocytes.

In vitro fertilization, GIFT and related technologies--hope in a test tube.

In vitro fertilization (IVF) is demanding, expensive and inefficient. Nevertheless, tens of thousands of couples have undertaken the procedure because of their intense desire to have a biological child. Modifications of the current IVF process--simplification of ovulation induction and prediction of successful cycles; use of ultrasound instead of laparoscopy for egg retrieval; freezing of excess embryos for later replacement; and the substitution of GIFT (gamete intra-fallopian transfer) for IVF when it is indicated--may increase its acceptability to couples and improve success rates. Meanwhile, IVF has had tremendous impact on our understanding of fertility and should help physicians in their approach to infertility in the future. It has also ushered in a new era of genetic engineering whose potential we have not yet begun to realize.

Physiological mechanisms associated with ovulation prediction using the CUE Ovulation Predictor.

It has been shown that monitoring of salivary electrical resistance (SR) enables prediction of ovulation several days in advance, since a peak in SR is seen 5-6 days before the LH peak. This paper explores physiological mechanisms that may account for this change. The pathway whereby oestrogen stimulates aldosterone (ALDO) secretion acting through the renin-angiotensin system was considered. It is shown that this mechanism would only result in increasing SR as oestrogen values rise during the follicular phase and therefore is not an explanation of the SR peak and declining SR 5-6 days before the LH peak. The reported trend of sodium in milk of ovulating women parallels that of SR. It is shown that these changes are most likely to be due to a similar change in aldosterone levels. A possible role for adrenocorticotrophic hormone (ACTH) in causing the changes in aldosterone is discussed and supported with data from other independent studies as well as with preliminary data obtained from two normally ovulating subjects. Peaks in ACTH, ALDO and SR were coincidental and occurred 6 days before the LH peak. The temporal relationship observed among these variables suggest that ACTH, by affecting ALDO, modifies salivary electrolytes and hence SR.

Ovulation prediction and detection with the CUE Ovulation Predictor.

Predicting ovulation is useful for managing the infertile patient and when done sufficiently in advance for fertility regulation by periodic abstinence. It has been reported that ovulation could be predicted by measurement of salivary and vaginal electrical resistance (SR and VR). These data from 32 menstrual cycles of 23 women were obtained to evaluate this technique. Data of 14 cycles were from subjects receiving clomiphene citrate (CC), while the others were from spontaneously ovulating subjects. A peak in SR was seen 5-7 days before the day of the LH peak in both natural and CC cycles. A correlation coefficient (r) of 0.94 was seen for the day of the SR peak and that of the LH peak. The SR trend was similar in both natural and CC cycles. VR in spontaneous cycles declined to a periovulatory nadir and then increased. The patterns of VR in CC cycles were similar except that values were initially depressed during and shortly after the end of CC therapy. Over 90% of VR increases were on the day of the LH peak and the day following. Results indicate that the method is useful for predicting ovulation in natural and CC cycles. Since the number of days by which ovulation is predicted exceeds the expected lifespan of spermatozoa in the female reproductive tract, the method also shows potential for use in natural family planning.

The prediction of ovulation and monitoring of the fertile period.

Simple and reliable methods have been sought for both predicting and confirming ovulation. Application of these methods could include management of infertile couples to aid in conception and for increasing the reliability of natural family planning (NFP) as a method of birth control. With the advent of specific hormone assays, serial measurements of estrogens, progesterone (and metabolites), and luteinizing hormone have been the gold standard of monitoring ovarian function in women. However, newer and simpler methodologies have been described and are currently either in use or being tested. These include the measurement of basal body temperature (BBT), the evaluation of the volume, consistency and electro-conductivity of cervicovaginal fluid, salivary steroid content and cellular enzymatic activity, the use of enzyme-linked immunosorbent assays applied to solid-phase formats, and the investigation of new hormonal molecules as markers of reproductive state and function. These new technologies are described herein and their potential for monitoring ovarian function is discussed.

Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate

This study was undertaken to evaluate the usefulness of measuring salivary and vaginal electrical resistance in monitoring ovulation induced by clomiphene citrate (CC). Data from 28 cycles of 12 women treated with CC were compared with those of 18 cycles of 13 women who were ovulating spontaneously. Patterns of salivary readings in CC and spontaneous cycles were similar and showed a preovulatory peak 6.2 (mean) days before the luteinizing hormone peak. The trend in vaginal readings for CC cycles differed from that of spontaneous ovulations in that the values were depressed during and shortly after CC therapy. Occurrence of the periovulatory nadir and subsequent rise was common to both groups. The rise in vaginal readings CC cycles occurred within 24 hours of the luteinizing hormone peak in 88% of cases. Retrospective analysis showed that, based on this method, artificial insemination would have been timed appropriately in 25 of 27 cycles or in every cycle, depending on the protocol used. The results indicate that the method is equally useful for predicting and confirming ovulation in cycles in which CC was used to induce ovulation as it is in spontaneous cycles.

The reliability of ovulation prediction by a single ultrasonographic follicle measurement.

Since ultrasonographic ovulation detection has been introduced many authors have speculated about the ovulation predictive value of this new technique. Reliable studies in this respect, however, are lacking. The present study describes ultrasonographic data of 158 spontaneously ovulating, infertile patients. Each patient contributed only one cycle to the study. To construct individual follicle growth curves serial follicular measurements were performed. A wide range existed in mean maximum diameters of the preovulatory follicles. Furthermore, the slopes of the follicle growth curves, as well as the durations of the follicle growth phases showed considerable variations. The intrinsic variability in the various characteristics of follicle growth makes a single measurement as accurate as serial measurements in predicting ovulation. A formula has been devised by means of the data of the first 100 women, which correlates follicular diameter with the time interval to ovulation. The formula was developed based on one randomly selected measurement per patient. The validity of the formula has been tested in 58 additional women, also contributing one measurement each. According to this validation the adequacy of the prediction rule was demonstrated. Ultrasound appeared to be a less sensitive method for prediction of ovulation than has been speculated by some investigators. It is, however, an improvement, compared to the prediction of ovulation based upon the length of the previous menstrual cycles. A single follicle measurement may therefore be helpful in timing post-coital tests or artificial inseminations, in addition to being an adjuvant to more reliable methods.

Correlation between the Endocrine Profile of Ovulation and the Ultrasonically Detected ‘Double Contour’ of the Preovulatory Follicle

The exact prediction of ovulation is becoming more important in the management of infertile couples. The routine methods used to monitor ovulation are plasma levels of estradiol and luteinizing hormone, and ultrasonic scanning of graafian follicle diameter. Ovulation is known to occur at a wide range of follicular diameters and it cannot be used as a single predictor of ovulation. In a previous study we described the preovulatory double contour of the dominant follicle occurring a few hours before ovulation. The purpose of this study was to correlate this sign with the hormonal profile to determine whether it can be used as a single parameter in predicting ovulation. The results demonstrate a close relationship between the LH peak and the appearance of the double contour which can be used as a reliable predictor of impending ovulation.

Clinical evaluation of the zona‐free hamster egg penetration test in the management of the infertile couple. Prospective and retrospective studies

Clinical evaluation of the zona‐free hamster egg penetration test in the management of the infertile couple. Prospective and retrospective studies

The prediction and/or detection of ovulation by means of urinary steroid assays

Twenty normally menstruating women volunteered for a study in which plasma samples were collected daily during an entire menstrual cycle. On the same days, samples of morning urine were also collected, as well as random samples of urine voided at the visit to the Outpatient Clinic. Progesterone (P), estradiol (E2) and lutropin (LH) were assayed in plasma, and pregnanediol-3-glucuronide (PdG), estrone-glu-curonide (E1G), estriol-16-glucuronide (E3G), P, and E2 were measured in urine using radioimmunoassays. Progesterone in urine was assayed both with and without preceding chromatography. All urinary glucuronides and progesterone exhibited cyclic patterns similar to those of E2 or P in plasma. Seven-fold increases from early follicular to luteal phase values (for PdG and urinary P; the latter both with and without chromatography), or to peak levels (for E1G and E3G) were observed. The difference between the baseline and peak levels was less distinct (~5-fold) for E2 in urine. The day-to-day coefficient of variation of early follicular phase values decreased from 40 % to 25 % by calculating the ratios of the glucuronides or P to creatinine (C). The peaks of estrogen glucuronides were delayed mostly by 1 day in comparison to the peaks of E2 in plasma. The urinary peaks of estrogens were in most cases more closely clustered around the day of the LH-peak when the measurements were corrected for C.

Prediction and detection of ovulation by the measurement of urinary pregnanetriol-3α-glucuronide. a multicentre study

The urine excretion pattern of pregnanetriol 3α-glucuronide (PT-3G) throughout the menstrual cycle in 26 normal ovulating women was evaluated in a multicentre study. The concentration of PT-3G was measured by radioimmunoassay in daily samples of early morning urine (EMU) from 20 women for three consecutive cycles and from 6 women who conceived during the period of study. PT-3G was also measured in 24-h urine samples from 5 additional women. The peak of urine LH was used as a reference point for ovulation (Day 0). The EMU concentration of PT-3G in the follicular phase of 60 normal ovulatory cycles was 5.10 μmol/l ± 0.11 (arithmetic mean ± SE). The first PT-3G defined rise (CUSUM analysis) occurred during the late follicular phase (Days -3 to 0) with a PT-3G maximum excretion (9.69 μmol/1 ± 0.55) on Day 0, whereas a PT-3G excretion peak occurred during mid-luteal phase (Days + 5 to + 9). The overall PT-3G excretion during the luteal phase (8.06 μmol/l ± 0.17) was significantly higher than that of the follicular phase ( P < 0.001). A further sustained increase in PT-3G excretion was noted after day +11 in the conceptional cycles. The 24-h excretion profile of PT-3G was similar to that obtained in EMU samples. No inter-centre significant variation was noticed in terms of PT-3G concentration values. The results were interpreted as demonstrating that the PT-3G excretion profile throughout the cycle exhibits a close resemblance to that of serum 17-OH progesterone. The data also indicates that although the immunoanalytical measurement of this urine steroid metabolite does not give an early sign for the occurrence of ovulation, it can be used for both the immediate prediction and the detection of ovulation.