Urinary Luteinizing Hormone Testing Research Articles

Natural cycle versus modified natural cycle for endometrial preparation in women undergoing frozen-thawed embryo transfer: An RCT.

Studies have evaluated different endometrial preparation methods, but the optimal frozen-thawed embryo transfer (FET) cycle strategy in terms of the in-vitro fertilization outcome is still debated. To compare the natural versus modified natural cycles for endometrial preparation in women undergoing FET. This study was designed as a randomized clinical trial, and it was performed at the Arash women's hospital between August 2016-2018. Hundred and forty eligible participants were enrolled in this study and were randomly divided into 2 groups by using the block randomization method, including true natural FET (n = 70) and modified natural FET (mNFET) (n = 70) cycles. Both groups were monitored for endometrial thickness and follicular size; simultaneously spontaneous luteinizing hormone surge using urinary luteinizing hormone testing kits. The mNFET group received 5000 IU of human chorionic gonadotropin injection to trigger final follicular maturation. Luteal support by vaginal progesterone (cyclogest 400 mg twice daily) was used in true natural FET from the day of transfer until the 10 wk of pregnancy. Chemical and clinical pregnancy and abortion rates were considered as the primary outcomes. There were no differences in the participants' baseline characteristics between groups. There was no difference in clinical pregnancy and abortion rate between groups, while the implantation rate was significantly higher in the mNFET group (29.2% vs. 17.6%; p = 0.036). The results demonstrated that both types of natural cycles were similar in pregnancy outcomes, while modified cycles might be associated with a higher implantation rate.

259 Tracking naturalistic sleep over the menstrual cycle with a wearable in healthy young women

Abstract Introduction A woman’s menstrual cycle is characterized by hormonal changes that might affect sleep and therefore daily functionality. While some studies using self-reports have shown a lower sleep quality in the peri-menstruation phase, objective – in lab – studies have not found significant differences in sleep continuity during the menstrual cycle, but are limited by only a few recordings across the cycle. The aim of this study is to examine changes in sleep during the healthy menstrual cycle using a multi-sensory wearable, allowing continuous, objective, reliable and ecologically valid measurement. Methods 12 healthy young women (28.14 ± 2.33) were monitored using Oura ring – a sleep and activity tracker – during an entire menstrual cycle. Participants also reported mood, readiness, and sleep quality using a diary. Four phases of the menstrual cycle were compared (menstruation, periovulation, mid-luteal, and late-luteal). Ovulation day was determined using a urinary luteinizing hormone test. Results Ovulatory cycles were confirmed by the Oura ring, which showed a significant increase in average nocturnal heart rate and skin temperature during the post-ovulatory luteal phase relative to menstruation and periovulation. Oura ring measures of sleep continuity (Sleep Onset Latency, Wake After Sleep Onset) and self-reported sleep quality did not change across the 4 menstrual phases. We observed a trend for objective sleep duration, which tended to be shorter in the mid-luteal and late-luteal phases. We also observed a small reduction in perceived readiness and mood during these two phases. Conclusion Physiological changes (increase in heart rate and body temperature) in the postovulatory phase of the menstrual cycle are detectable with the Oura ring. Sleep features remain quite stable during the healthy, ovulatory menstrual cycle, apart from a trend for slightly shorter sleep duration in the post-ovulatory phases. In comparison to self-reports, which rely on retrospective memory and might be biased by perception and mood, wearable technologies seem to be a sensitive and informative tool to track sleep and physiological changes during the menstrual cycle. Support (if any) Supported by RF1AG061355 (Baker/Mednick)

Mid-luteal uterine artery Doppler indices in the prediction of pregnancy outcome in nulliparous women undergoing assisted reproduction

Traditionally, the assessment of endometrial receptivity at transvaginal ultrasound scan has been based on the thickness and the morphological appearance of the endometrium. The objective of this study was to prospectively evaluate endometrial thickness (ET), endometrial morphology and uterine artery Doppler parameters prior to assisted reproduction treatment (ART) in the prediction of pregnancy outcome. This was a prospective cohort study. ET, morphology and uterine artery Doppler (UtAD) pulsatility index (PI) and resistance index (RI) were measured in the mid-luteal stage of the menstrual cycle ultrasonographically, timed with urinary luteinizing hormone testing. A total of 50 women were included in the analysis. The clinical pregnancy rate (CPR) per embryo transfer was 42.0% (n = 21/50). Twenty nine women (58.0%) had an unsuccessful outcome. There were no differences in mean ± SD endometrial thickness (ET) (10.0 ± 1.8 mm vs. 10.5 ± 2.4; p = 0.43), or endometrial morphology (100% (n = 21) vs 100% (n = 29); p = 1.00) between the pregnant and not pregnant groups. Similarly, there were no differences in mean ± SD UtAD PI (2.17 ± 0.83 vs. 2.07 ± 0.81; p = 0.67 or mean ± SD UtAD RI (0.84 ± 0.10 vs. 0.81 ± 0.10; p = 0.30). Ultrasonographic endometrial assessment did not differentiate between those who would have a subsequent clinical pregnancy.

Innovative Trial Design Using Digital Approaches: An Example From Reproductive Medicine [21I

INTRODUCTION: Loss to follow-up and missing data are common reasons why clinical studies fail. In a site-less digital clinical trial we assessed the accuracy of a wearable fertility tracker, where we examined participants’ retention, compliance, and satisfaction with the site-less design. METHODS: In this IRB approved study, participants were recruited remotely through social media, online platforms, and email invitations. Participants wore the Ava Fertility Tracker for up to 6 menstrual cycles, took body temperature and urinary luteinizing hormone tests. We collected all self-reported outcomes and wearable device data via a mobile app, wherein the study coordinator could monitor compliance and send participation reminders. An independent customer support team provided technical support. Participants gave input on the site-less study design via an online survey. RESULTS: Fifty-six Swiss women completed the satisfaction survey (85% of the 66 enrolled study participants), rating their experience with social media recruitment (83%), online registration (98%) and online invitations (98%) as good or very good. Almost two-thirds of respondents considered the trial design easy to integrate into their everyday life. Most participants were highly satisfied with the technical support (78%), while 98% reported the study coordinator’s remote support as very helpful. CONCLUSION: Our predominantly digital approach resulted in high rates of completion (92%) and procedural compliance (87%), while maintaining participant satisfaction. This suggests site-less designs in reproductive health research could increase the quality and quantity of clinical data collected while minimizing participation burden. Future replication studies with longer follow-up times should consider whether the sampled population is biased towards digital natives.

Wearable Sensors Reveal Menses-Driven Changes in Physiology and Enable Prediction of the Fertile Window: Observational Study.

BackgroundPrevious research examining physiological changes across the menstrual cycle has considered biological responses to shifting hormones in isolation. Clinical studies, for example, have shown that women’s nightly basal body temperature increases from 0.28 to 0.56 ˚C following postovulation progesterone production. Women’s resting pulse rate, respiratory rate, and heart rate variability (HRV) are similarly elevated in the luteal phase, whereas skin perfusion decreases significantly following the fertile window’s closing. Past research probed only 1 or 2 of these physiological features in a given study, requiring participants to come to a laboratory or hospital clinic multiple times throughout their cycle. Although initially designed for recreational purposes, wearable technology could enable more ambulatory studies of physiological changes across the menstrual cycle. Early research suggests that wearables can detect phase-based shifts in pulse rate and wrist skin temperature (WST). To date, previous work has studied these features separately, with the ability of wearables to accurately pinpoint the fertile window using multiple physiological parameters simultaneously yet unknown.ObjectiveIn this study, we probed what phase-based differences a wearable bracelet could detect in users’ WST, heart rate, HRV, respiratory rate, and skin perfusion. Drawing on insight from artificial intelligence and machine learning, we then sought to develop an algorithm that could identify the fertile window in real time.MethodsWe conducted a prospective longitudinal study, recruiting 237 conception-seeking Swiss women. Participants wore the Ava bracelet (Ava AG) nightly while sleeping for up to a year or until they became pregnant. In addition to syncing the device to the corresponding smartphone app daily, women also completed an electronic diary about their activities in the past 24 hours. Finally, women took a urinary luteinizing hormone test at several points in a given cycle to determine the close of the fertile window. We assessed phase-based changes in physiological parameters using cross-classified mixed-effects models with random intercepts and random slopes. We then trained a machine learning algorithm to recognize the fertile window.ResultsWe have demonstrated that wearable technology can detect significant, concurrent phase-based shifts in WST, heart rate, and respiratory rate (all P<.001). HRV and skin perfusion similarly varied across the menstrual cycle (all P<.05), although these effects only trended toward significance following a Bonferroni correction to maintain a family-wise alpha level. Our findings were robust to daily, individual, and cycle-level covariates. Furthermore, we developed a machine learning algorithm that can detect the fertile window with 90% accuracy (95% CI 0.89 to 0.92).ConclusionsOur contributions highlight the impact of artificial intelligence and machine learning’s integration into health care. By monitoring numerous physiological parameters simultaneously, wearable technology uniquely improves upon retrospective methods for fertility awareness and enables the first real-time predictive model of ovulation.

Corrigendum: Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?

[This corrects the article DOI: 10.3389/fpubh.2017.00320.].

Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?

To study the best possible luteinizing hormone (LH) threshold to predict ovulation within the 24, 48, and 72 h. Observational study. Multicenter collaborative study. A total of 107 women. Women collected daily first morning urine for hormonal assessment and underwent serial ovarian ultrasound. This is a secondary analysis of 283 cycles. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were estimated for varying ranges of LH thresholds. Receiver operating characteristic curves and cost-benefit ratios were used to estimate the best thresholds to predict ovulation. The best scenario to predict ovulation at random was within 24 h after the first single positive test. The false-positive rate was found to increase as (1) the cycle progressed or (2) two or three consecutive tests were used, or (3) ovulation was predicted within 48 or 72 h. Testing earlier in the cycle increases the predictive value of the test. The ideal thresholds to predict ovulation ranged between 25 and 30 mIU/ml with a PPV (50-60%), NPV (98%), LR+ (20-30), and LR- (0.5). At least, one day with LH ≥25 mIU/ml followed by three negatives (LH <25) occurred before ovulation in 31% of all cycles. When used throughout the cycle and evaluated together, peak-fertility type mucus with a positive LH test ≥25 mIU/ml provides a higher specificity than either mucus or LH testing alone (97-99 vs. 77-95 vs. 91%, respectively). We identified that beginning LH testing earlier in the cycle (day 7) with a threshold of 25-30 mIU/ml may present the best predictive value for ovulation within 24 h. However, prediction by LH testing alone may be affected negatively by several confounding factors so LH testing alone should not be used to define the end of the fertile window. Complementary markers should be further investigated to predict ovulation and identify the fertile window. The use of the peak cervical mucus along with an LH test may provide a higher specificity and predictive value than either of them alone. We recommend that manufacturers disclose their tests' threshold to the public.

Women’s emotional and sexual attraction to men across the menstrual cycle

There is ongoing debate about how and why the menstrual cycle affects women’s attraction to men. According to the dual sexuality hypothesis, women form pair-bond relationships with men who provide care but also obtain genetic benefits by biasing mating effort towards men with high-fitness genes during the fertile phase. By contrast, the commitment hypothesis proposes that attachment bonds with primary partners function to strengthen pair-bond relationships by enhancing in-pair attraction at the fertile phase, rather than extrapair attraction. We tested these hypotheses by measuring women’s daily sexual and emotional attraction towards men over the whole menstrual cycle. We employed 1) a urinary luteinizing hormone test to determine the day of ovulation, 2) a 5-part classification of menstrual cycle that identifies a distinct peri-ovulatory phase, and 3) individualized phase identification for each participant. There was a mid-cycle rise in extrapair sexual desire. Women gave and received more care from partners during the menstrual than the mid-cycle phases. Partner’s sexual attractiveness and mutual commitment did not moderate these findings. The results do not support either the dual sexuality or commitment hypotheses, and imply that female self-reported sexual desire is not strictly dependent on cyclic hormonal changes. Our results are more consistent with a recently proposed `spandrel’ hypothesis, positing cycle phase effects as a nonfunctional by-product of raised estradiol. Additionally, we found that, with the date of ovulation estimated by luteinizing hormone tests, 45% of ovulations were misclassified by the backward counting method, which urges caution in interpreting results based on counting methods.

A simple method of extended 8 days course of clomiphene citrate versus 5 days course in an attempt to suppress premature luteinizing hormone surge in an assisted reproductive technology program: A randomized controlled trial

Objective: To determine whether the use of prolonged, 8 days course of clomiphene citrate (CC) versus the standard use of 5 days is an effective method to prevent premature luteinizing hormone (LH) surge in assisted reproductive technology (ART) program. Materials and Methods: Eligible participants were randomized into one of the two treatment groups, In Group A, the patients received CC 100 mg for 5 days from cycle day 3-7 plus human menopausal gonadotropin (hMG), 150-225 IU on alternate days. In Group B, patients received CC 100 mg for 8 days from cycle day 3-10 plus hMG. Cycles were monitored with ultrasound and urinary LH tests only. Results: Two hundred and thirty-eight patients were randomized, but a total of 227 were analyzed. The percentage risk of premature LH surge was similar in both groups with (20% Group A vs. 24% Group B, P = 0.6) and there was no significant difference in live birth and clinical pregnancy rates per initiated cycle between the two groups, 6.4% Group A versus 10.6% in Group B and 12% (a) versus 17% (b), respectively. Cycle cancellation rates were also similar between the two groups, 36% (a) versus 31% (b). Conclusion: The trial shows that prolonged, 8 days course of CC does not suppress premature LH surge in ART program.

Reclaiming fertility awareness methods to inform timed intercourse for HIV serodiscordant couples attempting to conceive.

IntroductionIncreased life expectancy of HIV-positive individuals during recent years has drawn attention to their quality of life, which includes fulfilment of fertility desires. In particular, heterosexual HIV serodiscordant couples constitute a special group for whom the balance between desired pregnancy and the risk of viral transmission should be carefully considered and optimized. Although advanced assisted reproductive technologies are available, such treatments are expensive and are often unavailable. Moreover, standard viral load testing and antiretroviral therapy may not be accessible due to structural or individual barriers. To reduce the risk of HIV transmission, a lower cost alternative is timed condomless sex combined with other risk-reduction strategies. However, timed condomless sex requires specific knowledge of how to accurately predict the fertile window in a menstrual cycle. The aim of this study was to summarize inexpensive fertility awareness methods (FAMs) that predict the fertile window and may be useful for counselling HIV-positive couples on lower cost options to conceive.MethodsOriginal English-language research articles were identified by a detailed Medline and Embase search in July 2014. Relevant citations in the included articles were also retrieved.Results and discussionCalendar method, basal body temperature and cervicovaginal mucus secretions are the most accessible and sensitive FAMs, although poor specificity precludes their independent use in ovulation detection. In contrast, urinary luteinizing hormone testing is highly specific but less sensitive, and more expensive. To maximize the chance of conception per cycle, the likelihood of natural conception needs to be assessed with a basic fertility evaluation of both partners and a combination of FAMs should be offered. Adherence to other risk-reduction strategies should also be advised, and timely referral to reproductive medicine specialists is necessary when sub/infertility is suspected.ConclusionsFAMs provide effective, economical and accessible options for HIV serodiscordant couples to conceive while minimizing unnecessary viral exposure. It is important for health care providers to initiate conversations about fertility desires in HIV-positive couples and to educate identified couples on safer conception strategies.

Effects of the levonorgestrel intrauterine system (LNG-IUS) on cervical mucus quality and sperm penetration

OBJECTIVE: No study has shown that changes in cervical mucus prevent sperm penetration in LNG-IUS users. The purpose of this study was to compare the depth of sperm penetration in the mid-cycle cervical mucus of LNG-IUS users to non-users with in-vitro sperm penetration tests using standardized sperm from a single donor; and by performing WHO cervical mucus grading.DESIGN: 20 LNG-IUS users and 20 controls are being enrolled in an investigator-blinded, age-matched, pharmaco-physiologic study.MATERIALS AND METHODS: Cervical mucus assessment at mid-cycle was estimated by home urinary luteinizing hormone tests. Cervical mucus was microscopically examined and graded using WHO criteria. Mucus was incubated with sperm from one standardized donor using both the Kremer Sperm Cervical Mucus Penetration Test (SCMPT) and the WHO Modified Slide Test. Depth of linear penetration of the vanguard sperm, density of penetration and forward motility were assessed microscopically and categorically graded. All parameters were dichotomized and compared using Fisher Chi-Square tests.RESULTS: To date, 46 subjects have been enrolled. Twelve LNG-IUS users and fifteen controls have completed the study. Of users, 20% had cervical mucus analysis grading over 10 (“good”) vs. 71% of controls (p=.02). WHO Modified slide test showed significantly less mucus with penetration by sperm for LNG-IUS users than controls (11% vs. 58%, p=.04). SCMPT demonstrated significantly lower “good/excellent” penetration of cervical mucus by sperm for users vs. controls at 2 and 6 hrs (0% vs. 85% at 2 h, p =.0005; 0% vs 77% at 6 h, p =.002). No cervical mucus from LNG-IUS users had good sperm penetration of mucus.CONCLUSIONS: The quality and sperm penetrability of mid-cycle cervical mucus are significantly less among LNG-IUS users than controls. The high contraceptive efficacy of the LNG-IUS occurs because the local release of levonorgestrel prevents sperm transport through the cervical mucus to the endometrial cavity, and fertilization does not occur. OBJECTIVE: No study has shown that changes in cervical mucus prevent sperm penetration in LNG-IUS users. The purpose of this study was to compare the depth of sperm penetration in the mid-cycle cervical mucus of LNG-IUS users to non-users with in-vitro sperm penetration tests using standardized sperm from a single donor; and by performing WHO cervical mucus grading. DESIGN: 20 LNG-IUS users and 20 controls are being enrolled in an investigator-blinded, age-matched, pharmaco-physiologic study. MATERIALS AND METHODS: Cervical mucus assessment at mid-cycle was estimated by home urinary luteinizing hormone tests. Cervical mucus was microscopically examined and graded using WHO criteria. Mucus was incubated with sperm from one standardized donor using both the Kremer Sperm Cervical Mucus Penetration Test (SCMPT) and the WHO Modified Slide Test. Depth of linear penetration of the vanguard sperm, density of penetration and forward motility were assessed microscopically and categorically graded. All parameters were dichotomized and compared using Fisher Chi-Square tests. RESULTS: To date, 46 subjects have been enrolled. Twelve LNG-IUS users and fifteen controls have completed the study. Of users, 20% had cervical mucus analysis grading over 10 (“good”) vs. 71% of controls (p=.02). WHO Modified slide test showed significantly less mucus with penetration by sperm for LNG-IUS users than controls (11% vs. 58%, p=.04). SCMPT demonstrated significantly lower “good/excellent” penetration of cervical mucus by sperm for users vs. controls at 2 and 6 hrs (0% vs. 85% at 2 h, p =.0005; 0% vs 77% at 6 h, p =.002). No cervical mucus from LNG-IUS users had good sperm penetration of mucus. CONCLUSIONS: The quality and sperm penetrability of mid-cycle cervical mucus are significantly less among LNG-IUS users than controls. The high contraceptive efficacy of the LNG-IUS occurs because the local release of levonorgestrel prevents sperm transport through the cervical mucus to the endometrial cavity, and fertilization does not occur.

Variations in immunoglobulins and IgA subclasses of human uterine cervical secretions around the time of ovulation.

The quantity and subclass distribution of IgA produced by the human uterine cervix may have a significant impact on the defence against sexually transmitted diseases as well as the regulation of fertility. Cervical mucus was obtained from 15 normal ovulating women around the time of ovulation. The total amounts of secreted IgA (including IgA1 and IgA2), IgG, and IgM were determined by ELISA. IgA was detected at high levels in all samples of cervical mucus. When ovulation was ascertained by daily urinary luteinizing hormone testing, IgA production was maximal 2-3 days before ovulation. Equal proportions of IgA1 and IgA2 were detected in cervical mucus, and 80% of the IgA occurred in the polymeric forms. The increased levels of IgA, the ratios of IgA1 to IgA2, and the predominance of polymeric IgA indicate that much of the IgA in human uterine cervical fluid originates from local production.

The role of bilateral ovarian diathermy by KTP laser in the oligoovulatory patient

Objective: To assess the efficacy of ovarian diathermy in women who respond poorly to clomiphene citrate (CC). Methods: Retrospective analysis of patients who failed to respond to 200 mg of CC and subsquently were treated with KTP laser bilateral ovarian diathermy. Twenty-one patients with a total of 288 cycles were included. Results: The study patients had a mean age of 29.8 ± 5.0 years (n = 21) and a mean body mass index of 35.1 ± 10.0 (n = 20). Each patient had a mean of 10.1 ± 5.1 cycles of CC prediathermy and 3.6 ± 3.7 cycles of CC postdiathermy. For all CC dosages, and including two spontaneous cycles after diathermy that resulted in two pregnancies, there was a significant difference in the number of responsive cycles postdiathermy (24% versus 66%, P = 0.0003). Conception rates per cycle also were significantly different (3% versus 17%, P = 0.0029). Spontaneous abortion rates per pregnancy were higher prediathermy (4/6 versus 2/12, P insignificant). Conclusions: Oligoovulatory patients who respond poorly to CC therapy may benefit from bilateral ovarian diathermy using the KTP laser. A positive midcycle urinary luteinizing hormone test, sonographic evidence of follicular development to 18mm or greater, a midluteal phase serum progesterone of 10ng/mL or greater, and/or spontaneous menses (only in patients with oligomenorrhea) were considered positive responses to CC.

Ultrasound studies of vascular and morphological changes in the human uterus after a positive self-test for the urinary luteinizing hormone surge.

The aim of the study reported here was to establish complementary data for changes in uterine size, echogenicity and vascularity during the menstrual cycle relative to a positive self-test for urinary luteinizing hormone (LH) and day 1 of next menses. Thirteen volunteers (aged 23-32 years) with apparently regular menstrual cycles were recruited from the nursing staff. The plan was to examine all women by transvaginal ultrasonography with colour Doppler imaging on day 11 of the menstrual cycle. A urinary LH self-test was to be used daily until a positive result was obtained and the women were to be re-scanned daily until the dominant follicle had ruptured. All women were then to be scanned at least every 48 h (within +/- 2 h of the same time of day) until day 6 of the next menstrual cycle. Matched samples of peripheral blood were taken at the time of each scan for hormone analysis. The main outcome measures were the times of follicular rupture, a positive test result for urinary LH and the start of menses, uterine volume, cavity length, endometrial thickness and grade, pulsatility index (PI), and time-averaged and peak systolic maximum velocities in uterine and radial arteries and in subendometrial vessels. Nine women fulfilled the criteria for an ovulatory cycle, and seven provided data over the complete study. The principal changes relative to a positive urinary LH test were (i) a continued rise in endometrial thickness to days 3 and 4 (this index then remained relatively constant, but the layered appearance was lost) and (ii) a gradual decrease in the uterine arterial PI. There was a significant rise in uterine volume, cavity length and uterine arterial PI around the time of the next menses, and a fall in endometrial thickness and blood velocity in the uterine and radial arteries and subendometrial vessels. The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation or menstruation.

Reliability of home urinary LH tests for timing of insemination: a consumer's study.

In this study, intrauterine insemination (IUI) was timed either after the detection of a urinary luteinizing hormone (LH) surge at home by the patient (group A), or following a positive LH test as interpreted by the gynaecologist (group B). Afterwards, samples tested by the patient were retested by the gynaecologist and vice versa. The gynaecologist also rechecked his own findings and the results were correlated with ultrasound data and charts of basal body temperature. Forty-seven cycles were evaluated. The patient's and the gynaecologist's readings agreed (+/- 12 h) in 42 of the cases (89%), and in five cycles (11%) a difference greater than 24 h was found. The intra-observer variation in the gynaecologist's results was +/- 12 h in four cycles (8.5%). These findings suggest that the LH test can be used as a reliable home device for the prediction of pending ovulation and timing of IUI.

Reliability of urinary LH testing for planning of endometrial biopsies

A rapid urinary luteinizing hormone (LH) test was used to plan a late luteal phase endometrial biopsy from 20 women undergoing an infertility evaluation. Histologic dating was correlated with the day of urinary LH surge detection, the day of the basal body temperature (BBT) nadir, and the onset of the next menstrual period (NMP). From 17 interpretable specimens, histologic dating correlated well with the day of the biopsy as determined following a positive LH test detection ( P = 0.079). No correlation was found following the BBT shift ( P = 0.65), and it was significantly correlated with the NMP ( P = 0.016). Moreover, the urinary LH test showed to be the best method to predict the onset of the NMP. These findings confirm urinary LH testing as a valuable adjunct in the investigation of luteal phase disorders.

Overview and issues in ovulation prediction

Recent advances in our understanding of the physiology of reproduction have led to the ready availability of tests that allow women to self-monitor their fertility potential. Home pregnancy tests were the first to be marketed to the general public. Shortly thereafter, urinary luteinizing hormone tests also became available. In the privacy of her own home, a woman can now comfortably monitor for impending ovulation; by the time of her expected menstrual period, she can identify whether or not she is pregnant. However, there remains a great need for the development of further tests that women can use to identify the days of her cycle on which sexual intercourse is likely to result in pregnancy.

A controlled study of human chorionic gonadotrophin induced ovulation versus urinary luteinizing hormone surge for timing of intrauterine insemination

Forty-eight patients in a programme of intrauterine insemination (IUI) were randomized in a cross-over study. All were stimulated with clomiphene citrate (CC) and inseminated either after follicular rupture induced by human chorionic gonadotrophin (HCG) or after a spontaneous urinary luteinizing hormone (LH) surge. The HCG was administered when follicles of 18-22 mm in diameter were observed on ultrasound and IUI was performed 37-40 h thereafter. The monitoring of a urinary LH peak was carried out using a rapid urinary LH test. IUI took place approximately 22 h after detection of the LH surge. Overall, the pregnancy rates were 9.3% (4/43) after HCG induced ovulation and 20.5% (9/44) after spontaneous ovulation (P = 0.12). Analysis of mid-cycle events showed that following sonographic criteria, the HCG injection was performed significantly earlier in the cycle compared with the spontaneous LH surge. In addition, the mean diameter of the preovulatory follicles was significantly smaller and insemination was substantially earlier in the HCG induced cycles. These findings suggest that a beneficial effect arises from allowing the natural process of final follicular maturation to occur.

Urinary luteinizing hormone testing and prediction of ovulation in spontaneous, clomiphene citrate and human menopausal gonadotropin-stimulated cycles. A clinical evaluation

A urinary luteinizing hormone test was utilized to predict ovulation in 99 spontaneous, 122 clomiphene citrate, and 82 human menopausal gonadotropin stimulated cycles. Tests were performed in early morning and evening specimens and follicular development was monitored by daily ultrasonography. A positive detection rate of 98, 97, and 94%, respectively, was obtained. Evidence of luteinized unruptured follicles was seen more frequently in stimulated cycles, concurring with negative test results. In 2 spontaneous, 1 clomiphene citrate and 5 hMG induced cycles two distinct LH surges were detected concomitant with a pattern of follicular atresia and subsequent new follicular development. Most ovulations occurred between 16 and 28 h after LH detection, significantly earlier in spontaneous than in clomiphene citrate stimulated cycles (p less than 0.02), whereas pre-ovulatory follicles were larger in the clomiphene citrate group (p less than 0.001). The mean duration of the follicular and luteal phases, as calculated from the LH peak, was substantially shorter in the hMG cycles than in the other two groups (p less than 0.001).

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.