Chronological aspects of ultrasonic, hormonal, and other indirect indices of ovulation

Abstract

Objective To improve prediction of ovulation in normal cycles. Design Collection of women's characteristics and their menstrual cycles. Monitoring and analysis of time relationships between several indicators of ovulation: transvaginal ultrasonography, cervical mucus, basal body temperature, urinary luteinising hormone, and ratio of urinary oestrogen to progesterone metabolites. Setting Each of eight natural family planning clinics was to study 12 women for at least three cycles.Population One hundred and seven normally fertile and cycling women aged 18 to 45. Methods Daily measurements of urinary luteinising hormone, follicle stimulating hormone, oestrone-3-glucuronide and pregnanediol-3a -glucuronide. Basal body temperature recording and cervical mucus checking.Transvaginal ultrasound examination of the ovaries.Main outcome measures Delays between the expected day of ovulation according to the luteinising hormone peak or to ultrasound evidence and the expected days according to the other indices of ovulation.Results Ultrasonography was able to show evidence of ovulation in 283 out of 326 cycles. The average time lag between luteinising hormone peak and ultrasound evidence was less than one day (10.46) but premature and late luteinising hormone-expected date of ovulation were observed in nearly 10% and 23% of cycles, respectively. Basal body temperature rise was observed in 98% of cycles. Cervical mucus peak symptom, rapid drop in the ratio of urinary metabolites, and luteinising hormone initial rise were all close to ultrasonographic evidence in more than 72% of cycles.Conclusions For accuracy and practical reasons, the cervical mucus peak symptom, the ratio of urinary metabolites and luteinising hormone initial rise might be better indices of ovulation than the luteinising hormone peak.

Comparison of two isometric handgrip protocols on sympathetic arousal in women

“…Although the women in this study reported a regular menstrual cycle, anovulatory cycles are not uncommon in the college-aged females and they often go undetected. For example, in a recent study of college aged women, 26.9% of the female undergraduates had anovulatory cycles [44]; this proportion is similar to an earlier study that employed different methods to identify the ovulation point [45]. …”

Assessment of anovulation in eumenorrheic women: comparison of ovulation detection algorithms

“…Transvaginal ultrasound, the gold-standard (10), involves daily, mid-cycle ultrasounds, which is resource intensive and thus impractical in epidemiological studies. In the absence of gold standard methods, daily or multiple well-timed measurements of reproductive hormone concentrations are commonly used to identify ovulatory status in research settings.…”

Pilot test and validation of the Peak Day method of prospective determination of ovulation against a handheld urine hormone monitor

“…Based on the available evidence, it has been proposed that using symptom biomarkers for ovulation may prove as accurate and effective as using hormonal biomarkers, at a much more cost effective ratio for large population-based studies [14,27]. Basal body temperature (BBT) rises soon after ovulation and is well correlated with the estimated day of ovulation (EDO) based on gold standard markers (including follicular ultrasound and serum hormonal measures), but cannot prospectively identify when ovulation is imminent [28]. Cervical fluid secretion increases greatly in quantity and changes in quality in the days preceding ovulation, resulting in characteristic changes that women can observe, changes that are also well correlated with gold standards for the EDO [28-30].…”

“…Basal body temperature (BBT) rises soon after ovulation and is well correlated with the estimated day of ovulation (EDO) based on gold standard markers (including follicular ultrasound and serum hormonal measures), but cannot prospectively identify when ovulation is imminent [28]. Cervical fluid secretion increases greatly in quantity and changes in quality in the days preceding ovulation, resulting in characteristic changes that women can observe, changes that are also well correlated with gold standards for the EDO [28-30]. Because cervical fluid changes are necessary for sperm survival, they also accurately identify both the beginning and end of the fecund window (commonly called the fertile window), or the days when conception is most likely to occur [31,32].…”