Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women

Only 48% of LH surges in ovulating women are single peaks of <5 days. The variants are associated with significant differences in follicle size and hormone levels. Authors:
Ana Direito, M.D., Sébastien Bailly, M.Sc., Aude Mariani, M.D., René Ecochard, M.D., Ph.D

Volume 99, Issue 1, Pages 279-285.e3, January 2013


To describe the LH surge variants in ovulating women and analyze their relationship with the day of ovulation and other hormone levels.

Secondary analysis of a prospective cohort observational study.

Eight natural family planning clinics.

Normally fertile women (n = 107) over 283 cycles.

Women collected daily first morning urine, charted basal body temperature and cervical mucus discharge, and underwent serial ovarian ultrasound.

Main Outcome Measure(s):
Urinary LH, FSH, estrone-3-glucuronide (E3G), pregnanediol-3α-glucuronide (PDG), and day of ovulation by ultrasound (US-DO).

Individual LH surges were extremely variable in configuration, amplitude, and duration. The study also showed that LH surges marked by several peaks were associated with statistically significant smaller follicle sizes before rupture and lower LH level on the day of ovulation. LH surges lasting >3 days after ovulation were associated with a lower E3G before ovulation, a smaller corpus luteum 2 days after ovulation, and a lower PDG value during the first 4 days after ovulation.

In clinical practice, LH profiles should be compared with the range of profiles observed in normally fertile cycles, not with the mean profile.

  • JBS

    I congratulate the authors on an important article. They state that “prolonged LH surges were associated with: 1) lower E3G levels during the 5 days preceding USDO; 2) lower PDG levels during the 4 days after US-DO; and 3) a smaller corpus luteum 2 days after US-DO.” However, supplemental Table 2 gives only the maximum follicle diameter. Was the corpus luteum size also measured?

  • Congratulations on this worthy manuscript. I think this report provides key information about the diversity of LH surges. Two issues can be drawn from this interesting study; the first one is that the LH surge variants should be taken into account at the time of triggering ovulation after ovarian stimulation. We can ask, What is the importance of those patterns of spontaneous LH surges in the function or maturation of the oocyte?. The second issue is the relationship between the different LH surges variants and the window of implantation. Finally, I fully agree with the authors that the study would be more valuable if the LH surge variants were related to conception.

Translate »