Assessment of anovulation in eumenorrheic women Comparison of ovulation detection algorithms

Capsule:
Anovulation prevalence among eumenorrheic women varies greatly by algorithm. Urinary LH surge algorithms, such as used in fertility monitors, identified more anovulatory cycles compared with methods utilizing serum P.

Authors:
Kristine L. Lynch, Ph.D., Sunni L, Mumford, Ph.D., Karen C. Schliep, Ph.D., Brian W. Whitcomb, Ph.D., Shvetha M. Zarek, M.D., Anna Z. Pollack, Ph.D., Elizabeth R. Bertone-Johnson, Sc.D., Michelle Danaher, Ph.D., Jean Wactawski-Wende, Ph.D., Audrey J. Gaskins, B.S.E., Enrique F. Schisterman, Ph.D.

Volume 102, Issue 2, Pages 511–518.e2

Abstract:

Objective:
To compare previously used algorithms to identify anovulatory menstrual cycles in women self-reporting regular menses.

Design:
Prospective cohort study.

Setting:
Western New York.

Patient(s):
Two hundred fifty-nine healthy, regularly menstruating women followed for one (n = 9) or two (n = 250) menstrual cycles (2005–2007).

Intervention(s):
None.

Main Outcome Measure(s):
Prevalence of sporadic anovulatory cycles identified using 11 previously defined algorithms that use E2, P, and LH concentrations.

Result(s):
Algorithms based on serum LH, E2, and P levels detected a prevalence of anovulation across the study period of 5.5%–12.8% (concordant classification for 91.7%–97.4% of cycles). The prevalence of anovulatory cycles varied from 3.4% to 18.6% using algorithms based on urinary LH alone or with the primary E2 metabolite, estrone-3-glucuronide, levels.

Conclusion(s):
The prevalence of anovulatory cycles among healthy women varied by algorithm. Mid-cycle LH surge urine-based algorithms used in over-the-counter fertility monitors tended to classify a higher proportion of anovulatory cycles compared with luteal-phase P serum-based algorithms. Our study demonstrates that algorithms based on the LH surge, or in conjunction with estrone-3-glucuronide, potentially estimate a higher percentage of anovulatory episodes. Addition of measurements of postovulatory serum P or urine pregnanediol may aid in detecting ovulation.

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