Comparison of woman-picked, expert-picked, and computer-picked Peak Day of cervical mucus with blinded urine luteinising hormone surge for concurrent identification of ovulation
Stanford, J. B., Schliep, K. C., Chang, C. P., O'Sullivan, J. P., & Porucznik, C. A. (2020). Comparison of woman-picked, expert-picked, and computer-picked Peak Day of cervical mucus with blinded urine luteinising hormone surge for concurrent identification of ovulation. Paediatric and Perinatal Epidemiology, 34(2), 105-113. https://doi.org/10.1111/ppe.12642
Stanford JB, Schliep KC, Chang CP, O'Sullivan JP, Porucznik CA. Comparison of woman-picked, expert-picked, and computer-picked Peak Day of cervical mucus with blinded urine luteinising hormone surge for concurrent identification of ovulation. Paediatr Perinat Epidemiol. 2020;34(2):105-113. doi:10.1111/ppe.12642
Stanford, Joseph B., et al. "Comparison of woman-picked, expert-picked, and computer-picked Peak Day of cervical mucus with blinded urine luteinising hormone surge for concurrent identification of ovulation." Paediatric and Perinatal Epidemiology, vol. 34, no. 2, 2020, pp. 105-113.
Department of Family and Preventive Medicine, Office of Cooperative Reproductive Health, Division of Public Health, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, United...
Cervical mucus Peak Day agrees with ovulation in new charting users
In a secondary analysis of a randomized trial of 57 women with proven fertility and no charting experience, the Peak Day fell within 4 days of estimated ovulation in about 9 out of 10 cycles. The women, expert reviewers, and a computer algorithm each picked it from the same mucus charts.
Study at a glance, secondary analysis of a randomized trial of 57 women with proven fertility: Cervical mucus Peak Day agrees with ovulation in new charting users. Source: Stanford JB et al., 2020, PMID 32101336.
Key Findings
Women identified a Peak Day in 117 of 187 cycles (63%), expert reviewers in 185 cycles (99%), and the computer algorithm in all 187 cycles (100%).
Woman-picked Peak Days matched the referent day exactly in 25% of 117 cycles, within ±1 day in 58%, within ±2 days in 84%, and within ±4 days in 92%.
Expert-picked Peak Days fell within ±1 day in 50% and within ±4 days in 90% of cycles; computer-picked Peak Days did so in 47% and 87%.
Weighted kappa indicated substantial agreement for woman-picked (0.71, 95% CI 0.59 to 0.83), expert-picked (0.74, 95% CI 0.66 to 0.83), and computer-picked (0.72, 95% CI 0.63 to 0.81) Peak Days.
The computer-picked Best Quality Day agreed within ±4 days in 74% of cycles, with a weighted kappa of 0.58 (95% CI 0.47 to 0.70), indicating moderate agreement.
Interpretation
The analysis used data from a randomized trial of the Creighton Model FertilityCare System. The trial enrolled women aged 18 to 36 who had proven fertility and no earlier experience observing mucus, and 57 of them contributed 187 complete cycles. A blinded monitor recorded the urine luteinizing hormone surge, and the day after the surge served as the referent for ovulation. In this study the women determined their ovulation from cervical mucus observations only. The authors note that most participants were healthy young women with proven fertility. They call for further work on the instruction that produces high documentation of Peak Days in diverse groups.
RRM Context
Restorative reproductive medicine reads the cycle through its own signs. The Creighton Model FertilityCare System teaches a standard way to observe cervical mucus. The Peak Day marks the estimated day of ovulation. The paper's background calls ovulation a central event of the cycle and irregular or absent ovulation a marker of general health.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
Previous research has demonstrated that women instructed in fertility awareness methods can identify the Peak Day of cervical mucus discharge for each menstrual cycle, and the Peak Day has high agreement with other indicators of the day of ovulation. However, previous studies enrolled experienced users of fertility awareness methods or were not fully blinded.
Objective
To assess the agreement between cervical mucus Peak Day identified by fertile women without prior experience on assessing cervical mucus discharge with the estimated day of ovulation (1 day after urine luteinising hormone surge).
Methods
This study is a secondary analysis of data from a randomised trial of the Creighton Model FertilityCareTM System (CrM), conducted 2003-2006, for women trying to conceive. Women who had no prior experience tracking cervical mucus recorded vulvar observations daily using a standardised assessment of mucus characteristics for up to seven menstrual cycles. Four approaches were used to identify the Peak Day. The referent day was defined as one day after the first identified day of luteinising hormone (LH) surge in the urine, assessed blindly. The percentage of agreement between the Peak Day and the referent day of ovulation was calculated.
Results
Fifty-seven women with 187 complete cycles were included. A Peak Day was identified in 117 (63%) cycles by women, 185 (99%) cycles by experts, and 187 (100%) by computer algorithm. The woman-picked Peak Day was the same as the referent day in 25% of 117 cycles, within ±1 day in 58% of cycles, ±2 days in 84%, ±3 days in 87%, and ±4 days in 92%. The ±1 day and ± 4 days' agreement was 50% and 90% for the expert-picked and 47% and 87% for the computer-picked Peak Day, respectively.
Conclusions
Women's daily tracking of cervical mucus is a low-cost alternative for identifying the estimated day of ovulation.
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