Fertility Awareness · Methods

Detection of ovulation, a review of currently available methods

Su HW, Yi YC, Wei TY, Chang TC, Cheng CM

Published September 2017 Bioengineering & translational medicine, 2(3), 238-246
DOI 10.1002/btm2.10058 PMID 29313033 PMC PMC5689497

RRM Academy Synopsis

Serial ultrasound is the standard reference for detecting ovulation

A 2017 literature review of ways to detect ovulation finds that transvaginal ultrasound is the reference standard for finding when ovulation occurs. The authors compare urine hormone tests, temperature charts, cervical mucus and saliva with it. They suggest that several methods may be combined in one small device.

Key Findings

  • Repeated transvaginal scans place ovulation between the follicle's largest size and its collapse. The authors call the examination invasive, expensive and inconvenient.
  • A 2015 Cochrane review of 3 RCTs (n = 1,370) linked urinary hormone monitoring for timed intercourse with a higher pregnancy rate (relative risk 1.36, 95% CI 1.06–1.73).
  • Luteinized unruptured follicle syndrome, with a normal luteinizing hormone (LH) surge and menstruation but no egg released, was reported in 10.7% of cycles among normally fertile women.
  • In one large study, mucus-based timing of expected ovulation correlated with ultrasound-detected ovulation within  ± 1 day in 160/215 cycles (74.4%).
  • One study of women using the symptothermal method for contraception, which combines basal body temperature with cervical mucus, found an unintended pregnancy rate of 1.8%.

Interpretation

The paper is a literature review of methods for women who plan conception or practice contraception. The review reports figures from separate studies that compared methods with ultrasound or another reference test. The authors note that previous research used small samples and an inconsistent standard reference to true ovulation. Most studies enrolled fewer than 100 women and fewer than 1,000 cycles, mostly in Europe, and fewer studies included women with irregular menstruation.

RRM Context

Restorative reproductive medicine (RRM) treats the ovulatory cycle as a vital sign. Fertility awareness-based methods, such as the symptothermal method, follow that cycle each day through temperature and mucus. Serial ultrasound shows when a follicle ruptures. Some cycles release no egg, and RRM evaluates ovulation itself when conception is delayed.

Abstract

The ability to identify the precise time of ovulation is important for women who want to plan conception or practice contraception. Here, we review the current literature on various methods for detecting ovulation including a review of point-of-care device technology. We incorporate an examination of methods to detect ovulation that have been developed and practiced for decades and analyze the indications and limitations of each-transvaginal ultrasonography, urinary luteinizing hormone detection, serum progesterone and urinary pregnanediol 3-glucuronide detection, urinary follicular stimulating hormone detection, basal body temperature monitoring, and cervical mucus and salivary ferning analysis. Some point-of-care ovulation detection devices have been developed and commercialized based on these methods, however previous research was limited by small sample size and an inconsistent standard reference to true ovulation.

Topics

Related research

Fertility Awareness › Methods › Sympto-Thermal Method · Diagnostics › Cycle Biomarkers › Ovulation Detection · Menstrual Cycle › Cycle Biomarkers › Hormonal Markers
Hsiu-Wei Su, Yu-Chiao Yi, Ting-Yen Wei, Ting-Chang Chang, Chao-Min Cheng
H Su, Y Yi, T Wei, T Chang, C Cheng
PMID 29313033 29313033 DOI 10.1002/btm2.10058 10.1002/btm2.10058 Su et al. 2017, Su 2017