Direito, A., Bailly, S., Mariani, A., & Ecochard, R. (2013). Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2012.08.047
Direito A, Bailly S, Mariani A, Ecochard R. Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women. Fertility and sterility. 2013. doi:10.1016/j.fertnstert.2012.08.047
Direito, Ana, et al. "Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women." Fertility and sterility, 2013.
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Laboratoire de Biométrie et Biologie Evolutive03skt0t88
The LH surge varies widely in shape and length in healthy women
Among 107 normally fertile women, the LH surge before ovulation varied widely in shape, size, and length, a secondary analysis of a cohort study found. About 5 out of 10 LH surges had a single peak. The rest had a plateau or several peaks. Ultrasound confirmed ovulation in all 281 cycles.
Study at a glance, cohort study of 107 normally fertile women: The LH surge varies widely in shape and length in healthy women. Source: Direito A et al., 2013, PMID 22999798.
Key Findings
Of 281 cycles, the LH surge had a single peak in 134 (48%), a plateau in 30 (11%), two peaks in 93 (33%), and multiple peaks in 24 (8%).
The surge lasted 4.8 days on average (range 1 to 16 days), and its size varied widely from cycle to cycle.
The surge lasted more than 3 days after ovulation in 60% of cycles (170 of 281). These prolonged surges went with a smaller corpus luteum 2 days after ovulation.
Cycles with double or multiple peaks had smaller follicles just before rupture (P = .01) and lower LH levels (P = .03).
Each woman's surge pattern stayed consistent across her cycles (P = .0392). Comparing ages 18 to 39 with 40 to 45 reached no statistical significance (P = .1547).
Interpretation
This cohort study followed 107 normally fertile women across 281 cycles in five European countries. Ultrasound confirmed ovulation in every cycle. Surge shape and length tracked with follicle size before ovulation, corpus luteum size after, and LH levels. Each woman's own surge pattern stayed the same from cycle to cycle. The authors note that few pregnancies happened in the study, so it could not link surge pattern to the chance of getting pregnant. The findings support larger studies of how LH surge shape and length relate to fertility.
RRM Context
The women charted body temperature and cervical mucus, plus daily urine tests. Ultrasound marked the day of ovulation. The authors found that 52% of individual hormone curves had a shape different from the typical curve. A surge shape that differs from average can still come from a woman who ovulates normally. Restorative reproductive medicine reads a woman's own chart and hormone pattern in light of her own cycle. The authors note that multiple peaks and long surges may be signs of follicle and luteal problems.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To describe the LH surge variants in ovulating women and analyze their relationship with the day of ovulation and other hormone levels.
Design
Secondary analysis of a prospective cohort observational study.
Setting
Eight natural family planning clinics.
Subjects
Normally fertile women (n = 107) over 283 cycles.
Interventions
Women collected daily first morning urine, charted basal body temperature and cervical mucus discharge, and underwent serial ovarian ultrasound.
Main Outcome Measures
Urinary LH, FSH, estrone-3-glucuronide (E3G), pregnanediol-3α-glucuronide (PDG), and day of ovulation by ultrasound (US-DO).
Results
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.
Conclusions
In clinical practice, LH profiles should be compared with the range of profiles observed in normally fertile cycles, not with the mean profile.
