Reliability of ovulation tests in infertile women

Objective: To assess the reliability of the most widely used clinical metho ds for predicting or confirming ovulation. Methods: We monitored spontaneous cycles in 101 infertile women using basal body temperature (BBT), transvaginal ultrasound, a urinary stick system fo r LH surge, and three serum progesterone measurements in the midluteal phas e. Transvaginal ultrasound monitoring was standard for ovulation detection and sensitivity. We calculated specificity and accuracy of each method comp ared with that standard. Results: Follicular development and ultrasound evidence of ovulation were c onfirmed in 97 of 101 cycles (96%). Urinary LH surge preceded follicular ru pture assessed by ultrasonography in all cycles and showed concordance with ultrasound-evidenced ovulation in 98 of 101 cases. The timing of BET nadir had wide variability, and BET and ultrasonography agreed in a similar perc entage of cases (74%). Midluteal serum progesterone assessments showed ovul atory values in 93 subjects, and ovulation was concordant with ultrasonogra phy in 90 subjects. Conclusion: Urinary LH was accurate in predicting ovulation with ultrasonog raphy as the standard for detection, but time varied widely. The nadir of B ET predicted ovulation poorly. The BET chart was less accurate for confirmi ng ovulation, whereas a single serum progesterone assessment in midluteal p hase seemed as effective as repeated serum progesterone measures. (C) 2001 by The American College of Obstetricians and Gynecologists.