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Milk composition changes--a simple and non-invasive method of detecting ovulation in lactating women.

OBJECTIVE: To assess the possibility of detecting ovulation through observing changes in composition of milk and using this as a simple and non-invasive method. METHOD: Twenty five normal lactating women (menstruating and non-menstruating), varying in age from 18-35 years and taking no hormonal contraceptives were included in this study. Hormonal estimation was done by radioimmunoassay and changes in milk composition were observed by measuring the concentration of Na+, Cl-, K+ and lactose. RESULTS: Changes were observed in milk composition of four menstruating women (ovulatory), characterized by significant increase in concentration of Na+ and Cl- and decrease in concentration of lactose and K+. However, in one non-menstruating woman who was found to have ovulation, these findings could not be observed. CONCLUSION: Results show that the determination of Na+, K+, Cl- and lactose in milk of lactating women have a high value for detection of ovulation.

Adolescent↗

Human urinary glycosaminoglycans as accurate method for ovulation detection.

Urinary glycosaminoglycans (GAGs) content showed a characteristic pattern of fluctuation during normal and hormonally induced cycles with a distinct peak at ovulation. This peak of maximal GAGs concentration (106.7 +/- 46.2 micrograms/mL in urine) was centered according to the day of the midcycle LH surge, which serves as the reference point, designated day 0. All cycles are presumed to be ovulatory on the basis of biphasic BBT nadir, ultrasonographic studies, and progesterone assays (greater than 5 ng/mL of serum) during the secretory phase. In hormonally induced menstrual cycles, a noticeable increase in GAGs concentration (70%) was observed. This indirect evidence suggests a possible correlation between GAGs content and hormonal effect. All types of GAGs, with the exception of heparin, have been found in urine, chondroitin sulfate C being the major component at time of ovulation. These results strongly suggest that urinary GAGs determination is a precise method for ovulation detection.

Adult↗

A rapid method for ovulation detection.

Uronic acid (UA) content in whole urine showed a characteristic pattern of fluctuations during menstrual cycle (24 cycles) with a distinct peak on the day of ovulation (midcycle peak 1043 + 68 micrograms/ml urine. This peak of maximal UA concentration was validated by ultrasonography (abdominal and/or vaginal scanner and basal body temperature. In hormonal induced menstrual cycle (5 cycles) a significant decrease in Ua concentrations were observed during the follicular phase (20%) and in the midcycle peak (11%) when they were compared with the same values in the normal cycle. Nevertheless, two days after the ovulation peak occurs a second peak can be observed (1344 + 799 micrograms UA/ml urine). On the other hand in the anovulatory cycles (5 cycles) the same diminishing behavior in the UA concentrations were observed in both phases of the cycle (50-60%) with the expected lack of the midcycle peak. Results that clearly show that UA excretion in urine reflect a excellent correlation with the menstrual cycle allowing us to propose this technique as an accurate and reliable method to detect ovulation.

Adult↗

Cervicovaginal fluid changes to detect ovulation accurately.

OBJECTIVE: The purpose of this study was to evaluate changes in cervicovaginal fluid characteristics to identify ovulation. STUDY DESIGN: Several ovulation indicators were studied in a university-based natural family planning center. Fifteen parous women during 29 ovulatory cycles detected cervicovaginal fluid at the vulva. They self-aspirated their upper vaginal fluid, described it, and kept it for later checking. They also took basal body temperature, collected timed first morning urine samples for estrone and pregnanediol glucuronide enzyme immunoassays, and submitted to serial ovarian transvaginal ultrasound scans. RESULTS: Considering a +/-1-day period since ultrasound ovulation detection or allowing an extra day (-1 to +2), women perceived ovulation from cervicovaginal fluid at the vulva in 76% or 97% of cycles, on the basis of their visual description of vaginally extracted fluid in 76% or 90%, which rose to 90% or 97% for the instructor's description, and in 76% or 86% with a rapid drop in glucuronide ratio. Basal body temperature was less precise (71% or 79%). CONCLUSION: Evaluation of cervicovaginal fluid changes is an accurate ovulation indicator.

Adult↗

Approaches for incorporating ovulation detection devices and home kits into learning NFP--implications for service delivery.

This paper presents demographic data about use of NFP in Europe and the factors which have been identified as influencing that very low use level. Experience with a new ovulation detection device in clinical trials and observations of its over-the-counter promotions is discussed in the context of what is already known about how to maximize uptake of contraception in main-stream service provision. Some suggestions are offered as to appropriate means of encouraging women who are using artificial methods or no method to understand enough about their natural fertile cycle to consider NFP as an acceptable option.

Delivery of Health Care↗

The use of clearplan home ovulation detection kits in unexplained and male factor infertility.

One hundred and five couples with unexplained infertility and 43 couples whose infertility was thought to be due to reduced sperm motility were recruited. The median duration of infertility was 36 months (range 12-168). Couples were randomly allocated to either using Clearplan home ovulation detection kits for 3 cycles or were advised about the optimal time during their menstrual cycle to achieve a pregnancy. The clinical details of the 2 groups were similar. In couples with unexplained infertility over the study period 10 (20.4%) in the Clearplan group and 9 (16%) in the control group conceived with 58% of pregnancies occurring in the first cycle. In couples with reduced sperm motility, the results were disappointing with only 2 (8%) pregnancies in the Clearplan group and 2 (11.1%) in the controls. Assisted reproduction technology may not be justified as the first line of management in patients with unexplained infertility.

Adult↗

Ovulation detection methods for urinary hormones: precision, daily and intermittent sampling and a combined hierarchical method.

BACKGROUND: We evaluate the performance of ovulation detection methods and present new approaches, including evaluation of methods for precision, combining multiple markers into a hierarchical system and using ovulation markers in intermittent sampling designs. METHODS: With serum LH peak day as the 'gold standard' of ovulation, we estimated accuracy and precision of ovulation day algorithms using 30 ovulatory menstrual cycles with daily urinary and serum hormones and transvaginal ultrasound. Sensitivity and specificity for estimating the presence of ovulation were tested using visually assessed ovulatory (30) and anovulatory (22) cycles. RESULTS: Sensitivity and specificity ranged from 70 to 100% for estimating presence of ovulation with twice-per-cycle, weekly, twice weekly, every-other-day and daily specimens. A combined hierarchical method estimated ovulation day using daily specimens within +/-2 days of the gold standard in 93% of cases. Accuracy of estimating ovulation day within +/-2 days using intermittent sampling ranged from 40% (weekly sampling) to 97% (every-other-day). CONCLUSIONS: A combined hierarchical algorithm using precise and accurate markers allows maximal use of available data for efficient and objective identification of ovulation using daily specimens. In intermittent sampling designs, the presence and the timing of ovulation can be estimated with good sensitivity, specificity and accuracy.

Adult↗

The clinical value of Clearplan home ovulation detection kits in infertility practice.

A home ovulation testing kit, Clearplan, that detects the urinary luteinizing hormone (LH) surge was used by 32 patients on a donor insemination programme for 50 cycles to indicate when to first attend the clinic for a serum LH test to determine ovulation. Using Clearplan significantly reduced the number of clinic attendances (4.06 +/- 1.5) compared to the preceding control cycle (7.06 +/- 2.0 p less than 0.001). One serum LH peak was missed using Clearplan. Ovulation was predicted within 2 days of the serum LH surge in 77% of cycles. Home ovulation determination has the potential to reduce the stress and cost of fertility programmes.

Appointments and Schedules↗

Pregnancy and ovulation detection in bison (Bison bison) assessed by means of urinary and fecal steroids.

Sexually mature bison (Bison bison) cows were tested for both pregnancy and ovulation by means of urinary steroid metabolites and fecal steroids. The accuracy of pregnancy diagnosis was determined among 18 bison cows, in approximately the third month of gestation, by means of urinary pregnanediol-3 delta-glucuronide (PdG), urinary estrone conjugates (E1C), and fecal total estrogens (TE). Urinary PdG was 100% accurate, urinary E1C was 89% accurate, and fecal TE was 100% accurate in predicting pregnancy. Fecal progesterone (P4) and TE, as well as urinary E1C and PdG concentrations all increased from conception (August) through January, but significant differences were not apparent until November. During the rutting season ovulation was detected by increases in either urinary PdG or fecal P4 concentrations. Both pregnancy and ovulation were detected in uncaptured bison with reasonable accuracy by means of urinary and fecal steroids or their metabolites.

Animals↗

Evaluation of a semiquantitative urinary LH assay for ovulation detection.

Levels of urinary LH were determined by a rapid, semiquantitative enzyme immunoassay dipstick test (Ovustick, now known as OvuKIT) and the results were compared with a standard serum LH double-antibody radioimmunoassay in 63 cycles of 47 women undergoing stimulated cycles for in vitro fertilisation. A good correlation was found between the two assay methods in 70% of the cycles. An increase in serum LH was associated with a concurrent rise in the dipstick measurement. Using the Ovustick method, no false-positive finding was encountered, but the LH rise was missed in one case. The number of mature oocytes aspirated was significantly higher in the stimulated cycles without an endogenous LH surge. The use of this simple and rapid enzyme immunoassay method makes possible successful and precise timing of ovulation during artificial insemination or egg retrieval for IVF in treatments for infertility.

Evaluation Studies as Topic↗

Ovulation detection in the human.

The importance of predicting human ovulation for either optimizing or avoiding conception has been considered from an endocrine, morphological and clinical view point. Of the biochemical markers in peripheral blood, a knowledge of the LH peak is the most clearly defined, with a two to four fold increase above baseline levels for a relatively short 24-30 hour preovulatory period. Ovulation is considered to occur 28-36 hours after the beginning of the LH rise or 8-20 hours after the LH peak. Daily assessment of the rise in preovular oestrogen reflects Graafian follicle development but the rise is less distinct and spread over 3-4 days with marked day to day fluctuations. LH induces a marked reduction in oestrogen production some 12 hours prior to ovulation and at the same time induces a two to three fold increase in progesterone production above baseline levels. While these changes in themselves are not great enough for day to day discrimination, a knowledge of their reciprocal relationship may be. The preovular rise in FSH is relatively small compared to LH and the radioimmunoassay technique has not generally been refined to be as rapid and reliable. Monitoring the day to day growth of the preovular follicle ultrasonically is both linear and potentially predictable but there is a wide range of its final diameter (17-26 mm) prior to ovulation making prediction inaccurate. With further refinements in ultrasonic resolution, detection of intrafollicular changes of the cumulus oophorus and granulosal cell layer configuration and thickness may give a closer prediction of the time of ovulation. At a clinical level a knowledge of menstrual cycle length in association with body messages which herald ovulation are useful and may forewarn that ovulation in terms of days is approaching. Such markers as preovulation pain, the detection of periovular cervical mucus and the change in physical character and position of the cervix are reliable signs of preovulation for many well motivated and informed women for either promoting or avoiding conception. A knowledge of the basal body temperature is not a prospective guide to ovulation, but once the thermal shift is established in association with loss of periovular mucus symptoms, the fertile period can be considered to have passed. Because we do not have a precise and simple marker of human ovulation, it is necessary that the most suitable marker of pre- or postovulation is chosen for the particular need in a given individual.

Body Temperature↗

Ovulation detection following removal of levonorgestrel subdermal contraceptive implants.

The time to resumption of ovulation following the discontinuation of levonorgestrel subdermal implants (Norplant) was assessed in 10 women. A blood sample (2 ml) was taken at the time of Norplant removal and then twice weekly until the first evidence of ovulation (serum progesterone concentration greater than or equal to 5 ng/ml) was documented. Ovulation was resumed in 80% of the cases by 3 weeks and in all the cases by 7 weeks. Prompt return of ovulation following Norplant removal is an additional advantage of this mode of long-acting contraception.

Adult↗

Basal body temperature: unreliable method of ovulation detection.

Basal body temperature (BBT) charts for menstrual cycles of 98 women were evaluated by six experienced physicians. The time of ovulation as estimated from the charts by a consensus of at least five of the evaluators coincided with the luteinizing hormone (LH) peak +/- 1 day in only 17 (22.1%) of the 77 cycles that were determined by endocrine profiles to be ovulatory and to have adequate luteal phases. An additional 22.1% of these cycles were thought to have monophasic patterns by a consensus of the physicians. Extreme caution in interpretation is urged when BBT is used for clinical or research evaluations of ovulation or menstrual cycle dynamics.

Adolescent↗