Hum. Reprod. Advance Access originally published online on January 26, 2006
Human Reproduction 2006 21(6):1442-1452; doi:10.1093/humrep/dei497
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Ovulation detection methods for urinary hormones: precision, daily and intermittent sampling and a combined hierarchical method
1 Center for Studies in Demography and Ecology, 2 Department of Anthropology, University of Washington, Seattle, WA, 3 Drexel University College of Medicine, Philadelphia, PA, 4 Center for Population and Health, Georgetown University, Washington DC, 5 Seattle Reproductive Medicine, Seattle, WA, 6 Department of Women’s Studies and TREMIN Research Project on Women’s Health and 7 Department of Anthropology, and Population Research Institute, Pennsylvania State University, University Park, PA, USA
8 To whom correspondence should be addressed at: Department of Anthropology, Box 353100, University of Washington, Seattle, WA, USA. E-mail: oconnork{at}u.washington.edu
* These authors contributed equally to this work.
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.
Key words: estrone conjugates/estrone glucuronide/FSH/LH/pregnanediol glucuronide