Ovulation assessment can include testing for urine LH, progesterone level, basal body temperature, insulin resistance, prolactin, dehydroepiandrostenendione sulfate (DHEAS), and 17-OH progesterone.
Urine Luteinizing Hormone
The female menstrual cycle is under the hormonal control of the endocrine system, which involves the hypothalamus, pituitary gland, and ovaries.
When the endocrine system is functioning properly the hormones released by the ovary will eventually trigger a marked release of leutenizing hormone (LH). This is known as the “LH Surge.” This rise in LH will stimulate the rupture of the ovarian follicle and release of the oocyte into the abdominal cavity.
LH tests are used to help evaluate ovarian function by testing for the LH Surge. Urinary LH kits test for a form of LH that has an extended life span due to transformation in the urine. These kits are marketed for home testing for the rise in LH prior to ovulation.
With adequate monitoring in the setting of a fertility clinic you will not need to do urinary LH testing unless specifically directed by a physician or nurse practitioner.
Progesterone Level
Progesterone is produced in the ovary after ovulation and is instrumental in supporting the lining of the uterus and the early embryo.
A progesterone level drawn on day 21 or approximately seven days after the date of suspected ovulation can be an indicator of ovulatory function. A level greater than eight usually indicates ovulation has occurred and adequate progesterone is being made to support an early pregnancy.
In patients suspected of having inadequate progesterone secretion after ovulation (luteal phase defect), supplemental progesterone may be administered. There are several forms of progesterone available including vaginal suppositories and injectable progesterone.
Basal Body Temperature
Basal body temperature (BBT) is a nonintrusive way to predict ovulation. Since a woman’s temperature is generally lower before ovulation and higher afterwards, the method charts fertility through daily temperature measurements.
Most women have a BBT between 97 and 97.5 degrees Fahrenheit before ovulation and 97.6 to 98.6 degrees after. By keeping a daily record of her temperature, a woman may detect a dip right before ovulation, representing her most fertile time.
Insulin Resistance Screening
Resistance to the effects of insulin produces an increase in insulin production and circulating levels (hyperinsulinemia). Insulin can lead to skin disorders and elevated androgens (hyperandogenism).
The elevated androgens like DHEAS and testosterone can lead to male pattern hair growth and acne. The androgens cause an increase in free estrogen (by reducing sex hormone binding globulin which binds both estrogens and androgens), which results in a decrease in follicle stimulating hormone (FSH).
The follicles are initially stimulated to grow but do not have enough FSH to continue to grow. This results in the polycystic appearance of the ovaries. Because follicles are not developing normally women will not ovulate normally and will not have normal menses.
Other names which have been used to refer to this syndrome include Insulin Resistance Syndrome and Hyperestrogenic Anovulation. It is most likely this syndrome does not represent one disease process but several disease processes that result in a similar clinical presentation.
Prolactin
Prolactin is a hormone of the endocrine system that is released from the pituitary gland. The pituitary is located at the floor of the brain just above the mouth and nasal passages.
Prolactin is responsible for the production of milk. Prolactin levels can be elevated without causing galactorrhea (discharge of milk in a non-pregnant woman).
Prolactin can hormonally interfere with the normal function of the hormones that govern follicular development and the menstrual cycle. Prolactin tumors may also cause the pituitary to stop producing other hormones, namely FSH and LH, which will also have an impact on normal reproductive function.
DHEAS
DHEAS is an androgen produced by the adrenal cortex. In women, elevated androgens like DHEAS and testosterone can lead to male pattern hair growth and acne.
The androgens cause an increase in free estrogen (by reducing sex hormone binding globulin which binds both estrogens and androgens), resulting in a decrease in FSH. The follicles are initially stimulated to grow but do not have enough FSH to continue to grow.
This results in the polycystic appearance of the ovaries. Because follicles are not developing normally women will not ovulate normally and will not have normal menses.
17-OH Progesterone
A blood test is used to measure 17-OH progesterone and identify possible disorders in the adrenal gland.
Deficiencies may increase androgen levels leading to masculine characteristics and interfering with ovulation.
