Ovulation monitoring and fertility knowledge: Their relationship to fertility experience in a cross-sectional study.

BACKGROUND: Various aspects of fertility knowledge, including the timing of the fertile window, have consistently been found to be poor. Limited evidence also suggests ovulation monitoring to time intercourse could be common. However, there have been no studies that compare these two aspects of fertility and women's fertility/infertility experiences. AIM: To examine the frequency of ovulation monitoring and its relationship with fertility knowledge and experience. METHOD: A cross-sectional study of women aged 25-50 years resident in southern New Zealand was undertaken in 2011. Randomly selected women were asked to complete a fertility questionnaire. Outcome prevalence measures were calculated with 95% confidence intervals (CI) and associations investigated using χ2 tests and Poisson regression. RESULTS: Ovulation monitoring was common, having ever been undertaken by 31.4% (95% CI: 28.5-34.3%) of the 1034 participants. However, knowledge was poor, particularly regarding the fertile window. More women who had ever monitored ovulation correctly identified the fertile window, although the proportion was still very low (18.4 vs 13.1% in those who had not, P = 0.027). Regression modelling showed ovulation monitoring was independently associated with seeking medical help to conceive, education and fertility experience, but not with knowledge. CONCLUSION: This study confirms ovulation monitoring was commonly undertaken. However, many women, including those who had monitored their ovulation, had poor fertility knowledge and failed to identify the fertile window. Poor fertility knowledge needs to be addressed, especially among women intending to conceive.

Accuracy of a home-based device for giving an early estimate of pregnancy duration compared with reference methods.

OBJECTIVE: To assess a home pregnancy test's accuracy to concurrently detect pregnancy and determine pregnancy duration. DESIGN: Multicenter, prospective study. SETTING: Study sites in the United States. PATIENT(S): Women actively attempting to conceive who have menstrual bleeds (18-45 years). INTERVENTION(S): Volunteers collected early morning urine samples (three or fewer menstrual cycles). Pregnant volunteers underwent ultrasound dating scans. Ovulation day (LH surge +1 day) during pregnancy-resulting cycles was determined by quantitative measurement of LH. Random urine samples were tested with the hCG-measuring pregnancy test from 4 days before the expected period until 4 weeks later. MAIN OUTCOME MEASURE(S): A home pregnancy test's accuracy in determining pregnancy duration compared with ultrasound and ovulation day. RESULT(S): Agreement between pregnancy test results and time since ovulation was 93% (confidence interval [CI], 91.5-94.4). Agreement with ultrasound was dependent on the formula: there was 99% agreement when calculated with adjustment for Hadlock formula bias (Pexsters; CI, 98.2-99.4) or using a nonbias formula (Wu; CI, 98.6-99.6), when ultrasound error was accommodated. Agreement was lower when bias/measurement errors were not accounted for (Wu, 86%, CI, 83.9-88; Hadlock, 80.8, CI, 78.2-83.3). CONCLUSION(S): This home pregnancy test provides an accurate estimation of pregnancy duration in weeks categories, 1-2, 2-3, 3+ weeks since ovulation, thereby showing utility in dating pregnancy.

Cervical mucus monitoring prevalence and associated fecundability in women trying to conceive.

OBJECTIVE: To assess the use of cervical mucus monitoring (CMM) in women trying to conceive and determine whether monitoring is associated with increased cycle-specific probability of conception (fecundability). DESIGN: Time-to-pregnancy cohort study. SETTING: Population-based cohort. PATIENT(S): Three hundred thirty-one women trying to conceive, ages 30 to 44 years, without known infertility. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): CMM prevalence and fecundability. RESULT(S): During the first cycle of the study, CMM was performed consistently (checked on >66% of pertinent cycle days) by 20 women (6%), inconsistently (34% to 66% of days) by 60 women (18%), infrequently (≤33% of days) by 73 women (22%), and not performed by 178 women (54%). Cycles in which CMM was consistently performed were statistically significantly more likely to result in conception after adjusting for age, race, previous pregnancy, body mass index, intercourse frequency, and urinary luteinizing hormone (LH) monitoring. Fecundability also increased with increasing consistency of CMM. CONCLUSION(S): Among women trying to conceive, CMM is uncommon, but our study suggests that CMM-a free, self-directed method to determine the fertile window-is associated with increased fecundability independent of intercourse frequency or use of urinary LH monitoring.

Increased pregnancy rate with use of the Clearblue Easy Fertility Monitor.

OBJECTIVE: To determine the effect on pregnancy rates through use of the Clearblue Easy Fertility Monitor (CEFM) in women trying to conceive. DESIGN: Prospective study, in which volunteers were randomly assigned either to use or not to use the CEFM. All participants could also use other aids to conception. Data were self-reported by volunteers using daily diaries, supplied and collected by mail. SETTING: Home use, under conditions normally experienced by over-the-counter purchasers of the marketed device. PATIENT(S): Women who were trying to conceive; 653 (CEFM 305, control 348) provided evaluable information. INTERVENTION(S): CEFM was used for two cycles. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rates over two cycles of use. RESULT(S): The cumulative pregnancy rate for 2 cycles was significantly higher in the CEFM group (22.7%) compared with the control group (14.4%). More women who had been trying to conceive for <6 months became pregnant than women who had been trying to conceive for >6 months (odds ratio: 2.67). Previous pregnancy and younger age of partners were also significant prognostic factors, but use of other aids to conception was not. After adjustment for other factors, CEFM use remained a significant factor affecting the chance of conceiving within two cycles (odds ratio: 1.89). CEFM users found the device to be easy/very easy to use (90%) and convenient/very convenient (80%). CONCLUSION(S): Use of the CEFM increases the likelihood of getting pregnant during the first two cycles of use compared with its nonuse, in women who had been trying to conceive for up to 2 years.

Improved monofollicular ovulation in anovulatory or oligo-ovulatory women after a low-dose step-up protocol with weekly increments of 25 international units of follicle-stimulating hormone.

OBJECTIVE: To compare the effectiveness and efficiency of two low-dose step-up protocols for ovulation induction in women with anovulatory infertility (World Health Organization group II). DESIGN: Open-label, prospective, randomized, group-comparative, multicenter study. SETTING: Eighteen infertility centers in Europe and Canada. PATIENT(S): One hundred fifty-eight anovulatory or oligo-ovulatory infertile women. INTERVENTION(S): Patients were randomly assigned to one of two protocols for one cycle of follitropin beta (rFSH) using a pen device. The starting dosage was 50 IU/day for 7 days. In the absence of follicles > or =12 mm, the daily dosage was increased by either 25 or 50 IU per week. MAIN OUTCOME MEASURE(S): The percentage of all subjects treated who ovulated after one treatment cycle (efficacy) and the total rFSH dose to reach ovulation (efficiency). RESULT(S): The 25-IU group had a higher incidence of monofollicular growth (41.3% of 80 vs. 21.8% of 78 women) and ovulation (81.3% vs. 60.3%), a lower cumulative rFSH dose (887 IU vs. 984 IU), and fewer cancellations due to hyperresponse (>3 follicles > or =15 mm; 5.0% vs. 20.5%). Both protocols were well tolerated. CONCLUSION(S): Weekly increments of 25 IU in the daily dose were more effective and efficient than 50-IU increments.

Determination of the fertile window: reproductive competence of women--European cycle databases.

OBJECTIVES: The objective of the present paper is to review the main results of recent European cycle databases on ovulation detection and determination of the fertile window performed by the women themselves. METHODS: The ongoing German Long-term Cycle Database currently comprises 32788 prospectively collected cycle charts of 1551 women, the I European Cycle Database (10 countries) 1328 women/19048 cycles, the II European Cycle Database (six countries) 782 women/6724 cycles, and the World Health Organization Database (one European country) 234 women/2808 cycles. The women record cycle parameters (cervical mucus changes, temperature rise, etc.), family planning intention and sexual behavior. RESULTS: With the symptothermal method of natural family planning it has become possible to determine the fertile window in order to avoid pregnancy with a method effectiveness of 0.3%. According to a small sub-study, the ovulation time observed by the women themselves correlates closely with ovulation detected by ultrasound and measurement of luteinizing hormone (correlation within 1 day in 89% of the 62 cycles). Fertility awareness methods can be integrated into the management of sub-fertility. They seem to shorten the time to pregnancy. CONCLUSIONS: Self-observation of the fertile window puts women into a position to develop a high level of reproductive competence that could be used much more in different areas than is currently the case.

Characteristics of urinary luteinizing hormone (LH) during the induction of LH surges of different magnitude in blood.

Urinary luteinizing hormone (LH) testing has been proposed as a reliable method for the prediction of ovulation but its accuracy has been challenged by some studies. To check how accurately the oscillations of urinary LH reflected the plasma changes, surges of LH of different magnitude and duration were artificially induced in plasma and the hormone was measured simultaneously in urine. Post-menopausal women (n = 16) were stimulated during 1 week with a combination of transdermal oestradiol (400 micrograms) and i.m. progesterone (25 mg on day 4, 50 mg on day 5) to obtain an LH discharge comparable with the pre-ovulatory LH peak. A short and moderate peak of LH was induced by the i.v. injection of 100 micrograms gonadotrophin-releasing hormone (GnRH) in six premenopausal women, whereas an LH discharge of higher amplitude and longer duration was induced by a single dose of 0.3 mg s.c. buserelin. The total urine production of the day was fractionated into 8 h periods. LH was measured by a commercial radioimmunoassay. Unambiguous peaks of LH were detected in the urine of all the women stimulated with either oestradiol plus progesterone or buserelin, but in only three out of the six women receiving GnRH. The urine LH reproduced the plasma changes of the hormone with short delay since the peaks were mostly detected in the same time fraction in which the serum discharge occurred.

Previsäo do dia da ovulaçäo através da análise de regressäo linear dos parâmetros ultra-sonográficos do desenvolvimento folicular / Ovulation prediction through linear regression analysis of sonographic parameters of follicular development

A análise de regressäo linear dos parâmetros ultra-sonogr ficos do desenvolvimento folicular foi realizada com a finalidade de prever o dia da ovulaçäo, em 10 pacientes normais, submetidas à induçäo da ovulaçäo com citrato de clomifeno. O crescimento do diâmetro folicular médio do folículo dominante mostrou uma forte relaçäo linear (r2 = 0,98) em funçäo do tempo, até o momento da ovulaçäo. A taxa de crescimento folicular (C) e o dia provável do início do desenvolvimento folicular (Di) foram obtidos a partir da equaçäo de regressäo linear de cada paciente. O período total de crescimento do folículo (PTC) foi calculado através do valores de Di e C, uma vez que estes parâmetros apresentaram uma corelaçäo estatisticamente significativa (p < 0,001; r2 = 0,92). O dia menstrual da ovulaçäo (DMov) foi calculado através da fórmula DMov = (6,26 x C) + (0,33 x PTC) + 10,221, fornecendo um desvio padräo de 0,87 dia. Os DMov médios observados e previstos foram 15,46 +/- 0,93 e 15,45 +/- 0,53, respectivamente, apresentando correlaçäo linear estatisticamente significativa (p < 0,04; r2 = 0,32). A previsäo da ovulaçäo com uma variaçäo de +/- 20,9 horas (0,87 dia) tem aplicaçäo clínica imediata em procedimentos que necessitem da determinaçäo precisa do dia ovulatório, tais como inseminaçäo artificial e fertilizaçäo in vitro/transferência de embriöes.

[Folliculometry as a method for determining ovulation in insemination with frozen sperm]. / Folikulometriiata kato metod za opredeliane na ovulatsiiata pri inseminatsiite sus zamrazena sperma.

The authors carried out studies retrospectively on 57 women, who became pregnant in insemination with donor frozen spermatozoa. Ovulation problems and luteal insufficiency were diagnosed in advance and treated before and during the occurring cycles. Women were divided into two groups. The first group of 25 women were examined by ultrasound transvaginal transducer for follow-up of follicle growth in the ovaries in addition to measurement of body temperature and determination of the cervical factor. The second group of 32 women, in whom follicle-metry was not performed. The frequency of conception was 0.24 in the first group, but 0.26 in the second group. It is concluded that inspite of the significance of follicle-metry for determination of ovulation the traditional methods are still valid criteria for ovulation and can be used as independent methods for determination of the time for insemination with therapeutic donor frozen spermatozoa.