Ovulation assessment

1. Commonly used methods used to assess ovulation include measuring a rise in basal body temperature (BBT), identifying an elevation in the midluteal phase serum progesterone concentration, luteal phase endometrial biopsy, and detection of luteinizing hormone (LH) in the urine. The BBT chart is used to acquire information regarding ovulation and the duration of the luteal phase. Female patients are instructed to take their temperature upon awaking each morning before any physical activity. A temperature rise of 0.4°F (0.22°C) for 2 consecutive days is indicative of ovulation. The initial rise in serum progesterone level occurs between 48 hours before ovulation and 24 hours after ovulation. For this reason, a rise in temperature is useful in establishing that ovulation has occurred, but it should not be used to predict the onset of ovulation in a given cycle.

2. Another test used to assess ovulation is a midluteal phase serum progesterone concentration. A blood sample is usually obtained for progesterone 7 days after the estimated day of ovulation. A concentration greater than 3.0 ng/mL is consistent with ovulation, while a concentration greater than 10 ng/mL signifies adequate luteal phase support.

3. Alternatively, urine LH kits can be used to assess ovulation. Unlike the rise in BBT and serum progesterone concentrations, which are useful for retrospectively documenting ovulation, urinary LH kits can be used to predict ovulation. Ovulation usually occurs 24 to 36 hours after detecting the LH surge.

H. Tubal patency can be evaluated by hysterosalpingography (HSG) and/or by chromopertubation during laparoscopy.

Timing of the Infertility Evaluation

Test

Day

Hysterosalpingogram

day 7-10

Postcoital Test

day 12-14

Serum Progesterone

day 21-23

Endometrial Biopsy

day 25-28

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