Review of methodology for determining the day of urinary luteinising hormone surge
ESC Congress Library. Godbert S. 05/28/14; 50663; A-248 Disclosure(s): Sonya Godbert, Chris Shreeves and Sarah Johnson are employees of SPD Development Company Ltd., a fully owned subsidiary of SPD Swiss Precision Diagnostics GmbH., the manufacturers of Clearblue Pregnancy and Fertility tests. This study was funded by SPD Development Company Ltd.
Mrs. Sonya Godbert
Mrs. Sonya Godbert
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Abstract
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Objective: Many different methodologies have been described for determining the day of urinary luteinising hormone (LH) surge in pre-menopausal women.  This study examined published methodologies proposed for allocation of LH surge day to determine the most appropriate method for routine evaluation of ovulatory menstrual cycles.


Methods: A literature review was conducted and identified 12 important publications describing LH surge determination.  Surge was always defined as a substantive rise above baseline, but there were a variety of methods for assigning baseline.  Most required an initial estimate of the LH surge prior to characterisation, usually day of peak LH concentration or an initial estimate of LH surge.   Baseline LH would then be calculated using a varying number of preceding days from initial estimate.  Alternatively, some authors used fixed days within the cycle as baseline.  The substantive rise (i.e. surge) was also defined in different ways, for example, multiples of baseline level or a number of standard deviations above baseline level.


These methodologies were assessed on 254 cycles of daily urine samples (106 non pregnant and 148 conception cycles) from 227 women who were trying to conceive.  Results of these methodologies were compared to reference LH surge as determined by expert panel review of LH profiles (LH measured by AutoDELFIA).


Results: Using fixed days within the cycle to assign baseline was a poor method, as it was only able to correctly identify the LH surge, within +/- 1 day of reference day, in 58% of the cycles. The method using the day of the peak LH concentration as the initial estimate performed much better, correctly identifying the LH surge, within +/- 1 day, in 90% of the cycles.  Finally, the method using an initial estimate of the LH surge correctly identified the LH surge in 97% of the cycles


Conclusion:  A reliable method for the routine determination of the LH surge in ovulatory menstrual cycles is possible using an initial estimate of the LH surge.

Objective: Many different methodologies have been described for determining the day of urinary luteinising hormone (LH) surge in pre-menopausal women.  This study examined published methodologies proposed for allocation of LH surge day to determine the most appropriate method for routine evaluation of ovulatory menstrual cycles.


Methods: A literature review was conducted and identified 12 important publications describing LH surge determination.  Surge was always defined as a substantive rise above baseline, but there were a variety of methods for assigning baseline.  Most required an initial estimate of the LH surge prior to characterisation, usually day of peak LH concentration or an initial estimate of LH surge.   Baseline LH would then be calculated using a varying number of preceding days from initial estimate.  Alternatively, some authors used fixed days within the cycle as baseline.  The substantive rise (i.e. surge) was also defined in different ways, for example, multiples of baseline level or a number of standard deviations above baseline level.


These methodologies were assessed on 254 cycles of daily urine samples (106 non pregnant and 148 conception cycles) from 227 women who were trying to conceive.  Results of these methodologies were compared to reference LH surge as determined by expert panel review of LH profiles (LH measured by AutoDELFIA).


Results: Using fixed days within the cycle to assign baseline was a poor method, as it was only able to correctly identify the LH surge, within +/- 1 day of reference day, in 58% of the cycles. The method using the day of the peak LH concentration as the initial estimate performed much better, correctly identifying the LH surge, within +/- 1 day, in 90% of the cycles.  Finally, the method using an initial estimate of the LH surge correctly identified the LH surge in 97% of the cycles


Conclusion:  A reliable method for the routine determination of the LH surge in ovulatory menstrual cycles is possible using an initial estimate of the LH surge.

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