• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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• Q. What are the ways in which ovulation can be detected?

  • To detect impending ovulation
    • Urinary LH detection kit or serum LH
    • Basal body temperature measurement
    • Ultrasound
    • Change in cervical mucus – spinbarkitt
  • To detect ovulatory cycles
    • Menstrual cycle period and regularity – 28-35 days with normal regulatory- more likely to be ovulatory
    • Molimina symptoms
    • Luteal phase progesterone
    • Detect CL and endometrium on ultrasound
    • Endometrial biopsy

• Q. What length of cycles is generally ovulatory?

  • Menstrual cycles between 25-35 days are generally ovulatory
  • Both shorter and longer cycles suggest anovulation

• Q. What are the clinical symptoms that suggest ovulation ?

  • Midcycle
    • Cervical mucus becomes thin
    • Mittelschmerz (midcycle bleeding)
  • End of cycle – premenstrual (molimina symptoms)
    • 1 bloating
    • 2. Breast tenderness
    • 3. Fluid retention
    • 4. Mood changes
  • Presence of molimina symptoms suggest ovulation

• Q. When does the rise in basal body temperature take place?

  • Occurs 1-5 days after LH surge (generally 1-4 days after ovulation)

• Q. What is the fundamental of basal body temperature measurement?

  • Progesterone in the luteal phase affects the hypothalamus and increases basal body temperature

• Q. Describe the process of basal body temperature measurement?

  • Women measures the temperature by keeping the thermometer beneath the tongue every day before getting out of the bed
  • During the luteal phase, the temperature increase by 0.5 F compared to the follicular phase
  • It begins to rise 1-2 days after LH surge and remains high for ten days

• Q. If the woman does not give the above history of normal ovulatory cycles, then what is done?

  • Do a mid-lueteal phase progesterone
  • It is done seven days before the expected date of menses (21st day of cycle)
  • If the level is >3 pg/ml- it suggests that ovulation has occurred ^[1]

• Q. Is this test always done on the 21st day of the cycle?

  • No
  • It is done seven days before the expected menstrual period
  • For women with a cycle length of 28 days, it is done on the 21st day
  • With the cycle of the length of 30 days, it is done on the 23rd day and so on

• Q. What are the means of identifying the fertile period?

  • Calendar method
  • Basal body temperature measurement
  • LH surge using urinary LH detection kit
  • Recording the change in cervical mucous

• Q. How is the fertile period calculated?

  • The Fertile period is calculated by subtracting 14 days from the total cycle length of the shortest and longest periods
  • Couple is counseled for intercourse at least every other day during the fertile period
  • For example, if a person has a cycle length of 30 to 35 days – fertile days would be days 16 to 21 of the menstrual cycle (30-14 and 35-14)
  • LH surge occurs five days before ovulation

• Q. What is the time difference between LH surge in serum and urine?

  • LH surge in blood precedes urinary LH surge by 12 hours
  • This can be detected using home LH detection kits

• Q. When does ovulation take place after LH surge?

  • Ovulation occurs about 14-48 hours after LH generally
  • Couples are advised that maximum fertility is for two days after LH surge is detected by the Kit

• Q. How can ultrasound help in the diagnosis of ovulation?

  • It is most helpful if used serially
  • Both TAS and TVS can be used. TVS is preferred
  • Ovulation can be predicted by seeing a large preovulatory follicle of 20-25 mm in size before rupture

• Q. How does the ultrasound appearance of endometrium suggest the phase of menses?

  • Follicular phase- the ultrasound shows thick proliferative endometrium
  • Luteal phase shows- bright echogenic endometrium