Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating

Only 48% of LH surges in ovulating women are single peaks of <5 days. The variants are associated with significant differences in follicle size and hormone levels.

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Ana Direito, M.D., Sébastien Bailly, M.Sc., Aude Mariani, M.D., René Ecochard, M.D., Ph.D

Volume 99, Issue 1, Pages 279-285.e3, January 2013



To describe the LH surge variants in ovulating women and analyze their relationship with the day of ovulation and other hormone levels.


Secondary analysis of a prospective cohort observational study.


Eight natural family planning clinics.


Normally fertile women (n = 107) over 283 cycles.


Women collected daily first morning urine, charted basal body temperature and cervical mucus discharge, and underwent serial ovarian ultrasound.

Main Outcome Measure(s):

Urinary LH, FSH, estrone-3-glucuronide (E3G), pregnanediol-3α-glucuronide (PDG), and day of ovulation by ultrasound (US-DO).


Individual LH surges were extremely variable in configuration, amplitude, and duration. The study also showed that LH surges marked by several peaks were associated with statistically significant smaller follicle sizes before rupture and lower LH level on the day of ovulation. LH surges lasting >3 days after ovulation were associated with a lower E3G before ovulation, a smaller corpus luteum 2 days after ovulation, and a lower PDG value during the first 4 days after ovulation.


In clinical practice, LH profiles should be compared with the range of profiles observed in normally fertile cycles, not with the mean profile.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.