Assessment of anovulation in eumenorrheic women Comparison of ovulation detection algorithms

Anovulation prevalence among eumenorrheic women varies greatly by algorithm. Urinary LH surge algorithms, such as used in fertility monitors, identified more anovulatory cycles compared with methods utilizing serum P.


Kristine L. Lynch, Ph.D., Sunni L, Mumford, Ph.D., Karen C. Schliep, Ph.D., Brian W. Whitcomb, Ph.D., Shvetha M. Zarek, M.D., Anna Z. Pollack, Ph.D., Elizabeth R. Bertone-Johnson, Sc.D., Michelle Danaher, Ph.D., Jean Wactawski-Wende, Ph.D., Audrey J. Gaskins, B.S.E., Enrique F. Schisterman, Ph.D.

Volume 102, Issue 2, Pages 511–518.e2



To compare previously used algorithms to identify anovulatory menstrual cycles in women self-reporting regular menses.


Prospective cohort study.


Western New York.


Two hundred fifty-nine healthy, regularly menstruating women followed for one (n = 9) or two (n = 250) menstrual cycles (2005–2007).



Main Outcome Measure(s):

Prevalence of sporadic anovulatory cycles identified using 11 previously defined algorithms that use E2, P, and LH concentrations.


Algorithms based on serum LH, E2, and P levels detected a prevalence of anovulation across the study period of 5.5%–12.8% (concordant classification for 91.7%–97.4% of cycles). The prevalence of anovulatory cycles varied from 3.4% to 18.6% using algorithms based on urinary LH alone or with the primary E2 metabolite, estrone-3-glucuronide, levels.


The prevalence of anovulatory cycles among healthy women varied by algorithm. Mid-cycle LH surge urine-based algorithms used in over-the-counter fertility monitors tended to classify a higher proportion of anovulatory cycles compared with luteal-phase P serum-based algorithms. Our study demonstrates that algorithms based on the LH surge, or in conjunction with estrone-3-glucuronide, potentially estimate a higher percentage of anovulatory episodes. Addition of measurements of postovulatory serum P or urine pregnanediol may aid in detecting ovulation.

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