Revisiting the role of serum progesterone as a test of ovulation in eumenorrheic subfertile women: a prospective diagnostic accuracy study

The prevalence of ovulatory cycles in eumenorrheic subfertile women is high, which precludes the need to offer serum progesterone as a routine diagnostic ovulation test in these women.

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VOLUME 114, ISSUE 6, P1315-1321

Authors:

Parimala Chinta, M.S., Grace Rebekah, Ph.D., Aleyamma T. Kunjummen, M.D., D.N.B., Mohan S. Kamath, M.S., D.N.B.

Abstract:

Objective

To estimate the prevalence of ovulatory cycles in eumenorrheic subfertile women and compare the diagnostic accuracy of a single ultrasound with serum midluteal progesterone measurement in detecting ovulatory cycles.


Design

Prospective diagnostic accuracy study.


Setting

University-level hospital.


Patient(s)

A total of 208 subfertile eumenorrheic women.


Intervention(s)

None.


Main Outcome Measure(s)

To estimate the prevalence of ovulatory cycles in eumenorrheic women and compare the diagnostic accuracy of a single, well-timed ultrasound scan (index test) with serum progesterone measurement (reference test) by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR+) and negative likelihood ratio (LR–).


Result(s)

The prevalence of ovulatory cycles among subfertile eumenorrheic women was 92.9% and 99.5% when midluteal serum progesterone level and ultrasound scanning were used as the reference test, respectively. The sensitivity, specificity, PPV, and NPV of ultrasound in identifying ovulatory cycles were 100%, 7.1%, 93.4%, and 100%, respectively. The LR+ and LR− were 1.1 and 0, respectively. The agreement between the ultrasound and serum progesterone was almost perfect (prevalence and bias-adjusted kappa = 0.81.


Conclusion(s)

The prevalence of ovulatory cycles in eumenorrheic subfertile women appears to be high. A single well-timed ultrasound can be performed to identify ovulatory cycles during the infertility workup in eumenorrheic women.

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.