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Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?

OBJECTIVE: To study the best possible luteinizing hormone (LH) threshold to predict ovulation within the 24, 48, and 72 h. DESIGN: Observational study. SETTING: Multicenter collaborative study. PATIENTS: A total of 107 women. INTERVENTIONS: Women collected daily first morning urine for hormonal asse...

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Autores principales: Leiva, Rene Antonio, Bouchard, Thomas Paul, Abdullah, Saman Hasan, Ecochard, René
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712333/
https://www.ncbi.nlm.nih.gov/pubmed/29234665
http://dx.doi.org/10.3389/fpubh.2017.00320
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author Leiva, Rene Antonio
Bouchard, Thomas Paul
Abdullah, Saman Hasan
Ecochard, René
author_facet Leiva, Rene Antonio
Bouchard, Thomas Paul
Abdullah, Saman Hasan
Ecochard, René
author_sort Leiva, Rene Antonio
collection PubMed
description OBJECTIVE: To study the best possible luteinizing hormone (LH) threshold to predict ovulation within the 24, 48, and 72 h. DESIGN: Observational study. SETTING: Multicenter collaborative study. PATIENTS: A total of 107 women. INTERVENTIONS: Women collected daily first morning urine for hormonal assessment and underwent serial ovarian ultrasound. This is a secondary analysis of 283 cycles. MAIN OUTCOME MEASURES: The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were estimated for varying ranges of LH thresholds. Receiver operating characteristic curves and cost–benefit ratios were used to estimate the best thresholds to predict ovulation. RESULTS: The best scenario to predict ovulation at random was within 24 h after the first single positive test. The false-positive rate was found to increase as (1) the cycle progressed or (2) two or three consecutive tests were used, or (3) ovulation was predicted within 48 or 72 h. Testing earlier in the cycle increases the predictive value of the test. The ideal thresholds to predict ovulation ranged between 25 and 30 mIU/ml with a PPV (50–60%), NPV (98%), LR+ (20–30), and LR− (0.5). At least, one day with LH ≥25 mIU/ml followed by three negatives (LH <25) occurred before ovulation in 31% of all cycles. When used throughout the cycle and evaluated together, peak-fertility type mucus with a positive LH test ≥25 mIU/ml provides a higher specificity than either mucus or LH testing alone (97–99 vs. 77–95 vs. 91%, respectively). CONCLUSION: We identified that beginning LH testing earlier in the cycle (day 7) with a threshold of 25–30 mIU/ml may present the best predictive value for ovulation within 24 h. However, prediction by LH testing alone may be affected negatively by several confounding factors so LH testing alone should not be used to define the end of the fertile window. Complementary markers should be further investigated to predict ovulation and identify the fertile window. The use of the peak cervical mucus along with an LH test may provide a higher specificity and predictive value than either of them alone. We recommend that manufacturers disclose their tests’ threshold to the public.
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spelling pubmed-57123332017-12-11 Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation? Leiva, Rene Antonio Bouchard, Thomas Paul Abdullah, Saman Hasan Ecochard, René Front Public Health Public Health OBJECTIVE: To study the best possible luteinizing hormone (LH) threshold to predict ovulation within the 24, 48, and 72 h. DESIGN: Observational study. SETTING: Multicenter collaborative study. PATIENTS: A total of 107 women. INTERVENTIONS: Women collected daily first morning urine for hormonal assessment and underwent serial ovarian ultrasound. This is a secondary analysis of 283 cycles. MAIN OUTCOME MEASURES: The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were estimated for varying ranges of LH thresholds. Receiver operating characteristic curves and cost–benefit ratios were used to estimate the best thresholds to predict ovulation. RESULTS: The best scenario to predict ovulation at random was within 24 h after the first single positive test. The false-positive rate was found to increase as (1) the cycle progressed or (2) two or three consecutive tests were used, or (3) ovulation was predicted within 48 or 72 h. Testing earlier in the cycle increases the predictive value of the test. The ideal thresholds to predict ovulation ranged between 25 and 30 mIU/ml with a PPV (50–60%), NPV (98%), LR+ (20–30), and LR− (0.5). At least, one day with LH ≥25 mIU/ml followed by three negatives (LH <25) occurred before ovulation in 31% of all cycles. When used throughout the cycle and evaluated together, peak-fertility type mucus with a positive LH test ≥25 mIU/ml provides a higher specificity than either mucus or LH testing alone (97–99 vs. 77–95 vs. 91%, respectively). CONCLUSION: We identified that beginning LH testing earlier in the cycle (day 7) with a threshold of 25–30 mIU/ml may present the best predictive value for ovulation within 24 h. However, prediction by LH testing alone may be affected negatively by several confounding factors so LH testing alone should not be used to define the end of the fertile window. Complementary markers should be further investigated to predict ovulation and identify the fertile window. The use of the peak cervical mucus along with an LH test may provide a higher specificity and predictive value than either of them alone. We recommend that manufacturers disclose their tests’ threshold to the public. Frontiers Media S.A. 2017-11-28 /pmc/articles/PMC5712333/ /pubmed/29234665 http://dx.doi.org/10.3389/fpubh.2017.00320 Text en Copyright © 2017 Leiva, Bouchard, Abdullah and Ecochard. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Leiva, Rene Antonio
Bouchard, Thomas Paul
Abdullah, Saman Hasan
Ecochard, René
Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
title Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
title_full Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
title_fullStr Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
title_full_unstemmed Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
title_short Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
title_sort urinary luteinizing hormone tests: which concentration threshold best predicts ovulation?
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712333/
https://www.ncbi.nlm.nih.gov/pubmed/29234665
http://dx.doi.org/10.3389/fpubh.2017.00320
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