II. Physiology
- Normal ovulatory cycles are 21-35 days in duration
- Normal cycles typically vary by only 1-2 days per month
III. History: Suggesting Ovulation
- Keep a menstrual Diary for several months
- Record days of uterine bleeding and amount
- Record associated symptoms
- Document premenstrual and Menstrual Symptoms
- Breast tenderness
- Menstrual Cramps
- Depressed mood
- Mid-cycle pelvic cramping (Mittelschmerz)
IV. Signs: Basal Body Temperature (BBT)
- Basal Body Temperature increase of 0.3 to 1.0 F
- Inaccurate method
- Ovulation could occur 6 days before BBT nadir
- Ovulation could occur 4 days after BBT nadir
V. Labs: Indications of Ovulation (most accurate testing)
-
Mid-Luteal Serum Progesterone Level (Day 21)
- Level >5.0 ng/ml (15.9 nmol/L) suggests Ovulation
- Level <4.0 ng/ml suggests Anovulation
- Morning Urine LH surge testing
- Urine LH surge occurs 72 hours before Ovulation
VI. Efficacy: Ineffective methods of determining Ovulation
VII. Efficacy: Prediction of fertile window
- Prediction inaccurate in most women
- Days 6-21: 10% probability each day of fertile window