Ovulation and Pregnancy Testing
First Response Gold Digital
- 60% accurate if taken 5 days before expected period - 99% accurate if taken 1 day before expected period
Technology for Ovulation Tracking
- Mira Fertility Tracker (app) - Pearl Fertility Ovulation Test (app) - Proov Ovulation Confirmation Fertility Tracking Kit
Ovulation Kits
- Natalist Ovulation - First Response Ovulation - Clearblue Digital Ovulation - Clearblue Advanced Digital Ovulation Predictor - Pregmate OPK LH Surge Predictor - ClinicalGuard Ovulation Test Strips + Pregnancy
Counseling before getting prescription
- What did your doctor tell you this medication is for? - How did your doctor tell you to use this medication? - What did your doctor tell you to expect from this medication?
OTC Pregnancy Tests
- detects pregnancy 1-2 weeks after fertilization - 1st morning urine has peak hCG - qualitative
What may lessen accuracy of LH (ovulation) kits?
- fertility meds with LH - hCG - recent pregnancy - menopause - PCOS
Estrogen
- grows uterine lining - inhibits FSH - stimulate LH release (ovulation) - inhibits LH after ovulation
Counseling on OTCs
- how it works - how to use it - requirements or cautions - what to expect
Progesterone
- maintain uterine lining (endometrium) - inhibits LH after ovulation
Mira Fertility Tracker (app)
- measures LH only - follows irregular cycles - AI provides prediction $$$
Pearl Fertility Ovulation Test (app)
- measures LH, FSH, hCG, PdG - 5-6 d window - follows irregular cycles - photo-based algorithm
Proov Ovulation Confirmation Fertility Tracking Kit
- measures PdG (progesterone metabolite) - Progesterone inc 24-36 h ovulation "double check" - 1:1 PhD support via email or media
What may result in a false positive on a pregnancy test?
- menotropin injections - hCG injections - ovarian cysts - miscarriage - recent pregnancy (given birth in the last 8 weeks)
Ovulation Monitoring methods
- ovulation test - calendar method - basal body temp (BBT) - ovulation pain - cervical mucus - saliva
Human Chorionic Gonadotropic (hCG)
- produced by placenta after 20 weeks - nourishes egg - stimulate progesterone
FSH
- stimulate egg development - stimulate estrogen release
LH
- stimulate egg release (ovulation) - stimulate estrogen and progesterone production
How long does HCG remain elevated after a miscarriage?
4-6 weeks
Which ovulation kit is the only one to measure LH and estrogen AND has a 4 day measurement window?
Clearblue Advanced Digital Ovulation Predictor
Which ovulation kits is the least accurate?
ClinicalGuard Ovulation Test Strips + Pregnancy
Which ovulation kits have a 2 day measurement window?
First Response Ovulation Clearblue Digital Ovulation
Sensitivity
How accurate a test is in identifying those who do have a disease (true positive) TP/(TP+FN)
Specificity
How accurate a test is in identifying those who do not have a disease (true negative) TN/(TN+FP)
What do most ovulation kits measure?
LH
Interpreting pregnancy test results
Negative and menses does not occur: do hCG testing and physical exam Positive: seek medical care to know next steps
What are cheaper options for ovulation testing?
Pregmate OPK LH Surge Predictor ClinicalGuard Ovulation Test Strips + Pregnancy
Negative predictive value (NPV)
Probability that those who test negative do not have the disease TN/(TN+FN)
Positive predictive value (PPV)
Probability that those who test positive actually have the disease TP/(TP+FP)
Clearblue Fertility Monitor
SSS - touch screen tracks LH and estrogen - tells pt when to do urine tests and low, high, and peak fertility - stores 6 cycles of info - requires additional purchase of monitor sticks
Negative likelihood ratio
Tells you how much to decrease the probability of disease if the test is negative (1 - sensitivity) / specificity
Positive likelihood ratio
Tells you how much to increase the probability of disease if the test is positive sensitivity / (1 - specificity)
T/F: Estrogen and progesterone inhibit LH after ovulation
True
When should you start testing for ovulation?
cycle day 11 - LH surge lasts up to 5 days - ovulation most likely on surge day 2
What are some common pregnancy tests and how soon do they detect?
e.p.t - 4 d before period FactPlus - 4 d before period First Response - 6 d before period
Qualitative hCG range
not pregnant: < 5 indeterminate: 6-24 pregnant: > 25
