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