Tests For Ovulation

Serum Progesterone

• Premenstrual phase
• D – 8 < 1 ng/ml
• D – 21 > 6.5 ng/m1

Follicular Monitoring

• D8 and D21
• Follicle is measured by USG.

Laparoscopy

• D10 – D14 Secretory phase
• Recent corpus luteum is directly see

• Best diagnostic method which is an OPD procedure for hormonal evaluation 
• Indications:Chronic anovulation, abnormal vaginal bleeding,post-menopausal bleeding,DUB,TB, suspected uterine cancer, and infertility
• Usually performed in pre – menstrual phase from lateral wall of vagina.
• Interpretation :
• Presence of secretory endometrium Progesterone phase (cycles has been ovulatory)
• Presence of proliferative endometrium  Anovulatory cycle
• Luteal phase defect can also be diagnosed by endometrial biopsy (which shows a lag of 2 – 3 days between calendar and histological dating of specimen).
• Luteal phase defect is due to inadequte progesterone production by corpus luteum.

 Inadequate progesterone secretion could be due to :

• Inadequate follicular development
• Inadequate FSH or LH secretion
• Hyperprolactinemia
• Endometrial biopsy is contraindicated in suspected malignancy / sepsis. 
• Any radiological investigation in a young / reproductive age woman should be done between Day 1 to Day 10
• Endometrial Biopsy for diagnosis of TB should be done in late premenstrual phase as tubercles are present in superficial layer and shed during menstruation.
• Perforation of the uterus while doing endometrial biopsy in a case of suspected genital tuberculosis needs Laparascopy & Observation
• The tissue obtained is subjected to polymerase chain reaction test instead of culture.

FERN TEST:

• First done by Papanicolaou, in 1948.
• Cervical mucus during the estrogenic phase shows a characteristic pattern of fern formation, due to the presence of sodium chloride. 
• This ferning disappears after ovulation.
• At the time of ovulation, mucus has the property of great elasticity and will withstand stretching up to 10cm.
• This phenomenon is called spinnbarkeit or the thread test for oestrogen activity.
• During the secretory phase, the cervical mucus becomes tenacious & its viscosity increases so that it loses the property of spinnbarkeit (Tack)
• Insler devised a scoring system which took into account the various cervical mucus properties such as amount, spinnbarkeit, ferning, viscosity and cellularity.
• The maximum score is 15 and a score less than 10 are considered unfavorable.

Plasma progesterone:

• TT:progesterone suppository in the luteal phase or hCG 5000–10,000 IU weekly

Corpus luteal phase deficiency:

Eitiology:

• Hypopituitarism with low FSH, LH
• Poor follicular developmentHyperprolactinaemia.
• Clomiphene citrate (CC) ovulation induction
• Retrieval of egg in IVF.
• Poor response of endometrium to endogenous progesterone.

Diagnosis:

• Mid-luteal progesterone estimation
• BBT
• Endometrial biopsy

LH surge:

• 24 h prior to ovulation
• Ovulation is associated most commonly with LH surge
• RIA of morning sample of urine and blood give the LH results in 3 h
• Therapeutic applications in IVF & artificial insemination

FSH level:

• Raised :ovarian failure
• Low:pituitary dysfunction and anovulation

Thyroid tests:

• Hypothyroidism with raised TSH is related to hyperprolactinaemia

• Luteal phase defect is best diagnosed by Endometrial biopsy
• Perforation of the uterus while doing endometrial biopsy in a case of suspected genital tuberculosis needs Laparascopy & Observation
• Inadequate secretion of Progesterone may cause luteal phase defect 
• 20 – 22 days  is the right time in menstrual cycle to do endometrial biopsy in case of infertility.
• Fern test is due to Presence of NaCI under estrogenic effect
• The hormone responsible for a positive “Fern test” is Estrogen
• Ovulation is associated most commonly with LH surge
• Investigation of choice in post-menopausal bleeding is Endometrial biopsy
•  Endometrial biopsy best diagnostic method for finding out ovulation
• The best method of assessment of female fertility that allows accurate prediction of ovulation is the measurement of urinary LH surge (Hormonal Test).
• Hysteroscopy is not  a documentation test for ovulation in women of reproductive age
• The best time to do an endometrial biopsy in a patient with suspected endometrial cancer is 26th day