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Immunochemical tests of potential fertility.


 There are many methods of determining the physiological basis of cyclical periods of potential fertility: calculations, sensations, or physical or chemical biosensors. This article reviews the development of self-tests of potential fertility using immunoassay of hormone metabolites in urine. Indices of potential fertility in urine are the concentration of principal metabolites of steroid hormones and luteinizing hormone (LF). The ovaries produce an estimated 50-800 mcg of estradiol/day, the most active estrogen which is concentrated in the peripheral circulation during the preovulatory period of rapid follicular growth. Measurements may be taken from the blood, saliva, or cervico-vaginal fluid, and urine as estrogen-3 or 17 beta-glucuronide. The metabolism of progesterone shows changes at carbon atoms 3, 11, 17, and 20. Urine contains lower concentrations of 5 beta-pregnanediol-3 alpha-glucuronide (P3G), followed by 5 beta-pregnanediol glucuronide and 5 alpha-pregnanediol glucuronide. Methods of measurement are presented, including the mean changes in the urinary concentrations of estrogen 3-glucuronide (E3G) and P3G and their concentration ratio in relation to day 1 of menses, the day of luteinizing hormone LH peak, and the time limits for ovulation during menstrual cycle. A laboratory test of E3G in early morning urine (EMU) from 38 subjects showed that delineating a defined fertile period (day of maximum follicular diameter minus 3 to day plus 2) was possible in 89% of cases. New methods with immunotubes or immunostrips, novel antibodies, and idiometric assay attempt to improve the signal/background ratio; each method is described. Immunotubes for measuring steroid glucuronide may be light absorbing, light emitting (fluorescence polarization), and light emitting with time resolved fluorescence. Each procedure is described. The present technology demonstrates that immunoassays can be performed as self-tests, and what remains to be done is ascertaining the most appropriate one for determining potential fertility.
