gynecology and obstetrics
Ovulatory Dysfunction
Diagnosis of Ovulatory Dysfunction
Menstrual history Sometimes basal body temperature monitoring Home ovulation testing kits Measurement of urinary or serum hormones or ultrasonography Anovulation is often apparent based on the menstrual history. Symptothermal method can help determine whether and when ovulation is occurring. However, this method is often inaccurate. More accurate methods include Home testing kits,which detect an increase in urinary luteinizing hormone (LH) excretion 24 to 36 hours before ovulation (requiring daily testing for several days around midcycle, usually beginning about or after cycle day 9) Pelvic ultrasonography,which is used to monitor increases in ovarian follicle diameter and collapse of the follicle (monitoring should begin in the late follicular phase) Measurement of serumprogesteroneor urinary pregnanediol glucuronide(a urinary metabolite ofprogesterone) Serumprogesteronelevels of≥3 ng/mL (≥9.75 nmol/L) or elevated levels of pregnanediol glucuronide in urine (measured, if possible, 1 week before onset of the next menstrual period) indicate that ovulation has occurred. Intermittent or absent ovulation should prompt evaluation for disorders of the pituitary, hypothalamus, or ovaries (especially PCOS). 