To assess ovulation in infertile women using urinary luteinizing hormone surge kits versus transvaginal ultrasonography

Urmila Karya, Vibha Chauhan, Anupam Rani


Background: The study was conducted to evaluate the efficacy of urinary LH surge kits and TVS to detect ovulation in induced cycles and to compare the ovulation rates by both methods.

Methods: Prospective experimental randomized control trial on 72 women with an ovulatory infertility aged 18-35 years, fulfilling the inclusion criteria were given letrozole for ovulation induction. All were randomly divided in two groups. Group 1 woman were asked to check ovulation by urinary LH surge kits and group 2 women were called for follicle monitoring by TVS.

Results: Letrozole has no negative effect on endometrium; induced cycle has larger diameter of follicle (median: 22 mm). In induced cycle ovulation occurs later compared to normal cycle (D-16) and half of the women had a BMI more than the recommended WHO criteria (average was 25.28 kg/m2). Number of letrozole cycles (p=0.2642), dose requirement (p=0.0812) and pregnancy rates (10.26% versus 18.19%) were comparable in both groups.

Conclusions: TVS is objective, accurate and thus standard modality for ovulation detection. LH surge kit is subjective, having more chances of error but can be used as a good alternative in certain settings like woman of remote area, woman having fear of invasive modality and COVID era woman who are afraid to visit hospital repeatedly.


LH surge kit, TVS, Ovulation

Full Text:



Mais V, Keyser RR, CetelNS,Rivier J, Vale W, Yen SSC. The dependency of folliculogenesis and corpus luteum function on pulsatile gonadotropin secretion in cycling women using a gonadotropin releasing hormone antagonist as a probe. J Clin Endocrinol Metab. 1986;62(6):1250-5.

Chappel SC, Resko JA, Norman RL, Spies HG. Studies in Rhesus monkeys on the site where estrogen inhibits gonadotropins: delivery of 17β-estradiol to the hypothalamus and pituitary gland. J Clin Endocrinol Metab. 1981;52(1):1-8.

Buckler HM, Healy DL, Burger HG. Purified FSH stimulates production of inhibin by the human ovary. J Endocrinol. 1989;122(1):279-85.

Gould JE, Overstreet JW, Hanson FW. Assessment of human sperm function after recovery from the female reproductive tract. Biol Reprod. 1984;31(5):888-94.

Park S, Goldsmith L, Skurnick J, Wojtczuk A, Weiss G. Characteristics of the urinary luteinizing hormone surge in young ovulatory women. Fertil Steril. 2007; 88(3):684-90.

Ceric F, Silva D, Vigil P. Ultrastructure of the human periovulatory cervical mucus. J Electron Microsc. 2005;54(5):479-84.

Ellison PT. Salivary steroids and natural variation in human ovarian function. Ann N Y Acad Sci. 1994; 709(1):287-98.

Lu YC, Bentley GR, Gann PH, Hodges KR, Chatterton RT. Salivary estradiol and progesterone levels in conception and nonconception cycles in women: evaluation of a new assay for salivary estradiol. Fertil Steril. 1999;71(5):863-8.

Fehring RJ. Accuracy of the peak day of cervical mucus as a biological marker of fertility. Contraception. 2002;66(4):231-5.

Berglund Scherwitzl E, Lindén Hirschberg A, Scherwitzl R. Identification and wwprediction of the fertile window using Natural Cycles. Eur J Contracept Reprod Health Care. 2015;20(5):403-8.

Tiplady S, Jones G, Campbell M, Johnson S, Ledger W. Home ovulation tests and stress in women trying to conceive: a randomized controlled trial. Hum Reprod. 2012;28(1):138-51.

Young JR, Jaffe RB. Strength duration characteristics of estrogen effects on gonadotropin response to gonadotropin releasing hormone in women. II. Effects of varying concentrations of estradiol. J Clin Endocrinol Metab. 1976;42(3):432-42.

Cahill DJ, Wardle PG, Harlow CR, Hull MGR. Onset of the preovulatory luteinizing hormone surge: diurnal timing and critical follicular prerequisites. Fertil Steril. 1998;70(1):56-9.

Eichner SF, Timpe EM. Urinary based ovulation and pregnancy: point of care testing. Ann Pharmacother. 2003;38(2):325-31.