Evaluation of the accuracy of the home ovulation detection kit, Clearplan, at predicting ovulation

Similar accuracy and patient experience with different one-step ovulation predictor kits

OBJECTIVE

To examine the accuracy of five different at-home ovulation predictor kits (OPKs), and to understand patient experience with the use of those kits.

DESIGN

Prospective cohort study.

SETTING

Single academic fertility practice.

PATIENT(S)

Patients with regular menses undergoing monitored natural cycle frozen embryo transfer, timed intercourse, and intrauterine insemination cycles involving daily blood luteinizing hormone (LH) level monitoring between 2022 and 2024.

INTERVENTION(S)

Use of five commercially available OPKs for the first 5 days of blood LH level monitoring with a daily experience survey.

MAIN OUTCOME MEASURE(S)

The primary outcome was the accuracy of the OPKs defined as concordance between test results (positive or negative) and blood LH level (above or below 25 mIU/mL). Secondary outcomes included positive predictive value, negative predictive value, sensitivity, and specificity of OPK surge detection. We also examined patient reports regarding the clarity of kit instructions, confidence in kit results, and likelihood of future purchase and use.

RESULT(S)

A total of 23 patients completed 97 total days of OPK testing, and 13 patients had a documented blood LH surge during their testing. Ovulation predictor kit surge detection accuracy compared with blood LH surge was similar across the five kits (Easy@Home, 95.88%; Wondfo, 94.85%; Pregmate, 96.90%; Clearblue, 91.75%; and Clinical Guard, 91.75%). Sensitivity was slightly better for Easy@ Home (75.00%), Wondfo (69.23%), and Pregmate (76.92%) than for Clearblue (61.54%) and Clinical Guard (38.46%). There were no clinically significant differences between the five OPKs regarding positive predictive value, negative predictive value, or specificity of surge detection. Participant experience was qualitatively similar across all five OPKs, with exception of slightly fewer patients reporting that they were likely to purchase and use Clinical Guard again in the future.

CONCLUSION(S)

All five tested-at-home one-step OPKs were highly accurate and performed similarly regarding patient experience despite variations in price.

Three-step method for menstrual and oral contraceptive cycle verification

OBJECTIVES

Fluctuating endogenous and exogenous ovarian hormones may influence exercise parameters; yet control and verification of ovarian hormone status is rarely reported and limits current exercise science and sports medicine research. The purpose of this study was to determine the effectiveness of an individualised three-step method in identifying the mid-luteal or high hormone phase in endogenous and exogenous hormone cycles in recreationally-active women and determine hormone and demographic characteristics associated with unsuccessful classification.

DESIGN

Cross-sectional study design.

METHODS

Fifty-four recreationally-active women who were either long-term oral contraceptive users (n=28) or experiencing regular natural menstrual cycles (n=26) completed step-wise menstrual mapping, urinary ovulation prediction testing and venous blood sampling for serum/plasma hormone analysis on two days, 6-12days after positive ovulation prediction to verify ovarian hormone concentrations.

RESULTS

Mid-luteal phase was successfully verified in 100% of oral contraceptive users, and 70% of naturally-menstruating women. Thirty percent of participants were classified as luteal phase deficient; when excluded, the success of the method was 89%. Lower age, body fat and longer menstrual cycles were significantly associated with luteal phase deficiency.

CONCLUSIONS

A step-wise method including menstrual cycle mapping, urinary ovulation prediction and serum/plasma hormone measurement was effective at verifying ovarian hormone status. Additional consideration of age, body fat and cycle length enhanced identification of luteal phase deficiency in physically-active women. These findings enable the development of stricter exclusion criteria for female participants in research studies and minimise the influence of ovarian hormone variations within sports and exercise science and medicine research.

Psychological and neuroendocrine reactivity to ostracism

This study used the ostracism detection theory to investigate how ostracism impacts individuals in two ways: (1) immediate poststressor needs, mood, ruminative thoughts, and desire to affiliate, and (2) short-term affective and cortisol reactivity. A total of 58 college students were randomly assigned to the inclusion or ostracism conditions of Cyberball, a virtual ball-tossing game. Immediately following the experimental manipulation, ostracized participants reported more thwarted psychological need states, more negative mood, and fewer positive ruminative thoughts, relative to their included counterparts. Ostracized participants reported a greater interest in affiliating with others in online or in-person settings. In the short-term, ostracized males reported more hostility than included males, although the scores were within expected norms for most males. There was no relation between Cyberball condition and gender across time for depression, anxiety, or positive affect. Approximately 20 min after the onset of the stressor, women in the luteal phase and women taking oral contraceptives in the ostracized group displayed higher cortisol than their counterparts in the included group. Relative to baseline, however, cortisol did not reliably increase after the onset of the stressor. Ostracized females taking oral contraceptives showed the greatest decline in cortisol, compared to included oral contraceptive users. Overall, results suggest that most of the negative effects of ostracism are immediate and limited to psychological, not neuroendocrine, responses.

Reproductive-endocrine point-of-care testing: current status and limitations

Point-of-care (POC) testing for the detection of pregnancy and the prediction of ovulation has grown and evolved since the introduction of the first qualitative pregnancy test marketed directly to the consumer over three decades ago. Numerous publications have analyzed both pregnancy and ovulation prediction devices for their sensitivity, accuracy and general utility. Despite vast improvements in ease-of-use and sensitivity from their earlier forms, the primary literature regarding the utility of these devices is at times incomplete. This article reviews the literature focusing on the sensitivity and accuracy of the modern urine-luteinizing hormone ovulation prediction devices, and the effect these devices have on fertility rates. In addition, the analytical sensitivity and clinical utility of POC pregnancy tests will be reviewed, along with the potential causes of false negative and false positive results.

A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women

BACKGROUND

Cognitive dietary restraint (CDR) may mediate subclinical ovulatory disturbances, which may result in loss of bone mineral density (BMD). CDR is associated with greater physical activity, which may modify the effect of CDR and ovulatory disturbances on bone mass.

OBJECTIVE

We aimed to investigate the relations among CDR, ovulatory disturbances, and physical activity and their effect on BMD in healthy premenopausal women over a 2-y period.

DESIGN

In this prospective cohort study, key explanatory factors, important covariates, and BMD were measured at baseline and at 12 and 24 mo; 225 women completed the baseline assessment, and 189 completed the study. CDR was measured with the Three-Factor Eating Questionnaire, and physical activity was measured with the Baecke scale. An average of 9.8 menstrual cycles in 2 y were monitored by using salivary progesterone measurements and urinary ovulation detection kits. Ovulatory disturbances included anovulatory cycles or short luteal phase lengths of <10 d. BMD at the lumbar spine, femoral neck, and total body was measured by using dual-energy X-ray absorptiometry. General linear mixed modeling was used to determine predictors of change in BMD over time.

RESULTS

CDR was not associated with ovulatory disturbances or changes in BMD. The average annual rate of change in lumbar spine BMD was decreased by 0.01 g/cm(2) in women who had experienced > or =3 monitored cycles with ovulatory disturbances (P = 0.02).

CONCLUSIONS

CDR did not predict bone loss, and there was no relation between CDR and ovulatory disturbances. Ovulatory disturbances had a negative effect on the rate of change at the lumbar spine. The cause of these disturbances is unknown.

Estimation of the day-specific probabilities of conception: current state of the knowledge and the relevance for epidemiological research

Conception, as defined by the fertilisation of an ovum by a sperm, marks the beginning of human development. Currently, a biomarker of conception is not available; as conception occurs shortly after ovulation, the latter can be used as a proxy for the time of conception. In the absence of serial ultrasound examinations, ovulation cannot be readily visualised leaving researchers to rely on proxy measures of ovulation that are subject to error. The most commonly used proxy measures include: charting basal body temperature, monitoring cervical mucus, and measuring urinary metabolites of oestradiol and luteinising hormone. Establishing the timing of the ovulation and the fertile window has practical utility in that it will assist couples in appropriately timing intercourse to achieve or avoid pregnancy. Identifying the likely day of conception is clinically relevant because it has the potential to facilitate more accurate pregnancy dating, thereby reducing the iatrogenic risks associated with uncertain gestation. Using data from prospective studies of couples attempting to conceive, several researchers have developed models for estimating the day-specific probabilities of conception. Elucidating these will allow researchers to more accurately estimate the day of conception, thus spawning research initiatives that will expand our current limited knowledge about the effect of exposures at critical periconceptional windows. While basal body temperature charting and cervical mucus monitoring have been used with success in field-based studies for many years, recent advances in science and technology have made it possible for women to get instant feedback regarding their daily fertility status by monitoring urinary metabolites of reproductive hormones in the privacy of their own homes. Not only are innovations such as luteinising hormone test kits and digital fertility monitors likely to increase study compliance and participation rates, they provide valuable prospective data that can be used in epidemiological research. Although we have made great strides in estimating the timing and length of the fertile window, more work is needed to elucidate the day-specific probabilities of conception using proxy measures of ovulation that are inherently subject to error. Modelling approaches that incorporate the use of multiple markers of ovulation offer great promise to fill these important data gaps.

Urinary-Based Ovulation and Pregnancy: Point-of-Care Testing

OBJECTIVE

To review the literature concerning ovulation prediction devices and pregnancy detection tests for home use.

DATA SOURCES

Articles were identified through searches of the MEDLINE (1966–May 2003), EMBASE (1980–May 2003), and International Pharmaceutical Abstracts (1970–May 2003) databases using the key words ovulation, ovulation detection, pregnancy test, diagnostic reagent kit, and diagnostic test. Additional references were located through review of the bibliographies of the articles found in the literature search. Searches were not limited by time restriction, language, or use of human or animal subjects.

STUDY SELECTION AND DATA EXTRACTION

Review articles, textbook chapters, and experimental and observational studies on home use ovulation and pregnancy tests were selected.

DATA SYNTHESIS

Luteinizing hormone (LH)-based ovulation tests have demonstrated accurate and superior ovulation detection when compared to basal body temperature charting, calendar calculation, salivary ferning, or observation of vaginal or cervical discharge changes. Systems using LH and estrone-3-glucuronide (E3G) have also demonstrated accurate detection of the fertile period. Literature evaluating home use of pregnancy tests has demonstrated accurate use by lay persons.

CONCLUSIONS

Urinary-based ovulation prediction and pregnancy detection tests available for use by nonprofessionals enable women and couples to take an active role in the family planning process. Numerous products are available at reasonable costs to the consumer.

A comparison of modality-specific somatosensory changes during menstruation in dysmenorrheic and nondysmenorrheic women

OBJECTIVE

The objective was to evaluate somatosensory thresholds to a multimodality stimulation regimen applied both within and outside areas of referred menstrual pain in dysmenorrheic women, over four phases of confirmed ovulatory cycles, and to compare them with thresholds in nondysmenorrheic women during menstruation.

DESIGN

Twenty dysmenorrheic women with menstrual pain scoring 5.45 +/- 0.39 cm (mean +/- standard error of mean) on a visual analog scale (10 cm) participated. Fifteen nondysmenorrheic women with a menstrual pain score of 0.4 +/- 0.2 cm participated as controls. Ovulation was confirmed by an enzyme-multiplied immunoassay technique. Menstrual pain was described with the McGill Pain Questionnaire. Areas within menstrual pain referral were two abdominal sites and the midline of the low back, and the arm and thigh were the control areas. The pressure pain threshold (PPT) and pinch pain threshold were determined by a hand-held electronic pressure algometer, the heat pain threshold (HPT) by a contact thermode, and the tactile threshold with von Frey hairs.

RESULTS

In dysmenorrheic women the McGill Pain Questionnaire showed a larger sensory and affective component of pain than the evaluative and miscellaneous groups. The HPT and PPT were lower in the menstrual phase than in the ovulatory, luteal, and premenstrual phases, both within and outside areas of referred menstrual pain (p <0.01), with a more pronounced decrease at the referral pain areas. The pinch pain threshold was lower in the menstrual phase than in the ovulatory phase (p <0.02), and the tactile threshold did not differ significantly across the menstrual phases or within any site. Dysmenorrheic women had a lower HPT at the control sites and a lower PPT at the abdomen, back, and control sites, than in those of nondysmenorrheic women in the menstrual phase.

CONCLUSIONS

The results show reduced somatosensory pain thresholds during menstruation to heat and pressure stimulation, both within and outside areas of referred menstrual pain in dysmenorrheic women. Dysmenorrheic women showed a lower HPT at the control sites and a lower PPT at all the sites than those for nondysmenorrheic women in the menstrual phase. The altered somatosensory thresholds may be dependent on a spinal mechanism of central hyperexcitability, induced by recurrent moderate to severe menstrual pain.

Sensory changes during the ovulatory phase of the menstrual cycle in healthy women

This study compared the pain sensitivity in healthy women at the abdomen and lower back (presumed referral areas of menstrual pain), thigh and arm (control areas), in the menstrual, ovulatory, luteal and premenstrual phases of confirmed ovulatory cycles, with that of males. The pressure pain threshold (PPT) and pinch pain threshold (PiPT) was determined by an electronic pressure algometer, heat pain threshold (HPT) by a contact thermode and tactile threshold (TT) with von Frey hairs. The abdominal PPT was significantly lower in females in all menstrual phases as compared to the control sites ( p<0.0007). The abdominal and lower back HPT was significantly lower in females in all menstrual phases compared with control areas, and to the sites in males ( p<0.002). The TT was significantly reduced in females compared with males ( p< 0.013). There was no difference in the PiPT between females and males. In males, the HPT, PPT and TT were not different within any site. During the ovulatory phase, the HPT was significantly reduced at the abdomen and the PPT at the back compared with the menstrual, luteal and premenstrual phases (p<0.0002). There were no within-menstrual phase variations in the PiPT and TT at any site, or for the HPT and PPT at the control areas. The reduced thresholds in menstruating women may be due to the presence of latent uterine algogenic stimuli, and the increased levels of oestrogen and leuteinizing hormone at ovulation may enhance nociception by acting both at the peripheral and central level, resulting in the hypersensitivity changes at the abdomen and lower back areas.

Cardiovascular and mood responses to quantified doses of cigarette smoke in oral contraceptive users and nonusers

Previous research suggests that the female sex hormones may moderate cardiovascular and mood responses to cigarette smoking and abstinence. To test this possibility, acute effects of cigarette smoking on cardiovascular reactivity and mood were examined in 12 oral contraceptive users and 12 nonusers across two menstrual phases (early and late cycle). After overnight deprivation, each participant attended two sessions in which they first sham-smoked and then smoked two standard cigarettes, via a quantified smoke delivery system. Oral contraceptive users exhibited larger cigarette smoking-induced increases in heart rate compared with nonusers. In addition, cigarette smoking-induced cardiovascular changes varied with both the phase of the menstrual cycle and oral contraceptive use. No menstrual phase-dependent effects were observed for tobacco withdrawal symptoms, premenstrual symptoms, or moods prior to smoking. Cardiovascular hyperreactivity to cigarette smoke in oral contraceptive users may help explain the mechanisms by which smoking and oral contraceptive use contribute to an elevated risk for coronary heart disease.

The use of clearplan home ovulation detection kits in unexplained and male factor infertility

One hundred and five couples with unexplained infertility and 43 couples whose infertility was thought to be due to reduced sperm motility were recruited. The median duration of infertility was 36 months (range 12-168). Couples were randomly allocated to either using Clearplan home ovulation detection kits for 3 cycles or were advised about the optimal time during their menstrual cycle to achieve a pregnancy. The clinical details of the 2 groups were similar. In couples with unexplained infertility over the study period 10 (20.4%) in the Clearplan group and 9 (16%) in the control group conceived with 58% of pregnancies occurring in the first cycle. In couples with reduced sperm motility, the results were disappointing with only 2 (8%) pregnancies in the Clearplan group and 2 (11.1%) in the controls. Assisted reproduction technology may not be justified as the first line of management in patients with unexplained infertility.

The clinical value of Clearplan home ovulation detection kits in infertility practice

A home ovulation testing kit, Clearplan, that detects the urinary luteinizing hormone (LH) surge was used by 32 patients on a donor insemination programme for 50 cycles to indicate when to first attend the clinic for a serum LH test to determine ovulation. Using Clearplan significantly reduced the number of clinic attendances (4.06 +/- 1.5) compared to the preceding control cycle (7.06 +/- 2.0 p less than 0.001). One serum LH peak was missed using Clearplan. Ovulation was predicted within 2 days of the serum LH surge in 77% of cycles. Home ovulation determination has the potential to reduce the stress and cost of fertility programmes.