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Question
Posted by: new2ttc | 2008/07/16

Interpreting ovulation tests

Dear Dr. Cassim,

Have been TTC since Jnuary 08. I have been testing with ClearBlue ovulation urine test strips and have been ovulating for 5 months ( since testing, do not know if I DID ovulate before or not) Cycle is about 30 - 35 days long with Luteal Phase of 10 - 12 days. I am 34 and we are getting worried about fertility. Endocrinologist has tested hormones and found "slightly" raised prolactin - she is not concerned about prolactinoma and simply prescribed glucophage to assist ( she ensures me that my fasting glucose test was normal!) So I do not have diabetes and I am about 8kgs overweight with a BMI of 26.5 I am working on this with regular exercise and low GI eating plan - which seems to be bearing very little result - Have been very strict with the eating plan and have only lost 2kgs in two months! The gynea did a sonar and is satisfied that he cannot see endo or PCOS or any other structural problems.
Question 1: Does this testing strip show with cetainty that I am ovulating, or can one have the LH surge regularly without ovulating?
Question 2: What would the first line treatment be if I were to come in to Bio Art?
Thank you!

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Our expert says:
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Dear New2ttc

The ovulation testing kits depend on elevated LH levels and in some patients with severe PCOS, baseline LH levels may be indeed significantly elevated intermittently to give a positive pseudo-ovulation test. The approach to the problem may be to confirm a mid-luteal progesterone level in this particular instance i.e. 7 to 8 days after a positive ovulation test has been detected, a serum progesterone level should be done and if this level is in excess of 25 then one can assume adequate ovulation. Should levels be below that then the initial discussion holds. The approach to the treatment would be a phase of down-regulation using either oral contraceptives or progestins before commencing on an ovulation induction protocol together with follicular tracking by ultrasound scanning. Follicle tracking is by far the more superior method of monitoring ovarian response and ovulatory changes.



Answered by: Dr.M.I. Cassim

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