title: Ovulation detection methods for urinary hormones: precision, daily and intermittent sampling and a combined hierarchical method.
abstract: BACKGROUND
  We evaluate the performance of ovulation detection methods and present new approaches, including evaluation of methods for precision, combining multiple markers into a hierarchical system and using ovulation markers in intermittent sampling designs.
  
  
  METHODS
  With serum LH peak day as the 'gold standard' of ovulation, we estimated accuracy and precision of ovulation day algorithms using 30 ovulatory menstrual cycles with daily urinary and serum hormones and transvaginal ultrasound. Sensitivity and specificity for estimating the presence of ovulation were tested using visually assessed ovulatory (30) and anovulatory (22) cycles.
  
  
  RESULTS
  Sensitivity and specificity ranged from 70 to 100% for estimating presence of ovulation with twice-per-cycle, weekly, twice weekly, every-other-day and daily specimens. A combined hierarchical method estimated ovulation day using daily specimens within +/-2 days of the gold standard in 93% of cases. Accuracy of estimating ovulation day within +/-2 days using intermittent sampling ranged from 40% (weekly sampling) to 97% (every-other-day).
  
  
  CONCLUSIONS
  A combined hierarchical algorithm using precise and accurate markers allows maximal use of available data for efficient and objective identification of ovulation using daily specimens. In intermittent sampling designs, the presence and the timing of ovulation can be estimated with good sensitivity, specificity and accuracy.
authors.affiliation: Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA. oconnork@u.washington.edu
authors.forename: K A
authors.initials: KA
authors.lastname: O'Connor
authors.forename: E
authors.initials: E
authors.lastname: Brindle
authors.forename: R C
authors.initials: RC
authors.lastname: Miller
authors.forename: J B
authors.initials: JB
authors.lastname: Shofer
authors.forename: R J
authors.initials: RJ
authors.lastname: Ferrell
authors.forename: N A
authors.initials: NA
authors.lastname: Klein
authors.forename: M R
authors.initials: MR
authors.lastname: Soules
authors.forename: D J
authors.initials: DJ
authors.lastname: Holman
authors.forename: P K
authors.initials: PK
authors.lastname: Mansfield
authors.forename: J W
authors.initials: JW
authors.lastname: Wood
mesh_terms: D000328:Adult; D002624:Chemistry, Clinical / Q000379:methods*; D004970:Estrone / Q000031:analogs & derivatives / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006728:Hormones / Q000652:urine*; D006801:Humans; D007986:Luteinizing Hormone / Q000032:analysis / Q000097:blood; D008875:Middle Aged; D010060:Ovulation / Q000652:urine*; D011276:Pregnanediol / Q000031:analogs & derivatives / Q000097:blood; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D006728:Hormones; C022270:pregnanediol-3 alpha-glucuronide; C015856:estrone-3-glucuronide; D004970:Estrone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D011276:Pregnanediol