title: Use of urinary pregnanediol 3-glucuronide to confirm ovulation.
abstract: OBJECTIVE
  Urinary hormonal markers may assist in increasing the efficacy of Fertility Awareness Based Methods (FABM). This study uses urinary pregnanediol-3a-glucuronide (PDG) testing to more accurately identify the infertile phase of the menstrual cycle in the setting of FABM.
  
  
  METHODS
  Secondary analysis of an observational and simulation study, multicentre, European study. The study includes 107 women and tracks daily first morning urine (FMU), observed the changes in cervical mucus discharge, and ultrasonography to identify the day of ovulation over 326 menstrual cycles. The following three scenarios were tested: (A) use of the daily pregnandiol-3a-glucuronide (PDG) test alone; (B) use of the PDG test after the first positive urine luteinizing hormone (LH) kit result; (C) use of the PDG test after the disappearance of fertile type mucus. Two models were used: (1) one day of PDG positivity; or (2) waiting for three days of PDG positivity before declaring infertility.
  
  
  RESULTS
  After the first positivity of a LH test or the end of fertile mucus, three consecutive days of PDG testing over a threshold of 5μg/mL resulted in a 100% specificity for ovulation confirmation. They were respectively associated an identification of an average of 6.1 and 7.6 recognized infertile days.
  
  
  CONCLUSIONS
  The results demonstrate a clinical scenario with 100% specificity for ovulation confirmation and provide the theoretical background for a future development of a competitive lateral flow assay for the detection of PDG in the urine.
authors.affiliation: Hospices Civils de Lyon, Service de Biostatistique, F-69003 Lyon, France. rene.ecochard@chu-lyon.fr
authors.forename: R
authors.initials: R
authors.lastname: Ecochard
authors.forename: R
authors.initials: R
authors.lastname: Leiva
authors.forename: T
authors.initials: T
authors.lastname: Bouchard
authors.forename: H
authors.initials: H
authors.lastname: Boehringer
authors.forename: A
authors.initials: A
authors.lastname: Direito
authors.forename: A
authors.initials: A
authors.lastname: Mariani
authors.forename: R
authors.initials: R
authors.lastname: Fehring
mesh_terms: D000328:Adult; D005260:Female; D005298:Fertility / Q000502:physiology; D006801:Humans; D010060:Ovulation / Q000652:urine*; D011276:Pregnanediol / Q000031:analogs & derivatives* / Q000652:urine; D011446:Prospective Studies; D012372:ROC Curve; D055815:Young Adult
chemical_list: C022270:pregnanediol-3 alpha-glucuronide; D011276:Pregnanediol
keywords: Fertility awareness methods; Luteinizing hormone; Menstrual cycle; Natural family planning; Ovulation; Pregnandiol-3-glucuronide