title: Pilot test and validation of the peak day method of prospective determination of ovulation against a handheld urine hormone monitor.
abstract: BACKGROUND
  Transient exposures may influence fertility and early embryonic development. To assess the time of conception in vivo and conduct concurrent biomonitoring, ovulation must be identified prospectively. We report on the development and validation of a simple, prospective method, the Peak Day method, to determine likely day of ovulation based upon daily observations of cervical fluid.
  
  
  METHODS
  We recruited 98 women to learn the Peak Day method from a brochure, 26 of whom concurrently used the method with blinded daily urine hormone monitoring (estrone glucuronide and luteinizing hormone). All women were instructed to complete an exposure questionnaire immediately upon identifying ovulation. Briefly, the exposure questionnaire captured time-varying and transient exposures such as medication use, water consumption, and amount of sleep. We assessed timely completion of the exposure questionnaire, agreement of women's estimated day of ovulation (EDO) and the EDO by expert review, and agreement between the EDO by expert review and by blinded urine monitoring.
  
  
  RESULTS
  Of 147 cycles evaluated, women selected an EDO in 130 (88%) and subsequently completed the periovulatory exposure questionnaire in 122 (94%) cycles. Of the 26 cycles evaluated with blinded hormonal monitoring, the Peak Day "best quality" algorithm, based upon cervical fluid, identified ovulation ± 3 days of the urine monitor in 24 cycles (92%).
  
  
  CONCLUSIONS
  With simple written instructions, women can identify an estimated day of ovulation and perform periovulatory exposure assessment. The Peak Day method is highly cost-effective and could be applied by researchers to target periconceptional or very early developmental stage exposure assessment.
authors.affiliation: Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA. christy.porucznik@utah.edu.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Porucznik
authors.forename: Kyley J
authors.initials: KJ
authors.lastname: Cox
authors.forename: Karen C
authors.initials: KC
authors.lastname: Schliep
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Stanford
mesh_terms: D000293:Adolescent; D000328:Adult; D002582:Cervix Mucus / Q000502:physiology*; D004781:Environmental Exposure; D004970:Estrone / Q000031:analogs & derivatives / Q000652:urine; D005260:Female; D005298:Fertility / Q000502:physiology; D020719:Glucuronides / Q000652:urine; D006801:Humans; D007986:Luteinizing Hormone / Q000652:urine; D008597:Menstrual Cycle / Q000502:physiology; D010060:Ovulation / Q000502:physiology*; D010061:Ovulation Detection / Q000379:methods*; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods; D010865:Pilot Projects; D015203:Reproducibility of Results; D055815:Young Adult
chemical_list: D020719:Glucuronides; D004970:Estrone; D007986:Luteinizing Hormone