title: Development of the first urinary reproductive hormone ranges referenced to independently determined ovulation day.
abstract: BACKGROUND
  Urinary hormone level analysis provides valuable fertility status information; however, previous studies have not referenced levels to the ovulation day, or have used outdated methods. This study aimed to produce reproductive hormone ranges referenced to ovulation day determined by ultrasound.
  
  
  METHODS
  Women aged 18-40 years (no reported infertility) collected daily urine samples for one complete menstrual cycle. Urinary luteinising hormone (LH), estrone-3-glucuronide (E3G, an estradiol metabolite), follicle stimulating hormone (FSH) and pregnanediol-3-glucuronide (P3G, a progesterone metabolite) were measured using previously validated assays. Volunteers underwent trans-vaginal ultrasound every 2 days until the dominant ovarian follicle size reached 16 mm, when daily scans were performed until ovulation was observed. Data were analysed to create hormone ranges referenced to the day of objective ovulation as determined by ultrasound.
  
  
  RESULTS
  In 40 volunteers, mean age 28.9 years, urinary LH surge always preceded ovulation with a mean of 0.81 days; thus LH is an excellent assay-independent predictor of ovulation. The timing of peak LH was assay-dependent and could be post-ovulatory; therefore should no longer be used to predict/determine ovulation. Urinary P3G rose from baseline after ovulation in all volunteers, peaking a median of 7.5 days following ovulation. Median urinary peak E3G and FSH levels occurred 0.5 days prior to ovulation. A persistent rise in urinary E3G was observed from approximately 3 days pre- until 5 days post-ovulation.
  
  
  CONCLUSIONS
  This study provides reproductive hormone ranges referenced to the actual day of ovulation as determined by ultrasound, to facilitate examination of menstrual cycle endocrinology.
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.forename: Sarah
authors.initials: S
authors.lastname: Weddell
authors.forename: Sonya
authors.initials: S
authors.lastname: Godbert
authors.forename: Guenter
authors.initials: G
authors.lastname: Freundl
authors.forename: Judith
authors.initials: J
authors.lastname: Roos
authors.forename: Christian
authors.initials: C
authors.lastname: Gnoth
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006728:Hormones / Q000652:urine*; D006801:Humans; D010060:Ovulation; D012016:Reference Values; D016482:Urinalysis / Q000592:standards*; D055815:Young Adult
chemical_list: D006728:Hormones