title: Monitoring the menstrual cycle: Comparison of urinary and serum reproductive hormones referenced to true ovulation.
abstract: OBJECTIVE
  The aim of the study was to examine relationships and interindividual variations in urinary and serum reproductive hormone levels relative to ultrasound-observed ovulation in menstrual cycles of apparently normally menstruating women.
  
  
  METHODS
  This was a prospective study of normally menstruating women (no known subfertility), aged 18-40 years (n = 40), who collected daily urine samples and attended the study centre for blood samples and transvaginal ultrasound during one complete menstrual cycle. Serum luteinising hormone (LH), progesterone, estradiol, urinary LH, pregnanediol-3- glucuronide (P3G) and estrone-3-glucuronide were measured. Ultrasound was conducted by two physicians and interpreted by central expert review.
  
  
  RESULTS
  Menstrual cycle length varied from 22 to 37 days (median 27 days). Ovulation by ultrasound ranged from day 8 to day 26 (median day 15). Serum and urinary hormone profiles showed excellent agreement. Estrogen and LH hormone peaks in urine and serum showed a range of signal characteristics across the study group before and after ovulation. The rise in estrogen and LH always occurred before ovulation; the progesterone rise from baseline always occurred after ovulation.
  
  
  CONCLUSIONS
  Urinary and serum reproductive hormones showed excellent agreement and may be used interchangeably. The beginning of the surge in serum and urinary LH was an excellent predictor of ovulation. The rise in progesterone and P3G above baseline was a consistent marker of luteinisation confirming ovulation. Both LH and progesterone surges delivered clear, sharp signals in all volunteers, allowing reliable detection and confirmation of ovulation.
authors.affiliation: a Endocrinology- and IVF-Centre , Grevenbroich , Germany , and Department of Gynaecology and Obstetrics , University of Cologne , Cologne , Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Roos
authors.affiliation: b SPD Development Company Ltd , Bedford , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.affiliation: b SPD Development Company Ltd , Bedford , UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Weddell
authors.affiliation: c Medical Faculty (Biostatistics), Heinrich-Heine-University Düsseldorf , Hellenthal , Germany.
authors.forename: Erhard
authors.initials: E
authors.lastname: Godehardt
authors.affiliation: d Mathematical Institute, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Schiffner
authors.affiliation: a Endocrinology- and IVF-Centre , Grevenbroich , Germany , and Department of Gynaecology and Obstetrics , University of Cologne , Cologne , Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Freundl
authors.affiliation: a Endocrinology- and IVF-Centre , Grevenbroich , Germany , and Department of Gynaecology and Obstetrics , University of Cologne , Cologne , Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gnoth
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D019160:Endosonography; D004958:Estradiol / Q000097:blood; D004970:Estrone / Q000031:analogs & derivatives / Q000652:urine; D005260:Female; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood / Q000652:urine; D008597:Menstrual Cycle / Q000097:blood* / Q000652:urine*; D008991:Monitoring, Physiologic / Q000379:methods; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D010060:Ovulation / Q000097:blood* / Q000652:urine*; D010061:Ovulation Detection / Q000379:methods*; D011237:Predictive Value of Tests; D011276:Pregnanediol / Q000031:analogs & derivatives / Q000652:urine; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; C022270:pregnanediol-3 alpha-glucuronide; C015856:estrone-3-glucuronide; D004970:Estrone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D011276:Pregnanediol
keywords: Estradiol; Estrone-3-glucuronide (E3G); Luteinising hormone (LH); Ovulation; Pregnanediol-3-glucuronide (P3G); Progesterone; Reproductive hormones; Transvaginal ultrasound