Pregnancy Planning: Ovulation/Pregnancy Testing

Question 1

OVULATION TEST KITS

Answer 1

§ Predicts when ovulation will
occur (most fertile window)
§ Timing sexual intercourse to
coincide with most fertile
time
§ Ovum is viable for 12-24 hours
§ Sperm live up to 5 days
§ FOUR optimal days for
fertilization:
–2 days before ovulation
–Day of ovulation
–Day after ovulation
**Ideally, 24 hours after the LH
Surge

Question 2

Basal Thermometers

Answer 2

§ Basal body temperature is the temperature that occurs prior
to rising in the morning (need at least 4 hours of sleep).
§ Body temp rises as ovulation occurs – coinciding with
progesterone release
–0.5°F or 0.28°C over 3 days
§ Must be done at the same time each day.
§ Temperature can be taken oral, rectal or vaginal

we’re trying to predict when that initial increase in body temperature happens, so that we can predict when ovulation occurs

So ideally the basal temperature is taken over a few cycles. And when that body temperature rises, the recommendation is for the couple to have intercourse every two days

Question 3

Basal Thermometers
Issues

Answer 3

– Ovulation may have occurred before actual detection
– Interference: emotions, infections, movements, eating,
drinking, talking, smoking
Best used in conjunction with ovulation prediction tests

Question 4

symptothermal method

Answer 4

this is a symptothermal chart and it includes the measurement of the basal temperature, but also a number of other symptoms that could indicate fertility and when ovulation is happening, usually using a combination of using the basal thermometer as well as a number of other symptoms is probably more predictive of when ovulation is more likely to happen

ight around the time of ovulation, the cervical mucus changes from that sticky, white looking thicker mucus, two more that stretchy, clear. This gets kinda material to allow for sperm penetration

After ovulation, the progesterone levels increase and this results in that cervical mucus that is again back to being sticky and white and thicker.

Question 5

Saliva Tests

Answer 5

§ As estrogen levels increase, NaCl in mucus
secretions increases
–results in crystallization or ferning of mucus
when dried
§ During fertile period, the pattern of crystals
change from small dots to small ferns to large
ferns
§ Manufacturers claim that these devices if used
as directed should provide 24-72 hours of
advance notification of ovulation

Question 6

Ovulation Prediction Tests

Answer 6

§ Use of monoclonal antibodies specific to LH
§ LH gets sandwiched between two antibodies and results in a
color change
§ Color intensity depends on amount of LH present
§ Urine based tests

Question 7

Ovulation Prediction Tests

Answer 7

§ Results read in 3-5 minutes
§ Watch for change in color intensity over baseline
§ Once surge has been detected, stop testing
§ Best to use early morning urine sample (LH is most concentrated)
§ Begin testing 2-4 days before expected ovulation
§ Test for 5 to 7 consecutive days to determine color change

Question 8

Patient Counseling

Answer 8

§ Educate patient on the viability of ovum and sperm in the
reproductive tract.
§ Storage they should be kept in their original packaging
§ Review interferences:
*anovulatory or irregular cycles (test for 9 consecutive days)
*medications – danazol, fertility treatments
§ Good time to counsel about avoiding alcohol if trying to get
pregnant and other prenatal advice.

Question 9

Fertility Monitors

Answer 9

§ Detects LH and the rise of estrone-3-glucuronide (estradiol
metabolite, E3G)
–E3G concentrations are a good marker for the fertility
window
§ Personalized & accurate - Identifies up to 6 fertile days
–Stores 6 cycles of information
§ Does not require regular menstrual cycles

Question 10

Male Infertility

Answer 10

Home Sperm Tests
§ Uses monoclonal antibodies that recognizes sperm
specific acrosomal protein SP-10.
§ Best time: At least 48 hours but not more than 7
days since last ejaculation.
§ Sperm is ejaculated into collection cup, sit for 10
minutes – 1 hour (depending on test) and then
tested.
§ Role: self-diagnostic tool, help decide if need
further clinical evaluation
Positive result >15 -
20 million sperm/ml

The purpose of the test is to determine if further clinical evaluation is needed. Positive results mean good sperm count, meaning that there is 15 to 20 million sperms per mil or greater.

Question 11

Home Sperm Tests

Answer 11

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Question 12

Pregnancy Tests

Answer 12

§ Detect human chorionic gonadotropin (HCG) in urine
§ Details on HCG
–Can be detected up to 6 – 8 days after conception
–Doubles every 2 days until reaches peak 60-70 days after
conception, then decreases to a lower level throughout
pregnancy
–After birth, levels drop to undetectable in 8 weeks
–Highest concentrations between 9 am and 12 pm.
HCG binds to a monoclonal antibody
§ This complex then binds to a second monoclonal antibody
bound to a solid surface
§ Produces a reaction on the test/wand strip resulting in:
–a color change
–the appearance of lines
–or, the appearance of the word pregnant

The HCG initially binds to a monoclonal antibody, and then this complex then binds to a second monoclonal antibody that’s bound to a solid surface. This binding results in a reaction on the test, resulting in either like some kind of color change or the appearance of line where even the appearance of the word pregnant

And if there’s gonna be a problem, it’s usually because of human error. These tests are very sensitive. They are down to 20 milli international units per ml depending on the test

Question 13

Pregnancy Tests
Accuracy?

Answer 13

§ Manufacturers claim 94-99%
accuracy
§ Human error is most common
reason for erroneous results
§ Sensitive to 20 mIU/ml
depending on test (note: blood
tests can detect as low as 1
mIU/ml)
Limitations:
§ wide variation in HCG
concentrations (12-
2438mIU/ml) during 4th
week of pregnancy

Question 14

Patient Counseling preg test

Answer 14

Proper Use:
§ Remove from foil wrapper, remove cap
§ Hold absorbent end in urine stream (5-10 seconds)
§ Read results in 3 minutes, depending on kit chosen – note: can
wait up to 10 minutes.
§ Follow manufacturer specific instructions!

§ Determine if timing is appropriate
§ Store properly
§ Check expiration dates
§ If negative results, retest in 7 days if menses has not occurred
§ Good time to mention about avoiding alcohol.

Question 15

Pregnancy Tests
False Positives

Answer 15

miscarriage or abortion in
preceding 8 weeks
tumors which secrete HCG (uncommon)
fertility medications (i.e. HCG
injection

high specificity. There’s a low degree of false positives that can happen. False positives can occur because of a miscarriage or abortion in the preceding eight weeks.

Question 16

False Negatives:

Answer 16

test performed too early or
too late
expired testing kit
chilled or dilute urine
cloudy, pink or red urin

sensitivity is also high with pregnancy tests, but it’s not as high as their specificity. False negatives, though, a low-risk, are more common than false positives.
The reason for that is false negatives are often from human error and this can happen. E.g. false negatives can happen from a test performed too early or too late. So too early before there’s enough rise of HCG or too late when the hCG levels declined to a lower level. If the test is expired, if the urine is cloudy or if there’s blood in the urine could could affect that.