Parenting: Preconception

Couples with fertility problems can often improve their chances of conceiving by accurately predicting when and if the woman is ovulating. Available in more than a dozen different forms, ovulation predictors are making it easier for women to detect when they are ovulating. With so many varieties on the market, it can be difficult to know which one is right for you.

Urine vs. Saliva
"The trigger that causes ovulation to occur is the increased release of luteinizing hormone (LH) from the pituitary gland," explains Dr. Randy Morris, a reproductive endocrinologist from Naperville, Ill. "Before ovulation, the LH levels are low. At some point, the LH levels begin to rise rapidly. This is called the LH surge. The duration of time that the LH levels are high is about 48 hours from start to finish. Release of the egg from the ovary happens about 35 to 44 hours after the onset of the surge."

When comparing urine to saliva ovulation testers, it is important to understand how each works – and why.

The LH in the blood is eventually filtered through the kidney which causes the levels in the urine to increase, says Dr. Morris. "When a level of LH is present in the urine, it causes an indicator to change colors for most testers," he says. "A 'control' indicator is usually given to compare the change in color. Ovulation usually occurs in 12 to 24 hours."

There are advantages and disadvantages to both the urine and the saliva ovulation testers. With the urine testers, if the test starts out negative and then turns positive, it can be the most accurate indicator of impending ovulation.

"Even when the urine test turns positive, you still don't know exactly when the ovulation surge began," says Dr. Morris. "If, for example, you test every morning and it is negative on Monday and positive on Tuesday, when did the surge begin? Monday morning after the test? Monday night?"

The test can also be affected by how concentrated the urine is due to factors such as dehydration or first morning urine. They can also be affected by certain medical conditions that may cause a woman to have higher levels of LH at all times.

The saliva testers work by having women smear some saliva on a glass slide each day and then observe it through a hand-held microscope, says Dr. Morris. "In a woman who normally develops eggs each month, the slides should develop ferning as the estrogen levels rise and get close to the time when ovulation should occur," he says. "The advantage of this system is that it is easy to use, no messing with urine, and the development of ferns is a gradual process which allows a woman advance warning that ovulation may be getting close."

Dr. Morris indicates that the disadvantage to the saliva testers are that they don't actually predict ovulation, but instead demonstrate that the estrogen levels have increased and that the woman may therefore be close to the time of ovulation. "Anything that increases the estrogen levels, such as cysts, hormones and fertility medications may cause ferning when ovulation is not imminent," he says.

The Right Choice
Dr. Morris maintains that currently there isn't any data that indicates that ovulation predictor kits actually help couples achieve pregnancy more easily than having periodic intercourse. "If you have menstrual cycles that last 26 to 35 days, and you have intercourse every other day from day 13 through 21, you will be just as likely to get pregnant as you would with an ovulation predictor kit," he says.

If you were unsure whether you are ovulating, Dr. Morris says it would be wise to use a kit once or twice to confirm ovulation in order to obtain pregnancy. He explains that if you are trying to get pregnant with a method that requires very accurate timing of sperm placement in the uterus, the ovulation kit can be very helpful.

"Most of my patients do report using ovulation kits before coming to see me," says Dr. Morris. "In order to decrease the costs of monitoring, some of my patients will use ovulation kits to predict ovulation for the purpose of timing an intrauterine insemination."

What's the right choice? If your cycle is generally regular, Dr. Morris suggests that women use the least expensive urinary kit that they can find. If a woman's cycles are irregular or long, Dr. Morris suggests the saliva tester would be a better choice. "You can test for 40 to 50 days on a single kit," he says. "Combination urinary kits ... add nothing to the chances for achieving pregnancy and are dramatically more expensive."

Dr. Lawrence Layman, section chief of reproductive endocrinology and infertility genetics at the Medical College of Georgia, recommends urinary ovulation monitoring for his patients.

"We use them for women who are taking ovulation-inducing agents to predict if ovulation will occur," he says. "This can determine if the dose of medicine they are given is likely to work. It can also be used in women who are not taking ovulation medication. These tests are useful for several reasons: They can indicate to the patient to time intercourse; they can be used to determine if the medication is likely to be effective; and they can be used to time treatments, such as intrauterine insemination."

Dr. Layman points out that the kits do not confirm ovulation but rather predict if it is likely to occur. A blood test is needed to confirm ovulation.

Hope in a Lipstick Tube
One saliva tester on the market today is the Donna Fertility Tester, introduced by O2 Unlimited, a high-tech health care distribution company in Jericho, N.Y.

"Donna is as simple to use as opening up a lipstick," says Kenny Weinstein, president of O2 Unlimited. "Simply pull the black mini-microscope out of the inner tube. Lick or place a small amount of saliva on it. Replace the microscope into the inner tube, and place the outer cover over it."

After waiting about 10 minutes, remove the outer cover and hold the Donna up close and focus. What you will be looking for is the pattern. During non-fertile days, the pattern will be random and appear as a group of unconnected dots, but as a woman heads toward ovulation, a "fern-like" pattern will develop.

"It's hard to believe that a device so simple and inexpensive can give women the power to accurately and effectively predict their most fertile time of the month," says Dr. Anita Sadaty, an obstetrician and gynecologist in Great Neck, N.Y. "I predict that Donna will save thousands of women the anxiety and discomfort of costly infertility treatments and medications, allowing them to conceive safely and naturally on their own."

Debbie Zucker of Roslyn, N.Y. purchased the Donna after trying several months to get pregnant with her second child. "I had tried the urine kits and found them difficult to read," she says. "If you know every shade of blue, you've got it made. Otherwise, it is hard to figure out when you are ovulating."

When the definitive ferning pattern appeared, Zucker was thrilled. It looked exactly like it was supposed to look. "The Donna was easy to read and very clear in its definition of time of ovulation," she says. "I used it, and within two months I was pregnant!"