Assessing ovulation by lab methods

How to asses Ovulation:-Ovulatory defects are present in 40% of infertile women and in approximately 15% of couples with infertility. Often a defect in ovulatory function manifests itself in menstrual disturbances and can be identified by history in the majority of women.  Are the cycles regular??  Intrpretaiins:-A patient with menstrual abnormalities should be investigated for underlying causes such as polycystic ovarian syndrome, thyroid disease, hyperprolactinemia, and hypothalamic causes secondary to weight changes. Eumenorrhea—normal menstrual cycles by history—is a highly accurate marker of ovulation and anovulatory levels of serum progesterone (< 3 ng/mL) are found in only a very small minority of eumenorrheic patients

In addition to  a) thorough menstrual history, other methods used to evaluate ovulation include, b) urinary luteinizing hormone (LH) ovulation predictor kits,  c)  mid luteal serum progesterone testing,.& d) Follicular monitoring(Follicular tracking from day 9 alt day for 7-9 days) .  Ovulation predictor kits are only useful for women who do not have very long menstrual cycles and can be used by couples to appropriately time intercourse.

What are the drawbacks of Midluteal Prog estimation??  Mid luteal progesterone levels are measured around day 21 in women with regular (∼ 28 day) cycles. However, they are often poorly timed if they are drawn on cycle day 21 in women with irregular menses. In such women it is better to use an ovulation kit and measure the progesterone levels 7 to 8 days after the LH surge is detected. Serum progesterone levels higher than 3 ng/mL suggest that ovulation has occurred and levels higher than 10 ng/mL are optimum. Although endometrial biopsy results were previously used to diagnose luteal phase defect, they do not correlate with fertility status and hence are no longer recommended. .

How best to assess  Ovarian Reserve??

Who are the candidates?? . Women with advanced age or history of prior ovarian surgery are at risk for diminished ovarian function or reserve. Given the relatively noninvasive nature of the testing, several practitioners are including the evaluation of ovarian reserve as first-line workup for infertility. The testing includes 1) AMH 2) AFC 3 a cycle day 3 serum follicle-stimulating hormone (FSH) 4) and estradiol level. Rarely in research do settings can one do clomiphene citrate challenge test, The results of these tests are not absolute indicators of infertility but abnormal levels correlate with decreased response to ovulation induction medications and lowered live birth rates after IVF