Use of urinary pregnanediol 3-glucuronide to confirm ovulation

Area of Science:

• Reproductive endocrinology
• Gynecology
• Biomarker research

Background:

• Fertility Awareness Based Methods (FABM) rely on identifying fertile and infertile phases.
• Urinary hormonal markers can potentially enhance FABM efficacy.
• Pregnanediol-3a-glucuronide (PDG) is a key urinary marker for ovulation.

Purpose of the Study:

• To evaluate the accuracy of urinary PDG testing in identifying the infertile phase of the menstrual cycle.
• To determine the optimal protocol for using PDG testing within FABM.
• To assess PDG testing's specificity for ovulation confirmation.

Main Methods:

• Secondary analysis of a multicentre European observational and simulation study.
• Inclusion of 107 women and 326 menstrual cycles.
• Daily first morning urine (FMU) collection, cervical mucus observation, and ultrasonography for ovulation confirmation.
• Testing scenarios included PDG alone, PDG after positive LH, and PDG after fertile mucus disappearance.
• Evaluation of one-day vs. three-day PDG positivity for infertile phase declaration.

Main Results:

• Three consecutive days of PDG testing above 5μg/mL, following a positive LH test or end of fertile mucus, achieved 100% specificity for ovulation confirmation.
• This protocol identified an average of 6.1 to 7.6 infertile days.
• The combination of urinary markers demonstrated high accuracy in defining the luteal phase.

Conclusions:

• A clinical approach using three consecutive days of elevated urinary PDG confirms ovulation with 100% specificity.
• This method provides a reliable way to identify infertile days for FABM users.
• Findings support the development of a point-of-care assay for urinary PDG detection.