OTCs Today
Mary Warner
Many young couples look forward to starting a family, and it’s now easier than ever to predict ovulation and check fertility.
At-home pregnancy tests have been around since the late 1960s, but ovulation test kits came on the market much later, in 1989. There are even tests for male fertility that can be used at home. The tests range from simple yes-or-no test strips to devices that connect to a phone and can track hormone levels over time.
Women are most fertile around the time of ovulation, and once released, the egg has 12 to 24 hours to become fertilized. The chance of pregnancy is highest when live sperm are present in the fallopian tubes during ovulation. So how can you tell if you’re ovulating? And if there are sufficient sperm available to fertilize the egg?
Predicting ovulation
Most women will ovulate within 4 days of the middle point of their menstrual cycle, and using a calendar to track the length and midpoint of the menstrual cycle is often used as a first step toward determining when ovulation is likely to occur. Tracking basal body temperature is another option, as body temperature rises slightly during ovulation. But the most accurate way to predict ovulation is by tracking the rise in hormones that occurs just before ovulation.
Yes-or no test strips. These ovulation kits look for a rise in the luteinizing hormone (LH), which causes women to ovulate and release an egg. Like the commonly used pregnancy stick tests, the stick is dipped in urine and results are indicated by lines on the stick—one line is the control and the other indicates a positive result for LH. Urine should be tested daily until a positive result is obtained. Examples include ClearBlue, Easy@Home, and Premom, and most kits come with at least 15 sticks.
These kits are simple to use, but they can result in both false positives or consistent negatives if eggs are not released, there are excessive amounts of LH in the urine, or the patient has an ovulatory dysfunction. The LH surge may also be missed if a day of testing is missed or if the patient has irregular menstrual cycles. Patients should also be aware that they should not drink large amounts of fluids before using the test and that clomidphrene citrate can increase LH levels and cause a false positive result.
Hormone-level tests. Another type of ovulation test (Inito) also uses a test strip but with a device that attaches to an iPhone and uses an app to report levels of four hormones. (The system is not available for Android phones.) The system tracks levels of estrogen and LH to predict fertile days, PdG (urine metabolite of progesterone) to confirm ovulation, and FSH to track follicle growth.
The user dips the test strip in urine, attaches the monitor to the phone, then inserts the strip into the device and reads the hormone level from the app. Personalized hormone charts help patients better understand their cycles. As with the other type of test strips, medications that affect hormone levels can prevent the system from providing accurate levels.
Testing sperm levels
Research has shown that in one-third of infertile couples, the problem is with the man, making sperm testing an essential part of fertility testing. Laboratory-based sperm testing has been available for many years, but the first at-home test, SpermCheck, was introduced only in 2012.
SpermCheck detects levels of SP-10, a protein only present in the head of mature sperm. Similar to a pregnancy test or a yes–no ovulation test, it uses colored lines to show a normal or low sperm count. A semen sample is placed in the solution bottle provided and the two are mixed. Drops of the mixture are then placed in the testing device, which measures the sperm count level in the sample. If the sperm count is under or over 250,000 per mL, patients will see either only the control line “low count” or both lines “high count,” respectively.
A more recently developed test from YO uses a measurement device connected to a mobile phone app to measure not only sperm count, but also sperm motility, progressive motility, mobile sperm concentration, and progressive motile sperm concentration based on the latest WHO recommendations for semen testing. The YO app records and displays a live video of the sample during the analysis so users can visualize their semen.
What to tell your patients
Ensure that patients are aware of the results their chosen test will provide (simple yes–no results or more comprehensive hormone or semen levels) and that for urine tests early morning collection is recommended because the LH surge usually begins early in the day and the urine concentration is relatively consistent when measurement is performed at the same early morning time. Advise patients to consult a health care provider if they have trouble using the test or becoming pregnant, as they may need additional fertility treatment.
For further information, see the section on Home Testing and Monitoring Devices in APhA’s Handbook of Nonprescription Drugs, available in the bookstore at pharmacist.com or in APhA OTC at pharmacylibrary.com. ■