Ovulatory dysfunction

The ovulatory dysfunction obgyn specialist’s concerns:

‘Ovulatory dysfunction’ bears the imprimatur of a succinct medical diagnosis, but what does it really mean and above all, how do you diagnose it, especially in women with a normal menstrual history?

Although we have multiple measures in our modern toolbox: ultrasound for daily follicular monitoring, hormonal assays of serum, urine and saliva (some for instance LH available over the counter to our patients), and even, heaven forbid, an endometrial biopsy; these are expensive, invasive and labor intensive for both physician and patient to document, and often lacking in evidence-based cutoffs.

We are likely to assume that a woman is #ovulating regularly if her #menstrualcycle length is 21–35 days (thanks to classic studies of Treolar et al. (1967) which were based on #menstrual diaries collected on the back of a postcard, beginning in young women recruited during their college years and then collected over their lifetimes)… but what does it really mean and above all, how do you diagnose it…?

This is cited from “The quality of #ovulation is strained in normal women” by Richard S. Legro, Human #Reproduction, Vol.28, No.6 pp. 1446–1447, 2013. Read the editorial at https://academic.oup.com/humrep/article/28/6/1446/604215/The-quality-of-ovulation-is-strained-in-normal

The bioZhena answer (and my imprimatur) is this: You diagnose it with the help of #bioZhena‘s menstrual cycle ovulographicTM profiling, cyclic profiles recorded longitudinally at home. Also referred to as the technology of Folliculogenesis In VivoTM.

For a summary outline of the diagnostic power visit the home page at https://biozhena.wordpress.com/home-page-of-biozhenas-weblog/ (scroll to section MORE ABOUT THE TECHNOLOGY).

And the thought is: You do not just assume, in evidence-based #medicine.

I am referring here to Richard Legro having written further: The bottom line is that the most common clinical practice to screen for ovulatory dysfunction is a menstrual history. Much of our knowledge of the normal length of the menstrual cycle and the effects of age on the menstrual cycle comes from the classic studies of Treloar et al. (1967) … We are likely to assume that a woman is ovulating regularly if her menstrual cycle length is 21–35 days (thanks to Treloar).

But then let’s ponder on this:

Sequential predictions of menstrual cycle lengths

Here is a good example of cycle length variability of a woman who charted well over a hundred of her menstrual cycles (Fig. 1 in Biostat (2010) http://biostatistics.oxfordjournals.org/content/11/4/741.full )

Dr. Largo discussed the diagnostic difficulties and concluded his editorial by referring to the expert panel from the recent NIH sponsored Evidence-Based Methodology Workshop on PCOS that recommended in their final report to ‘Improve the methods and criteria used to assess ovulatory dysfunction’ (http://prevention.nih.gov/workshops/2012/pcos/docs/PCOS_Final_Statement.pdf). He wrote: I concur, though like them I am lacking in a specific test or method.

fig-2-fig-5-panorama-3-baseline-3-non-baseline-cycles-raw-data

Fig. 2 & Fig. 5 panorama 3 baseline & 3 non-baseline cycles raw data, Ovulona prototype

bioZhena’s Folliculogenesis In Vivo provides the needed method.

The monitored menstrual cyclic pattern exhibits a number of well defined peaks and troughs with the first post-menstruation minimum (or trough, nadir) occurring typically on day 6, 7, or 8. The signal then rises to a maximum (the long-term predictive peak), the highest reading of the cycle. Over the next several days, the readings fall toward the minimum before the short-term predictive peak (predictive of imminent #ovulation).

Thus, in the recorded 30 days long cycle, the long-term predictive peak is 8 days wide. It is followed by the usually narrow short-term predictive peak, which falls off directly into the trough of the ovulation marker, the lowest reading of the cycle.

We have found the ovulation-marker minimum to correlate with urinary LH and FSH peaks, and we view the marker to be an effect of the steroid hormone dominance switch that occurs at ovulation (estrogen dominance to progesterone dominance). Note that the corresponding basal body temperature (BBT) curve rises to the post-ovulatory higher level after the ovulation marker. This indicates, to the extent that the BBT can be relied on, that ovulation had, indeed, occurred. The planned sonographic (ultrasound) investigations will confirm this correlation with a better accuracy.

It was important that Dr. Benedetto carefully selected baseline subjects for the pilot trial. Even in these baseline subjects, the classical BBT “biphasic profile” is unreliable. The belated rise of the BBT3 curve (the triangular data points of the 27 years old subject) is clearly noticeable and it is symptomatic of the uncertainty inherent in the basal body temperature measurements.

Wealth of information and elucidation of DF peak.jpg

Click on the image to view the slide

How the features of the menstrual cyclic profile relate to folliculogenesis is explained in slide 3 of the Friendly Technology – Wealth of Information slide set (https://biozhena.files.wordpress.com/2017/02/friendly-technology-wealth-of-information-510k-vltava-fda-nih-e.pps ), and more detail about the tracking of the dominant follicle is explained in a single slide at https://biozhena.files.wordpress.com/2017/02/wealth-of-info-elucidation-of-domin-folli-peak-single-slide.pps (see the clickable image just above).

The resolve to deliver is expressed by the recent tweet (which too referenced Dr. Largo’s concluding line): Not Merchant of Venice, #bioZhena‘s ventures ARE in one bottom trusted, ARE to one place https://lnkd.in/eMtXhNk . #Ovulona‘s 1st guinea pig, meet the Bard’s 1st love!  🙂

Anne Whateley by Giovanni Antonio Boltraffio

Anne Whateley by Giovanni Antonio Boltraffio (Italian High Renaissance painter, ca.1466-1516)

(Anne Whateley, Shakespeare’s First Love. Not his wife, Anne Hathaway, “who married the Bard after he got her pregnant and eventually got a second-best bed in his will in return, a sure sign of spite.”)

One Response to “Ovulatory dysfunction”

  1. The Ovulona is not another ovulation kit, my dear | bioZhena's Weblog Says:

    […] the benefit of systematic longitudinal recording of your menstrual cycle vital sign signatures, to facilitate better diagnosis of a health problem you may […]

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