LH surge question and lining question
3 Replies
silli_kitti - May 30

What do you look for when determining a natural LH surge? I've been told a doubling of cd 11 LH, and on another occasion I was told a tripling of cd 3 LH.

Also, I have a uterine lining measuring 5 mm on cd 11 (yesterday). What is a good lining for cd 11? How thick should it ideally be before ovulation? I was told I may have to go on prometrium if the lining doesn't significantly improve by cd 13. Should they have erred on the side of caution and already started me on prometrium?


Barry Jacobs, M> D. - May 30

The most cost effective way to determine if you have had an LH surge is an over the counter "ovulation predictor kit". The kit does not tell you about ovulation, only about LH surge.

Prometrium will NOT make your endometrium thicker. It is a progestin. Estrogens make the endometrium thicker. On the day of ovulation, it needs to be GREATER than 7 mm thick. The estrogen comes from the follicle about to ovulate. If you do not have a preovulatory follicle, adding estrogen will not help achieve a pregnancy.
For more information, I invite you to see our web page at <www.texasfertility.com>.
Good luck.


silli_kitti - May 31

Thank you for your response. I must have misunderstood what they said about prometrium. I will ask them for clarification today when I go for my cd 13 bw and u/s.

Regarding the LH surge, my RE takes blood and measures LH and E2 everyday starting on day 11. They said I can use OPK if I want to, but the blood is what they go by as it is more accurate and also laboratory controlled so there is less chance of error. What LH and E2 blood levels/patterns does one look for when determining whether an natural LH surge has occured?


Barry Jacobs, M. D. - May 31

Estradiol reaches a peak of about 250 pg/ml to 350 pg/ml prior to the LH surge, and possible ovulation. LH is very low, until after the estradiol peak, then rises dramaticly for a short but tall spike.
Good luck.



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