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What should be assessed What should NOT be assessed Serialbasalbodytemperature(BBT) Changes in the characteristics of cervical mucus Endometrialbiopsy(EBM) Folliculargrowthmonitoringby ultrasound Prolactin and thyroid assessment in asymptomatic women NICE Guidelines 2017 M • • • • • M e en ns s t Diagnosis of regular ovulation Pregnancy as the ultimate test of ovulation H l H y ys st tr to r u or u a r y y al R rI R e eg g u Mid luteal progesterone determination Measurement of ovarian and pituitary hormones u l la ar Ir rr re eg gu ul l a ar r Diagnosis of “good” ovulation ‐ Luteinized unrupture follicle syndrome (LUF): US monitoring is not recommended as LUF is not typically repetitive and is unlikely to be a cause of continuing infertility. ‐ Luteal phase defect: Endometrial biopsy no more indicated. Progesterone (P) measurement not a reliable criterion 1) 2) 3) P secretion is pulsatile and serum levels may vary up to 7‐fold within an interval of a few hours. No treshold serum P concentration (e.g. 5‐10 ng/mL) defines ‘‘fertile’’ luteal function. Corpus luteum function varies from cycle to cycle in normal fertile women ‐ Ovulation of an abnormal/dysmature/aneuploid oocyte: Incidence in spontaneous cycles is uncertain. It increases strikingly with age. No tests are available to detect oocyte quality (Preimplantation genetic diagnosis to be considered a post hoc information). (Hassold and Hunt, 2001) 26 23