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Peer-reviewedCC BY 4.0Frontiers in Endocrinology

Timing luteal urinary pregnanediol glucuronide assessment using urinary luteinizing hormone: agreement with ultrasound-determined ovulation

  • Rene Leiva1,2
  • Rene Ecochard3,4
  • Jonathan Yang5
5 affiliations
  1. 1Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
  2. 2Bruyère Health Research Institute, Ottawa, ON, Canada
  3. 3Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France
  4. 4Centre National de la Recherche Scientifique (CNRS), Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
  5. 5Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Abstract

Background: Urinary pregnanediol glucuronide (PdG) is a non-invasive marker of luteal progesterone exposure, but its interpretation depends on timing relative to ovulation. We evaluated whether urinary luteinizing hormone (LH)-derived reference points could approximate ultrasound-determined ovulation (USDO) for scheduling mid-luteal PdG assessment.

Methods: This retrospective secondary analysis included 283 ultrasound-confirmed ovulatory cycles from 102 women. We evaluated the retrospectively identified urinary LH peak and the first urinary LH concentrations ≥10, ≥15, ≥20, ≥25, and ≥30 mIU/mL. PdG measured 6–9 days after each LH reference was compared with PdG measured on the corresponding USDO-timed day. A PdG threshold of ≥15 µg/mL was used for the primary descriptive classification, with sensitivity analyses at ≥5, ≥10, and ≥20 µg/mL. Ninety-five percent confidence intervals were estimated using participant-level cluster bootstrap.

Results: First urinary LH ≥15 mIU/mL occurred a median of 0 days from USDO (IQR −0.5 to +1), with 70.0% and 80.7% of events occurring within ±1 and ±2 days, respectively. At PdG ≥15 µg/mL, overall agreement ranged from 74.3% to 82.2% across days +6 to +9, with AUC values of 0.764–0.835. Alternative PdG thresholds produced different trade-offs between positive and negative agreement, while ≥15 µg/mL provided a comparatively balanced descriptive profile.

Conclusions: First urinary LH ≥15 mIU/mL is a candidate prospective reference for scheduling day-specific mid-luteal urinary PdG assessment. The present study establishes a candidate timing strategy rather than a clinically actionable decision rule; a single LH-timed PdG result should not be used alone to diagnose luteal dysfunction or direct treatment. These findings are hypothesis-generating; numerical LH and PdG thresholds are assay-dependent, require prospective platform-specific validation, and should not be interpreted as diagnostic criteria for luteal phase deficiency unless validated in a clinical trial.

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Cite

BibTeXRIS
BibTeX
@article{leiva2026timing,
  title = {{Timing luteal urinary pregnanediol glucuronide assessment using urinary luteinizing hormone: agreement with ultrasound-determined ovulation}},
  author = {Rene Leiva and Rene Ecochard and Jonathan Yang},
  journal = {Frontiers in Endocrinology},
  year = {2026},
  month = oct,
  doi = {10.3389/fendo.2026.1992715},
  url = {https://doi.org/10.3389/fendo.2026.1992715},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Timing luteal urinary pregnanediol glucuronide assessment using urinary luteinizing hormone: agreement with ultrasound-determined ovulation
AU  - Rene Leiva
AU  - Rene Ecochard
AU  - Jonathan Yang
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Endocrinology
DO  - 10.3389/fendo.2026.1992715
UR  - https://doi.org/10.3389/fendo.2026.1992715
AB  - Background: Urinary pregnanediol glucuronide (PdG) is a non-invasive marker of luteal progesterone exposure, but its interpretation depends on timing relative to ovulation. We evaluated whether urinary luteinizing hormone (LH)-derived reference points could approximate ultrasound-determined ovulation (USDO) for scheduling mid-luteal PdG assessment.  Methods: This retrospective secondary analysis included 283 ultrasound-confirmed ovulatory cycles from 102 women. We evaluated the retrospectively identified urinary LH peak and the first urinary LH concentrations ≥10, ≥15, ≥20, ≥25, and ≥30 mIU/mL. PdG measured 6–9 days after each LH reference was compared with PdG measured on the corresponding USDO-timed day. A PdG threshold of ≥15 µg/mL was used for the primary descriptive classification, with sensitivity analyses at ≥5, ≥10, and ≥20 µg/mL. Ninety-five percent confidence intervals were estimated using participant-level cluster bootstrap.  Results: First urinary LH ≥15 mIU/mL occurred a median of 0 days from USDO (IQR −0.5 to +1), with 70.0% and 80.7% of events occurring within ±1 and ±2 days, respectively. At PdG ≥15 µg/mL, overall agreement ranged from 74.3% to 82.2% across days +6 to +9, with AUC values of 0.764–0.835. Alternative PdG thresholds produced different trade-offs between positive and negative agreement, while ≥15 µg/mL provided a comparatively balanced descriptive profile.  Conclusions: First urinary LH ≥15 mIU/mL is a candidate prospective reference for scheduling day-specific mid-luteal urinary PdG assessment. The present study establishes a candidate timing strategy rather than a clinically actionable decision rule; a single LH-timed PdG result should not be used alone to diagnose luteal dysfunction or direct treatment. These findings are hypothesis-generating; numerical LH and PdG thresholds are assay-dependent, require prospective platform-specific validation, and should not be interpreted as diagnostic criteria for luteal phase deficiency unless validated in a clinical trial.
SN  - 1664-2392
ER  -