How Does PCOS Affect Ovulation Tests & What to Do About It?

by Sep 29, 2021

The journey to conception is full of ups and downs, but when you have PCOS it can start to feel like you don’t know which way you’re facing!  A condition affecting approximately 10 percent of women, polycystic ovarian syndrome (PCOS) can cause issues with hormone levels, cystic ovaries, and a chronic lack of ovulation.  Together, these issues effectively mean the egg may not develop or may not be released during ovulation as it should, making it that much harder for you to get pregnant.

The first step of getting pregnant is knowing when ovulation is occuring.  Many turn to ovulation tests as a tool for predicting ovulation and planning pregnancies, but for those with PCOS these at-home tests may not work in the same way.  Read on to learn more about how PCOS impacts ovulation tests and what you can if you’re diagnosed to help your body conceive.

Can PCOS impact ovulation test accuracy?

Ovulation test kits (OPKs) are used to help pinpoint your fertile window and work by detecting hormone levels that signal impending ovulation.  However, if you have PCOS, hormonal imbalances mean ovulation may not always take place and estrogen and LH levels may not follow predictable patterns, making ovulation testing that much more challenging.  OPKs work by comparing hormone levels to thresholds, but if you have several peaks the results will be less than accurate.

In terms of accuracy, it all depends on you and your cycle.  If you’re having regular periods there’s a good chance that OPKs will work for you.  But given the hormonal variations that may be present in PCOS, there are a number of variables that can influence the accuracy and ovulation tests may not be the most reliable.

PCOS and ovulation

Although PCOS is common, how it shows up can vary widely.  Those with the condition experience everything from not having a period at all, to irregular periods, to egg quality issues and many things in between.  But a hallmark of PCOS (although not an absolute requisite for diagnosis) is the lack or absence of ovulation and is one of the most common causes of infertility in women.

How does PCOS affect ovulation?

As part of a healthy menstrual cycle, in concert with the cascade of hormones that make this possible, the ovaries make the egg that is released each menstrual cycle.  The hormonal imbalance associated with PCOS can create problems in the ovaries which means the egg may not develop as it should or may not be released during ovulation like it should.

In a typical menstrual cycle, the surge in luteinizing hormone (LH) is what signals the ovaries to release an egg.  But because women with PCOS often have high LH levels or multiple LH peaks in a cycle their ovulation is affected.

When LH levels are already high, there is no LH surge to signal ovulation and therefore it may not occur.  Those with PCOS may also have reduced levels of FSH, or higher levels of estrogens and overproduction of androgens.  Due to these hormonal imbalances, women with PCOS often have irregular cycles and their ovulation is unlikely to be typical.

How does PCOS affect OPKs?

OPKs measure your luteinizing hormone (LH) in urine to track ovulation.  The surge in LH is an indication that ovulation is about to take place and you generally begin testing a couple of days before you expect to ovulate.  If your cycles are regular and you can generally predict ovulation, OPKs are a great way to identify your fertile window and the best time to have sex if you are planning a pregnancy.

While OPKs work for some women with PCOS who have only minor hormonal imbalances or cycle irregularities, they don’t work for all.   For some women, they are able to use OPKs to predict ovulation with minor adjustments to the timing, but for many with PCOS, abnormal hormone levels make them difficult to use and the results inaccurate.  Irregular periods make it difficult to know when to start testing, and persistently high LH levels may skew any results you do get.

How do I know if I’m ovulating with PCOS?

When you have PCOS, it can be difficult to know when you are ovulating.  Regular periods are only one sign of ovulation but there are other ways you can determine if you are ovulating or not too.  Signs and symptoms vary between women with some women knowing exactly when they ovulate while others experience no symptoms at all.

When you have PCOS, it can be more challenging to determine if you are ovulating especially from hormone levels alone.  OPKs may work for some women, but if your hormone levels are outside of average levels they will not be a reliable predictor of ovulation.  Other methods include measuring basal body temperature, checking your cervical mucus, cervical position, and tracking any cycles you do have.  Getting to know your body by noticing ovulation symptoms and paying attention to the signs can help narrow down when ovulation may occur.

How to test and monitor ovulation with PCOS

If you have PCOS, one of the best things you can do is educate yourself and be proactive about your condition.  Experiences can range greatly and getting to know your own body and cycles is the first step in managing this condition.  While it can be frustrating and may take more legwork, it’s important for you to keep track of ovulation especially if you are trying to conceive.

Talk to your doctor

While it may seem obvious, talking to your doctor about PCOS should be your first step.  You may need an evaluation or exam and your doctor will be able to determine if further steps are necessary.  While there is no universal cure for PCOS, it can be treated but you will need to talk to your doctor first to rule out any other underlying issues.

Try different OPKs

Ovulation kits may not be as reliable for women with PCOS, but you can still use them to help predict ovulation.  Tests range in both price and accuracy with some tests measuring only LH while others measure other hormones as well.  And given the inconsistencies in hormone levels with PCOS, some doctors recommend using multiple OPKs a day to try and catch your LH surge making cost a factor as well.  Personal preference will largely determine which tests work best for you, but don’t be afraid to try different ones if you are not getting clear results.

Use different methods

Having PCOS can make it difficult to accurately track ovulation especially when your hormone levels are outside what is considered “normal”.  There are several other methods you can use to monitor and track ovulation:

  • Checking your basal body temperature
  • Monitoring changes in cervical mucus
  • Observing changes in your cervical texture and position

The above are all low-tech methods that can all help predict ovulation.  However, given the variability in these methods, results may be misleading or incorrect altogether.

To better understand your cycle, you can track your actual hormone concentrations with the help of a digital fertility analyzer.  The Mira digital fertility analyzer tracks hormone levels and gives you actual LH levels throughout your cycle.  Together with the companion app that uses smart learning to track your cycle over time, you’re able to track personalized information on par with what you would get at a doctor’s office.

With Mira you can see your actual hormone levels and curve, and still see your ovulation even if your baseline LH is high.  The Mira Fertility tracker can help better understand your cycles and the hormone data that Mira provides can be extremely useful for those with PCOS.

✔️ Medically Reviewed by Katerina Shkodzik, M.D., OB-GYN

Dr. Katerina Shkodzik is a certified OB-GYN with a special focus on reproductive endocrinology and infertility issues. She has been practising since 2015.

Dr. Shkodzik completed her residency program in the Department of OB/GYN at the Belarusian State Medical University and fellowship program in the Department of Gynecological Surgery at the Medical University of Bialystok, Poland.

Dr. Shkodzik is extensively involved in digital health projects providing her medical expertise and integrating of cutting edge technologies in medical science and clinical practice since 2018.

Dr. Shkodzik has participated in several studies focused on PCOS, endometriosis, menstrual cycle characteristics and their abnormalities based on big data of digital health in collaboration with leading universities.

She believes that paying special attention to women's health is a crucial step to improving the world we live in.

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