According to a scroll dated 1350 B.C.E., a woman would urinate on wheat and barley seeds for several days in a row. If the wheat began to grow, it meant she was carrying a girl. If barley grew, it meant a boy was on the way. And if nothing sprouted, it meant there was no pregnancy.
The Egyptians may have been on to something. According to an article about the history of pregnancy tests posted on the National Institutes of Health’s website (A Thin Blue Line), “Scientists tested this theory in 1963 and found that 70 percent of the time the urine of a pregnant woman did promote growth, while the urine of non-pregnant women and men did not.”
We don’t have to urinate in a field any more to find out if we’re pregnant, but many of us will urinate into a cup or onto a stick for the same information. The point is we’re all still hungry for information about our reproductive status. Three thousand years after the ancient Egyptians, we can now choose from dozens of brands of easy-to-use, at-home pregnancy tests that can tell us within minutes if we’re expecting a baby. The modern age has also brought us techniques that allow us to pinpoint ovulation (the most fertile phase of a woman’s cycle) by recognizing changes in basal body temperature, urine, sweat, or saliva. And now even men get can in on the home-testing phenomenon by using kits that evaluate sperm concentration to assess fertility.
So many options are now available for at-home fertility and pregnancy testing that it may seem as if a degree in reproductive endocrinology is required to choose and use one. So to help sort through the mass of merchandise, we asked infertility experts to weigh in on how the products work and who would benefit the most from using them. Ultimately, these kits can provide valuable information to help women improve their chances of conceiving.
Pinpointing Your Fertile Phase . . . With Urine
When a woman is about to ovulate, there are many physical changes that occur, including an increase in luteinizing hormone. This hormone is secreted by the pituituary gland and sends a message to the ovaries that it’s time to release an egg. Increased levels of luteinizing hormone (also referred to as the LH-surge) are detectable in a woman’s urine, and high levels are typically an indicator that an egg will be released within the next 24 to 48 hours. The kits that use samples of urine all work essentially the same way by testing for levels of this hormone. What differs most from test to test is how the urine sample is obtained.
Some tests ask that you hold an absorbent stick in your urine stream, while others want you to place a few drops of urine on the stick. Still others have you collect your urine in a cup, and then dip a stick into it. As with most at-home pregnancy tests, a colored line indicates a positive LH-surge.
Urine-based ovulation kits average between $15 and $38 per kit, with most kits containing between 5 and 7 tests—the number to be used during one cycle. While these products all use a technology called monoclonal antibody sensing to measure the LH levels in urine, some products may be more sensitive than others. More than two years ago, Consumer Reports magazine tested nearly a dozen national brands. Top honors were given to Clearblue Easy Ovulation Test Pack, followed by Clearblue Easy Fertility Monitor. These kits are easy to find in any pharmacy, and many drugstore chains even sell their own house brand. Because accuracy varies, if you haven’t gotten a surge using one product, you might want to try another, keeping in mind that there might still be other reasons for not seeing a surge.
A small percentage of women with normal-length cycles (between 24 and 34 days) don’t always ovulate within the expected timeframe (14 days before the start of their next period), which means a test may miss the surge. Some women don’t ovulate at all. Experts recommend you see a physician if you don’t see a surge after three months of using the kits.
Still other women may see the surge each month and find they’re ovulating normally, but are still unable to get pregnant. “A test may tell you month after month that you’re ovulating perfectly, but there are other age-related conditions, such as blocked tubes, that could be preventing you from conceiving,” says Diane Clapp, R.N., B.S.N, medical information director for Resolve: The National Infertility Association. That’s another reason to see a physician if pregnancy doesn’t occur.
Clearblue Easy Fertility Monitor:
Electronic urine-test ovulation monitors are newer to the market and demand more for their high-tech capabilities. Clearblue Easy Fertility Monitor retails for around $200 for the actual monitor, and then you must also buy the test sticks, which cost an additional $50 for 30 of them. The advantage of these more expensive monitors, says Nancy O’Malley, who runs the online fertility resource store, The Fertility Shop (www.thefertilityshop.com), where many of these items can be purchased “is that they allow you to establish a bigger fertility window because you get to see changes as estrogen levels begin to rise, rather than right before when LH levels surge.” And since sperm can live for 72 hours, there’s a benefit to widening the 24 to 36 hour window that you typically get with other urine-based tests.
. . .With Sweat
The newest ovulation-tracking device (launched in February) to get FDA-approval is the OV Watch. This watch is equipped with a sensor that measures the amount of chloride excreted in sweat. Increasing levels of chloride precede the hormonal surges that signal ovulation, offering women advance notice that ovulation will occur within the next few days. In order to get an accurate reading, the watch must be set (or re-set) on days 1, 2, or 3 of a woman’s menstrual period. Then it should be worn for at least six hours each night, while sleeping, until it indicates the fertile phase. A starter kit, which includes the watch plus a three-month supply of sensors, costs $249. For more information visit www.ovwatch.com or call 1-877-249-BABY (2229).
. . .With Basal Body Temperature
Basal body temperature (BBT) monitoring is yet another way to track ovulation. A woman uses a special, extra-sensitive thermometer to take her temperature (either rectally or orally) each day, first thing in the morning. A rise in temperature of approximately half a degree Fahrenheit, lasting at least three days, usually indicates ovulation. Increasing estrogen levels are responsible for the extra heat.
If you opt to use BBT monitoring, you’ll have to follow instructions carefully in order to get an accurate reading. You’ll need to take your temperature every morning, after at least three to four hours of solid sleep, before you do anything, including getting out of bed. Other things that can throw off the accuracy of BBT readings: “Illness, lack of sleep, excessive alcohol intake, and stress can all elevate BBT,” says Diane Clapp. And because BBT monitoring can only tell you when you’ve ovulated—as opposed to when you’re about to—it doesn’t work as an ovulation predictor. In other words, you’ll learn something about your cycle, but you won’t be able to take advantage of that knowledge right away by timing sexual intercourse for conception.
Fairhaven Health Digital Basal Thermometer:
Temperature tracking requires the smallest financial investment of all the at-home tests. This digital BBT thermometer from Fairhaven, for instance, sells for $7.95. There are also mercury thermometers available for around the same price.
. . .Saliva
Saliva-based monitors work differently from urine monitors; instead of testing for LH, they measure the levels of estrogen detectable in electrolytes found in the saliva. To use these kits, a small amount of saliva is applied to a lens. Once the sample dries it’s examined under a microscope. Saliva with a higher level of estrogen—indicating a fertile phase—will have a distinct, fern-like pattern. Saliva-based microscope monitors generally cost between $25 and $60; brands include Cycle Check, Donna, Fertile Focus, Fertility Tracker, Lady-Q, MaybeMom, Ovulation Scope, Ovulens, Ovulite, and TCI, among others.
The OvaCue Fertility Monitor—an automated, electronic device—is more expensive, at $298, but easier to use. With OvaCue, a woman uses a small oral sensor, and the device measures the changes in the electrolytes and predicts the best time to attempt conception. As with the electronic urine monitors, the more expensive electronic saliva monitor can provide a greater peak fertility window. “The higher-priced models also interpret the results for you—by giving specific numbers rather than leaving it up to you to interpret whether the line is dark enough or your saliva looks fern-like enough,” says O’Malley. This may be especially important for women who wear glasses, for whom viewing a saliva sample through the microscope can be difficult.
Ovulite Ovulation Microscope:
Companies have packaged some mini-microscopes for saliva testing in sleek, lipstick-inspired cases. The Ovulite test kit ($39.95) employs a method similar to laboratory staining. After preparing a sample of saliva and allowing it to dry, a woman observes the pattern through the microscope and compares it to diagrams included with the kit. Ovulite’s manufacturer says the device will last for up to five years.
It was only a matter of time before a product came on the market to aid men on the road to conception. Babystart Male Fertility Test (also called FertilMARQ) is the first FDA-approved, at-home sperm test kit available over-the-counter. (Other home tests for men are currently in development.) Each packaged Babystart kit contains two tests, and costs around $40.
If your partner is concerned about or simply curious to know his sperm concentration levels, he can now find out in the privacy of his own home. The Babystart test will determine whether a man’s sperm concentration is above or below 20 million sperm cells per milliliter (mL) considered the cutoff for fertility. According to the informational pamphlet that accompanies the kit, two test results of less than 20 million/mL may indicate a problem.
To use the test, a man must abstain from ejaculating for three days. Then he obtains a sperm sample through masturbation or intercourse (using a special condom contained in the kit). The sample is added to a special cup (included in the kit) to make it liquefy faster. Then the liquefied sample is dropped onto a test stick and mixed with two different solutions (also included in the kit). The test has an overall accuracy rate of 78 percent.
“Men who are using it just need to remember that they could be one of the quarter of men who aren’t getting an accurate result,” says Brad Miller, M.D., a board-certified reproductive endocrinologist and partner at Reproductive Medicine Associates of New Jersey, a private-practice infertility specialists group located in West Orange, New Jersey. Dr. Miller also points out (as do the manufacturers) that this test can only measure levels of sperm and not morphology (shape) or motility (how fast they swim), which are just as important for determining fertility. He adds, “And even if the test determines that a man falls with a fertile range, it doesn’t mean there aren’t other non-sperm related issues, such as a blockage, that could be interfering with his fertility.” Even with these caveats, the test can provide men with information they would not previously have been able to obtain on their own, information that may aid them in their quest for fatherhood.
When you’ve been giving baby-making your all, there’s nothing quite as alluring as an at-home pregnancy test. Knowing that this one little stick could reveal what your heart’s been yearning for all these months or years, it’s no wonder some women can’t resist using one even before they’ve missed a period.
The majority of these tests—and there are dozens of different ones available—involve holding an absorbent stick in your urine stream for a few seconds, and then waiting a few minutes for the result to appear. The tests work by measuring levels of the hormone hCG (human chorionic gonadotropin), secreted by the developing placenta shortly after fertilization. Most pregnancy tests fall within a similar price range. First Response Early Result, for example, comes with 3 tests in a package and sells for around $17.99, while a brand called Confirm comes with two tests and costs $10.99.
The good news about home pregnancy tests is that they are extremely reliable and accurate. In fact, most ob/gyns no longer use blood tests to determine pregnancy, instead relying on results from a urine test nearly identical to the ones women perform at home.
One determining factor in the test’s reliability is timing. For the most accurate result, a woman should wait until a week after the first day of a missed period. By then, if she is pregnant, a fertilized egg will have attached to the uterine wall, indicating that the pregnancy is potentially viable. Of course, not every hopeful woman can wait that long for an answer. So the next best scenario is to wait until one day after a missed period, which is around the time when pregnancy hormones are detectable.
While the tests are considered extremely accurate, there is a very slight risk of false results. According to the American Fertility Association, false positives can occur in women taking hCG hormones to help stimulate ovulation, since the hormone is the same one produced by a pregnancy and measured by the test. False negatives may occur when a woman performs the test even before she’s missed a period, when the egg hasn’t yet attached to the uterine wall, and hasn’t started therefore hasn’t started manufacturing hCG.
Simplicity “No-Step” Pregnancy Test
This new test, called Simplicity, works the same way as traditional stick tests, by measuring the amount of hCG in urine. The twist: No sticks. You urinate into a cup, and the cup itself gives you the result. Two lines appearing in the cup’s window indicate pregnancy, a single line means not pregnant. One Simplicity test retails for $9.99.
Home Fertility Tests: What You Need To Know
Experts caution that using a fertility monitor is no substitute for tracking your cycles. In fact, the accuracy and success of the monitors depends in part on how well you know your own cycle. “Even the most advanced over-the-counter fertility predictor isn’t going to pay off unless you get very familiar with your individual menstrual cycles,” says Lawrence Grunfeld, M.D., a clinical associate professor of obstetrics and gynecology at the Mt. Sinai School of Medicine in Manhattan. Writing in an American Fertility Association fact sheet, he continued, “It’s basic knowledge that helps you use the kits most efficiently.”
And before you invest your money and time to buy and use these tests, it’s important to also keep in mind that fertility monitors can only tell you so much about your reproductive status. There are other factors besides not ovulating that can lead to difficulties conceiving.
“At a certain point, the bigger question a woman needs to be asking herself is whether she should be seeking the help of a specialist,” says Mark D. Hornstein, associate professor of obstetrics and gynecology at Harvard Medical School in Boston.