If you’re trying to conceive or simply find out if you ovulate, you may have been told about ovulation prediction kits (OPKs). And if you are someone who menstruates (regularly or not), you may have tried an app to keep track of your cycle. Asking around will get you mixed answers, even from doctors. Some say OPKs are perfectly reliable even with PCOS. Others even encourage the use of cycle tracking apps, without warning you they might not work. And others will tell you OPKs are totally unreliable for PCOS. So where’s the truth? Here’s everything you need to know about ovulation prediction kits and PCOS.
What are ovulation prediction kits
Ovulation prediction kits are urine tests that check the levels of your luteinizing hormone (LH).
This hormone is generally low throughout the cycle and then rises abruptly (a process called an LH surge) usually somewhere in the middle of the cycle. If everything is well in your body, this surge triggers ovulation within 36-48 hours.
Once ovulation happens, the luteinizing hormone goes back down, until it will be time to rise again in the next cycle.
The problem here, for every woman, not just those with PCOS, is that there is no guarantee ovulation will happen after this surge. In most healthy women, with fairly regular cycles, this process is straight forward with little errors. However, a false LH surge can happen in any cycle. Acute stress, a change in diet or lifestyle, an illness earlier in the cycle, can throw your hormones off and the ovaries may be unable to release an egg despite the LH surge.
Ovulation prediction kits and PCOS – why they are unreliable
Having PCOS adds a whole new issue to using OPKs: chronically high LH.
High luteinizing hormone, or an elevated LH to FSH ratio is one of the classic markers of PCOS. No, not all women have it. But many do. If this is you, then you’ll most likely get positive or very close to positive OPKs constantly. And no, that absolutely does not mean you are constantly ovulating, there’s no such thing.
Ovulation happens once per cycle (you can release more than one egg, but once the egg is out, the process is done for that cycle). Sadly, it usually means the opposite: that you’re not ovulating because being in a chronically high LH state blocks ovulation from happening. It also means you’re wasting your money on these tests.
Another issue is that women with PCOS are more prone to LH surges that don’t lead to ovulation. So again, you may be in for a great disappointment if this is all you’re relying on to track your cycle.
This isn’t to say OPKs never work for women with PCOS. They do for some. However, be mindful of the purpose you’re using them for. If you’re using them to avoid getting pregnant, you’re at very high risk. If you are using them to get pregnant, without tracking cervical mucus, the risk is you’ll actually miss your most fertile time. Sperm can live up to 5 days and trying to conceive only on ovulation day actually reduces your chances of success.
Finally, if you are on medication to trigger ovulation, this all might not apply to you as well. But even in that case, I would advise against relying only on ovulation prediction kits.
How to know if you have chronically high LH with PCOS
Since chronically high LH makes it completely pointless to waste your money on OPKs, the big question is, how to know if you have this issue. It’s simple, really. You need to do a blood test. It’s preferable to do it on day 2-4 of the cycle after you ovulated the previous cycle.
That’s because, at this point, all your hormones will be at a baseline low level. You should never test for LH alone though. FSH needs to be tested in conjunction as it is the LH to FSH ratio that needs to be evaluated. Normally this ratio is 1:1. In many women with PCOS, it is 2:1 or even 3:1 and higher. If you want to do more reading on the main hormonal blood work you should do, when to test, and what those tests tell you, check out this hormonal blood work cheatsheet (it’s free).
A word on cycle tracking apps
Because they are very common and I’ve seen them recommended even by medical professionals, I want to mention these apps briefly.
Cycle tracking apps are prediction apps. But they are much worse than an ovulation prediction kit that tests the level of a hormone. They essentially guess where you should be in your cycle based on the rhythm method (which says ovulation always happens on day 14). Sometimes they also consider your previous cycles as reference.
Why they aren’t any good? Because there is no way an app can know what’s going on in your body. The rhythm method has been debunked 100 times over. Even healthy women don’t always ovulate on day 14.
As for the apps that take into consideration previous cycles…us women with PCOS know too well that cycles can be extremely different from one another. The fact that you always ovulated on day X and had your period on day Y, doesn’t mean you won’t get a wonky cycle. There is absolutely no way for a prediction app to know that.
If you want to use them to keep track of symptoms and dates, that’s fine. But DO NOT rely on them for conception, or for avoiding pregnancy.
What to use instead to track ovulation?
So if ovulation prediction kits and PCOS don’t go hand in hand, and prediction apps are no good, what’s left? The fertility awareness method! There’s a bit of a learning curve, but once you get the hang of it, you’ll know what’s going on in your body each day.
How to do it? In short, you track two fertility signs out of three: basal body temperature (BBT), cervical mucus (CM), and cervical position (CP). BBT and CM are the most common. There are a few methods that only use cervical mucus. They are a bit tricky for PCOS because we can have multiple attempts at ovulation. This means, we’ll get what looks like an ovulatory pattern in our CM, without actually ovulating. If you want to try such a method, please only do that with a certified educator.
Otherwise, you need to add another fertility sign, such as the BBT. Cervical mucus will show you your body is trying to ovulate, and you are potentially fertile. Basal body temperature will show you when ovulation occurred. I talked about this method in a previous post and I also have an e-book to help you learn the basics.