Revisiting the role of serum progesterone as a test of ovulation in eumenorrheic subfertile women: a prospective diagnostic accuracy study

To estimate the prevalence of ovulatory cycles in eumenorrheic subfertile women and compare the diagnostic accuracy of a single ultrasound with serum midluteal progesterone measurement in detecting ovulatory cycles. Prospective diagnostic accuracy study. University-level hospital. A total of 208 subfertile eumenorrheic women. None. To estimate the prevalence of ovulatory cycles in eumenorrheic women and compare the diagnostic accuracy of a single, well-timed ultrasound scan (index test) with serum progesterone measurement (reference test) by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR+) and negative likelihood ratio (LR–). The prevalence of ovulatory cycles among subfertile eumenorrheic women was 92.9% and 99.5% when midluteal serum progesterone level and ultrasound scanning were used as the reference test, respectively. The sensitivity, specificity, PPV, and NPV of ultrasound in identifying ovulatory cycles were 100%, 7.1%, 93.4%, and 100%, respectively. The LR+ and LR− were 1.1 and 0, respectively. The agreement between the ultrasound and serum progesterone was almost perfect (prevalence and bias-adjusted kappa = 0.81. The prevalence of ovulatory cycles in eumenorrheic subfertile women appears to be high. A single well-timed ultrasound can be performed to identify ovulatory cycles during the infertility workup in eumenorrheic women. Revisando el papel de la progesterona sérica como un test de ovulación en mujeres subfértiles eumenorreicas: un estudio prospectivo de precisión diagnóstica Estimar la prevalencia de ciclos ovulatorios en mujeres subfértiles eumenorreicas y comparar la precisión diagnóstica de una única ecografía con medición de progesterona sérica de mitad de fase lútea para detectar ciclos ovulatorios. Estudio prospectivo de precisión diagnóstica. Hospital de nivel universitario. Un total de 208 mujeres eumenorreicas subfértiles. Ninguna. Estimar la prevalencia de ciclos ovulatorios en mujeres eumenorreicas y comparar la precisión diagnóstica de una única ecografía oportuna (prueba índice) con medición de progesterona sérica (prueba de referencia) calculando la sensibilidad, especificidad, valor predictivo positivo (PPV), valor predictivo negativo (NPV), y razón de probabilidad positiva (LR+) y razón de probabilidad negativa (LR-). La prevalencia de ciclos ovulatorios entre mujeres eumenorreicas subfértiles fue 92.9% y 99.5% cuando el nivel de