The measurement of urinary steroid glucuronides as indices of the fertile period in women. World Health Organization, Task Force on Methods for the Determination of the Fertile Period, special programme of research, development and research training in human reproduction.

The concentrations of various estrogen glucuronides and pregnanediol-3 alpha-glucuronide have been measured in daily samples of early morning urine (EMU) and 24 h pooled collections throughout a total of 70 menstrual cycles (58 subjects). The immediate objective was to identify and assess the potential value of measuring hormone metabolites to locate the fertile period in women, with the ultimate aim of developing a non-invasive immunochemical test. The project was undertaken in five centres and the results showed that: (i) there was good agreement in the patterns and mean concentrations of metabolites between the centres; (ii) estrone-3-glucuronide should be the estrogen glucuronide selected for further study; (iii) the analysis of EMU provided information that was as useful as the corresponding measurements on pooled collections for 24 h; (iv) a rise in the concentration of estrone-3-glucuronide (50% over the mean of three preceding values) could be used to locate the start of the fertile period in greater than 90% of the ovarian cycles (from day LHmax -- 3 to day LHmax -- 7); attempts to locate the end of the fertile period by a threshold value or a defined rise in the level of pregnanediol-3 alpha-glucuronide were disappointing. A 50% rise over the mean of three preceding values in the derived concentration ratio of estrone-3-glucuronide/pregnanediol-3 alpha-glucuronide could be used to indicate the start of the fertile period, and a 50% decrease plus two days the start of the infertile period in greater than 80% of the ovarian cycles. The limitations, implications and future developments are discussed.