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Have you ever felt confused about which surge was the real one when tracking your LH levels? Welcome to the club.
There’s a lot that goes into tracking your hormone levels accurately. So, let’s tackle this struggle head on: Can you get a false LH surge before the real one? Yes, you can. It’s actually fairly common and happens for multiple reasons.
In fact, 41% of cycles have more than one LH surge. Sometimes double or multiple surges can lead to “fake” surges on an at-home LH test strip.
Basically this means that you may get multiple positives in a single cycle.
Try not to worry too much if you’ve experienced this. You’re not doing anything wrong. But keep reading to learn the difference between a false LH surge and the real surge. Because at the end of the day, to get pregnant, you want the most reliable data to track your fertile window. But first, let’s learn more about LH surges and ovulation.
Understanding your LH surge and ovulation
The luteinizing hormone (LH) is a key player when it comes to ovulating. LH is the hormone that triggers our ovaries to release an egg. About 24 – 36 hours before you ovulate, your LH levels will begin to rise. Then when you are about 8-20 hours within ovulation, your LH will “peak.” It is after this LH peak that you will ovulate.
It’s important to realize that your LH levels may not always follow the same pattern. The value of your LH during your surge in one cycle may be higher or lower than during your surge in the next cycle. There is really no true “normal” LH value. But it does help to understand and track your baseline LH value.
Based on a study of the average cycle, the typical LH surge will fall between 2.5 – 14.8 times the amount of your baseline levels. And the average is 7.7 times the amount of your baseline LH.
Take this as an example. At the start of your cycle, your LH levels are at 10 mlU/ml. This is your baseline. When LH peaks that same cycle, your highest level reached was 77 mlU/ml. This is the peak of your LH surge.
But again, your levels will likely vary cycle to cycle. And it’s possible to have no LH surge at all or one that happens so quickly you miss it. This is why you should also track your progesterone or its metabolized version PdG.
The ruptured follicle that released the egg forms the corpus luteum. Your corpus luteum produces progesterone after the egg is released. So monitoring this rise in progesterone and its metabolite PdG helps you confirm that you actually ovulated.
What is a false LH surge?
In simple terms, a false surge is a rise in LH that doesn’t actually signal the beginning of ovulation. Remember, your LH peaks 8-20 hours before you ovulate. So, the true LH surge will be the one that brings about ovulation.
But sometimes you may get a confusing rise in LH before or after this true surge. This can be frustrating because LH (along with estrogen and FSH) help you predict your most fertile days. So not knowing which surge is the real one makes TTC even harder.
Thankfully, another fertility hormone, progesterone, helps keep things real for you by actually confirming ovulation. While LH levels can only help tell you when ovulation is approaching your progesterone levels can help you know for sure that you ovulated.
Progesterone levels rise after ovulation which helps mark your true LH surge. Track your progesterone and PdG levels to see which true LH surge brought on ovulation.
Read on to learn more about why false LH surges happen and how you can properly track ovulation.
When will you get a false LH surge?
When you use a typical ovulation predictor kit (OPK), there are a few reasons your test strip could give you a false reading.
The first is if you have LH levels that are higher than the strip’s threshold.
The second is if you have a cycle with more than one LH peak.
And the third is crossreactivity of hormones (more on this later).
Here’s why this happens. Most OPKs are designed for average LH “thresholds”. On these over-the-counter ovulation tests, the average amount of LH needed to register on the strip is usually 25 – 30 mIU/ml. Let’s break this down a little further.
Let’s say your baseline LH is 6 mIU/ml. During your surge, your levels peak at 23 mIU/ml. You can still ovulate at this value, but on most OPKs, this value of LH will not register on the strip.
The opposite issue can also lead to a false reading too. Let’s say your baseline LH is 25 mIU/ml. During your surge, your levels peak at 115 mIU/ml. But your baseline reading may have already shown a positive result on the test strip before your LH levels truly peaked. This is why tracking your fertility with threshold values can be problematic.
Let’s understand how tracking your LH levels with an ovulation test vs with Inito can make a difference.
Tracking LH with an OPK vs. tracking with Inito
Want to know how you may detect two LH surges and how to tell the real one from the “fake” one? This section will make this much more clear especially if you don’t understand how most ovulation tests work.
Double LH surge
A double LH surge happens when you have two LH peaks in one cycle. While this is absolutely normal, it could be caused by hormonal imbalance or irregular cycles.
The first rise in LH may not be enough to trigger ovulation and hence a second LH surge is required. Double LH surges occur in 33% of cycles.
Let’s understand how to determine your true LH surge from the false one on OPKs and while using Inito.
Tracking with OPKs: Ovulation tests help measure your LH using an average threshold. This is usually above 25 mIU/ml. So if you have a double LH surge type and your LH levels are above this threshold, you could get multiple false positives on an OPK.
This makes it difficult to track your true LH surge.
If you look at the image above, you will see a positive test line on CD 9 and CD 13 on the ovulation test. But you can’t confirm the true surge with just these LH test lines.
Tracking with Inito: Inito measures your actual hormone values and plots them on easy-to-read charts. With Inito, you can track your LH values daily to understand your fertile window better. You can also mark your true LH surge by tracking your PdG levels that rise after.
In the Inito chart, you can see the 2 LH surges on the chart for CD 9 and CD 13. With the extra information of PdG rise on CD 18, you can confirm that CD 13 was the true LH surge.
Biphasic LH surge
This is when your LH levels spike twice. Biphasic surges happen for about 44% of cycles. In this pattern, the first spike will be less pronounced than the second. It’s likely that the first surge wasn’t high enough to cause ovulation. Therefore, a second surge of LH was triggered.
Tracking with OPKs: Your ovulation kit could show a positive ovulation test for both surges. This is because the first surge may still surpass the threshold level of the test strip like we talked about earlier.
In the image above, you see a surge on CD 10 and CD 13 on the OPK. But it would be nearly impossible for you to know which one was the true surge.
This is when OPKs can start to get a little tricky for predicting ovulation and fertility. Most OPKs only tell you your two most fertile days. So seeing two positive tests a few days apart will make it challenging to determine the best time to have sex. If you want to keep using OPKs, you should have sex during both surges to make sure you don’t miss the true surge.
Tracking with Inito: With Inito, the monitor also tests for estrogen. When your estrogen levels begin to rise, this is the start of high fertility. Knowing this additional information can help you better plan for your 6-day fertile window. Inito can also help you confirm ovulation by measuring PdG. This will let you know for sure which LH surge was actually the real one when you look back at the data.
Look above at the chart for the biphasic surge on the Inito chart. In this cycle, there was a slight surge on CD 10. But the LH value was just below 10 mIU/ml. This probably wasn’t enough to trigger ovulation. So then there was a second surge on CD 13. This was the “real” surge because ovulation was confirmed 3 days later on CD 16 with the rise in PdG.
Multiple LH surge
This type of surge is the least common. It occurs in just 8% of cycles. And it’s when you have more than two peaks in LH in a given menstrual cycle.
Tracking with OPKs: Multiple surges are the most challenging type of cycle to track with an OPK. This is because your OPK may show you a positive test strip for each surge. In the image of the OPK, you see a surge on days 11, 15, 16, 18, and 19. There’s no way for you to tell the true surge from other surges. By using a more advanced tracking method, you would be able to predict your fertility more accurately.
Tracking with Inito: With Inito’s monitor, you will be able to see the actual values of LH for each surge. Then you can look at your PdG values to confirm if you ovulated or not. Remember, a rise in PdG confirms ovulation.
If you look above at the chart for this cycle, you see three LH surges. The first was on CD 11, then another on CD 15, and a final one on CD 19. In this case, the middle surge was the one that triggered ovulation. The rise in PdG confirmed ovulation on CD 19.
Gradual LH surge
More than half of women experience what’s called a gradual surge. This means that your levels rise over the course of 2 – 6 days. Gradual surges make tracking with ovulation kits difficult.
Tracking with OPKs: The OPK reads positive on day 1 of your LH surge (assuming the level is above the threshold). But since LH is rising gradually, it will stay high for a few days. You can’t measure these peaks accurately.
You could get a positive ovulation test result all through the days of the progressively increasing LH. In the image of the OPK, you see a positive test result on days 15 and 16. This makes it hard to know when you will actually ovulate.
Tracking with Inito: If you look at the Inito chart for the gradual onset, you see LH slowly rising on CD 13. Then it peaks on CD 15 but remains high even on CD 16. Finally, on CD 20, ovulation was confirmed with the rise in PdG. This means that CD 14 marked your true LH surge.
False positives
Now, hopefully you better understand the possible LH surge patterns. But let’s dive deeper into the two main reasons that you may get a false positive result on ovulation tests. One involves a better understanding of the makeup of the luteinizing hormone. And the second involves a hormonal disorder. Both are explained below.
1. The cross-reactivity between alpha & beta LH
LH comes in two different subunits: beta LH and alpha LH. It’s important to know the difference between the two because it can affect your results when you are cycle tracking.
Your pituitary gland secretes both LH and follicle stimulating hormone (FSH). These two hormones are made up of similar genes. Therefore, they have similar molecular qualities—each with an alpha and beta subunit.
Now, here’s the confusing part. The alpha subunit of luteinizing hormone and FSH are identical. So if you’re using a test that measures alpha LH, it may cross-react with FSH. When you use a strip to test your luteinizing hormone surge, the test may pick up on FSH.
This will unfortunately give you the wrong result without you even realizing it. Since most ovulation predictor kits measure alpha LH, they are likely to give you false positive results.
This can be very frustrating, and it’s why Inito came up with a better way for tracking ovulation. Inito’s fertility monitor tests for the beta subunit of luteinizing hormone instead of the alpha unit. And with Inito, you can track PdG (the metabolite of progesterone) on top of your luteinizing hormone to confirm ovulation.
LH and other hormones like estrogen and FSH are helpful for predicting high and peak fertility. But progesterone and its metabolite PdG is the only hormone that can confirm ovulation.
2. Having polycystic ovary syndrome (PCOS)
Women who suffer from PCOS can also have hyperovulation. This means that in some cycle
s, they may release more than one egg. And in other cycles, they may not ovulate at all. This is caused by excess androgens. Due to this hormonal imbalance, most PCOS patients have high LH levels throughout their menstrual cycle.
These consistently high luteinizing hormone levels will give false-positive results on the OPK. So what’s the solution? Not to sound like a broken record here, but measure PdG with a monitor like Inito to confirm ovulation!
Read More: False Positive on an Ovulation Test: 6 Reasons They Happen
FAQs
How will I know which is the true LH surge?
The only way to distinguish between the false and true LH surge is to test for a rise in your progesterone and PdG levels. Again, this is because when ovulation occurs, the levels of progesterone and its metabolite PdG will rise shortly after.
How do I differentiate between false positives due to PCOS or due to improper ovulation testing?
If you have PCOS, your irregular cycles and LH levels may not be the best predictor of ovulation. This is because LH levels in women with PCOS will rise and fall throughout their menstrual cycle.
This is why it is essential to track your progesterone or PdG (a urine metabolite of progesterone) to confirm ovulation. Progesterone levels will rise after ovulation for up to about 10 days. And then if you get pregnant, they will keep rising. If you don’t get a positive pregnancy test, progesterone will begin to fall again.
Many women with PCOS and irregular cycles have had success using Inito, which helps you more accurately predict ovulation. This is because, unlike your typical ovulation predictor kits, Inito tracks all four sex hormones – estrogen, LH, FSH, and PdG (urine metabolite of progesterone).
What to do if I have a false LH surge before the real one?
Here are some pro tips!
- Accurately track your LH so you don’t miss the real surge.
- Have sex during both surges so you don’t accidentally miss your most fertile days. Remember, you can only confirm ovulation after it actually happens. But your LH surges can help you predict when ovulation is about to happen.
- Use a monitor that gives you clear data about your hormone levels and patterns. This will help you tell the real LH surge from other surges. Inito’s fertility monitor gives you numerical values for your luteinizing hormone and PdG (urine metabolite of progesterone) levels. LH levels help you predict your peak fertility. But PdG helps you confirm ovulation.
Takeaway
- Between 24 – 36 hours before ovulation, your luteinizing hormone (LH) will begin rising.
- Luteinizing hormone is a key sex hormone that helps trigger ovulation. Many women test for their LH surge so they can predict ovulation and their fertile window.
- With traditional ovulation kits, there are several reasons you could get a false positive test result.
- The true LH surge is the one that is followed by a steady rise in PdG. PdG is the urinary metabolite of progesterone.
- The best way to avoid confusion with tracking ovulation is to track your progesterone. Inito does this by giving you data about your actual PdG levels.
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- Detection of ovulation, a review of currently available methods – PMC
- Luteinizing Hormone (LH) Levels Test: MedlinePlus Medical Test
- Luteinizing hormone surge in normally ovulating women – Fertility and Sterility
- The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study
- chorionic gonadotropin: a cross-reactivity study of two immunometric assays used in prenatal maternal serum
- Pituitary-ovarian function in normal women during the menopausal transition
- Assessment of anovulation in eumenorrheic women: comparison of ovulation detection algorithms
- Urinary Luteinizing Hormone Tests: Which Concentration Threshold Best Predicts Ovulation?
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